ASTRO’s role

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RadoncPGY5

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Long-time SDN follower (pre-med, med, radonc), but first time poster, so please be gentle- given all the shenanigans going on in our field I have to ask what is ASTRO doing about this? I know it just came out, but what’s the plan? Why do we have an organization that seems to idly standby and do nothing other than “oppose” the CMS change in direct versus general supervision? Forgive my uninformed CMS/government knowledge, but can we not ask for an exclusion for RO services on the grounds of patient safety or some other concern? Washington has always been a place where lobbyists can effect change- doesn’t ASTRO do the whole advocacy day?

Meanwhile ASTRO are celebrating a small code freeze through 2020- I mean seriously? The letter response just states that the organization is deeply concerned-okay, so we got nothing.

Per their website, this is how they define the organization: Founded in 1958, ASTRO’s mission is to advance the practice of radiation oncology by promoting excellence in patient care, providing opportunities for educational and professional development, promoting research and disseminating research results and representing radiation oncology in a rapidly evolving health care environment.

How exactly is ASTRO promoting RO? Through twitter hashtags?

Why should any of us have any faith in the feckless leadership at ASTRO?
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RadoncPGY5 said:
Long-time SDN follower (pre-med, med, radonc), but first time poster, so please be gentle- given all the shenanigans going on in our field I have to ask what is ASTRO doing about this? I know it just came out, but what’s the plan? Why do we have an organization that seems to idly standby and do nothing other than “oppose” the CMS change in direct versus general supervision? Forgive my uninformed CMS/government knowledge, but can we not ask for an exclusion for RO services on the grounds of patient safety or some other concern? Washington has always been a place where lobbyists can effect change- doesn’t ASTRO do the whole advocacy day?

Meanwhile ASTRO are celebrating a small code freeze through 2020- I mean seriously? The letter response just states that the organization is deeply concerned-okay, so we got nothing.

Per their website, this is how they define the organization: Founded in 1958, ASTRO’s mission is to advance the practice of radiation oncology by promoting excellence in patient care, providing opportunities for educational and professional development, promoting research and disseminating research results and representing radiation oncology in a rapidly evolving health care environment.

How exactly is ASTRO promoting RO? Through twitter hashtags?

Why should any of us have any faith in the feckless leadership at ASTRO?
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Agree. Where is my ASTRO money going to?
 
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To be fair, ASTRO is only as strong as its lobbyists, which is to say they aren't strong at all. ASTRO is an ant compared to elephants like the hospital and pharma lobby

Moreover, the ASTRO PAC (political action committee) spent years trying to fight urorads (and by association, many community/pp docs) rather than try to unite the specialty.

CMS is headed by a big pharma sympathizer in Azar so cost savings will be rung out from other areas first, hence we get APM, rollback of supervision regulations etc. And it's not like direct supervision was the law of the land for decades.... I believe it was around 2008-2009 when supervision changed from general to direct, could have been earlier, @scarbrtj likely knows better than any of us. So really, CMS is basically coming to its own conclusion that the last decade or so did not see any difference between rural/critical access hospital RO under general and everyone else under direct.

ASTRO is impotent to stop any of it, quite frankly, and rather than unite the specialty behind anything re: the efficacy and value of RT, which might have been our best hope, much of the message and agenda has been geared over the last couple of decades to the hospital-based academic community and denigrating things like urorads setups
 
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Okay- well if we forget CMS and Washington, what about residency expansion- can ASTRO as an organization not create an initiative to limit the number of residency spots? I am sure this is wishful thinking, but it would be great if the number of spots in the country were controlled by ONE organization so we can set quotas and prevent this from happening again.
 
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RadoncPGY5 said:
Okay- well if we forget CMS and Washington, what about residency expansion- can ASTRO as an organization not create an initiative to limit the number of residency spots? I am sure this is wishful thinking, but it would be great if the number of spots in the country were controlled by ONE organization so we can set quotas and prevent this from happening again.
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Many threads on this issue. Restriction of trade considerations make ASTRO unwilling to engage. The only group that can change this is the academic programs (SCAROP). I suspect March 2020 will lead to some (not enough) to consider contraction.
 
RadoncPGY5 said:
Okay- well if we forget CMS and Washington, what about residency expansion- can ASTRO as an organization not create an initiative to limit the number of residency spots? I am sure this is wishful thinking, but it would be great if the number of spots in the country were controlled by ONE organization so we can set quotas and prevent this from happening again.
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Nope. The leader of ASTRO hides behind the BS anti trust issue

The Residency Training Landscape - ASTRO Blog- American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

A look at the overall training and oversight system that trains medical students to provide specialized care as a licensed physician.
www.astro.org www.astro.org

SDN is actually more powerful than you think. Last year's match didn't happen on accident and made radonc academics "woke"
 
Chartreuse Wombat said:
ASTRO PAC is impotent.

Go to the link and keep scrolling

www.opensecrets.org

Health Professionals PACs contributions to candidates, 2019-2020

Health Professionals PACs gave $21,654,837 total to federal candidates in 2020. See the details.
www.opensecrets.org www.opensecrets.org

2020 cycle $65K...but we are ahead of the Pediatric dentists..

Money poorly spent in my view
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I mean the key here is that you need money to lobby. ASTRO PAC is open for business so any critic here is more than welcome to donate and simultaneously state what political issues matter to you. The reason those other lobbies have power is their members are willing and able to contribute a lot of money.
 
I think people have to consider that the pre-CMS supervision opinions may not hold true now.

This has shifted the entire conversation.

No one would dare talk residency expansion now when contraction is
Being actively
Discussed
 
Krukenberg said:
I mean the key here is that you need money to lobby. ASTRO PAC is open for business so any critic here is more than welcome to donate and simultaneously state what political issues matter to you. The reason those other lobbies have power is their members are willing and able to contribute a lot of money.
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well we know big pharma is behind med onc- so why is Varian not donating more to support our organization? Oh that’s right, they win no matter what happens to our field. Our industry sponsors are clearly in it for themselves
 
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ASTRO doesn't represent our interests, I'm going to quit ASTRO -> quits ASTRO -> ASTRO represents even less -> quits ASTRO -> ASTRO represents even less -> quits ASTRO ...

meanwhile

ASTRO PAC doesn't do ****, I'm giving less money -> ASTRO PAC does even less -> give ASTRO PAC less money -> ASTRO PAC does even less -> give less money to ASTRO PAC ...

:rolleyes:

this approach is self destructive

the only option is to increase participation and increase influence. either with time or money or twitter or whatever resources one has available
 
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medgator said:
Nope. The leader of ASTRO hides behind the BS anti trust issue

The Residency Training Landscape - ASTRO Blog- American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

A look at the overall training and oversight system that trains medical students to provide specialized care as a licensed physician.
www.astro.org www.astro.org

SDN is actually more powerful than you think. Last year's match didn't happen on accident and made radonc academics "woke"
Click to expand...

I've recently felt this out with some of the ASTRO/ABR leadership. My understanding is that an OFFICIAL ASTRO statement on Residency Expansion could be considered anti-trust. However, members of ASTRO and the ABR stating and acting in such a way as to combat this in an unofficial manner wouldn't have the same legal ramifications.

I plan on feeling this out more in the near future.
 
RadoncPGY5 said:
Okay- well if we forget CMS and Washington, what about residency expansion- can ASTRO as an organization not create an initiative to limit the number of residency spots? I am sure this is wishful thinking, but it would be great if the number of spots in the country were controlled by ONE organization so we can set quotas and prevent this from happening again.
Click to expand...
Absolutely, they can take a policy position. No, they cant implement it, but they can take a position!. They take positions on reimbursement, supervision, lots of things they dont control. This is the most important issue facing most docs, and they are silent, likely because those in control benefit from it. Has ASTRO retained an anti-trust lawyer? Antitrust law is based on what is best for the US consumer. Beware of using anti trust as a magic wand to dismiss concerns, especially when waved by a few radonc who are also non practicing lawyers. ACRO was formed at one time because ASTRO was not felt to be representing its members interests.

The EMERGENCY MEDICINE PROFESSIONAL SOCIETY HAD NO PROBLEM RELEASING A POLICY STATEMENT DENOUNCING RESIDENCY EXPANSION!
 
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elementaryschooleconomics said:
I've recently felt this out with some of the ASTRO/ABR leadership. My understanding is that an OFFICIAL ASTRO statement on Residency Expansion could be considered anti-trust. However, members of ASTRO and the ABR stating and acting in such a way as to combat this in an unofficial manner wouldn't have the same legal ramifications.

I plan on feeling this out more in the near future.
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Individual programs did EXACTLY that to lower salaries and screw the field several years ago, reference the response to C Shah's "bloodbath editorial" from the chair at WUSTL complaining about rising faculty salaries in 2013
 
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medgator said:
Individual programs did EXACTLY that to lower salaries and screw the field several years ago, reference the response to C Shah's "bloodbath editorial" from the chair at WUSTL complaining about rising faculty salaries in 2013
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Yeah.

Without going into details - the people I spoke with were utterly convinced an official statement could not be made, legally.
 
elementaryschooleconomics said:
Exactly. I had this conversation a week or so before the CMS ruling, I'm curious how that will effect things. To be continued I guess?
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I imagine double digit unemployed PGY-5 grads, coupled with double digit unfilled residency slots will have a chilling effect on the optics of this field, going forward.

Sad it had to come to that, but we all know where the blame lies
 
medgator said:
If ASTRO won't address it, let the chairs reap what they sow this match and beyond.
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If they really believe there is no solution to the problem then 1) dont be an astro member 2) they should make it known to all MS4
If ER society publishing policy statement denouncing residency expansion, is this not a slightly inconvenient fact?
 
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No academics are all pansies

they hide behind Ben Falit as if he is the only lawyer available in the US who can talk about antitrust

prob too cheap to pay someone and Falit does it for free
 
radoncdoc16 said:
No academics are all pansies

they hide behind Ben Falit as if he is the only lawyer available in the US who can talk about antitrust

prob too cheap to pay someone and Falit does it for free
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Falit is a nonpracticing lawyer. He would know very little/next to nothing, Even a practicing lawyer is not going to know much about a highly specialized area like anti-trust that 99% of lawyers dont deal with. Everything ASTRO says flys in the face of a quick google search on anti-trust being based on what is best for the public.
"Judge Robert Bork's writings on antitrust law (particularly The Antitrust Paradox), along with those of Richard Posner and other law and economics thinkers, were heavily influential in causing a shift in the U.S. Supreme Court's approach to antitrust laws since the 1970s, to be focused solely on what is best for the consumer rather than the company's practices.[45] "
 
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With an eye toward the past, as best as I can tell:
Most people in ASTRO were completely obtuse re: rad onc's declining utilization (this is aka hypofractionation).
Then it seemed like they were being intentionally ignorant re: residency expansion.
ASTRO leadership skews strongly academic as you know; academic jobs grew at a much more significantly rapid pace than PP over the last ~15 years. No one in ASTRO saw that as any warning sign whatsoever.
Then with the CMS ruling, once we again we saw significant calorie expenditure given over to denying there could be any problems.
I am not a smart man.
But it seems like there's a pattern here.

* one could also go down many "interesting" & stupefying rabbit holes of the past too; see @medgator's allusion to Urorads and the high school drama surrounding that...
 
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scarbrtj said:
With an eye toward the past, as best as I can tell:
Most people in ASTRO were completely obtuse re: rad onc's declining utilization (this is aka hypofractionation).
Then it seemed like they were being intentionally ignorant re: residency expansion.
Then with the CMS ruling, once we again we saw significant calorie expenditure given over to denying there could be any problems.
I am not a smart man.
But it seems like there's a pattern here.

* one could also go down many "interesting" & stupefying rabbit holes of the past too; see @medgator's allusion to Urorads and the high school drama surrounding that...
Click to expand...
Exactly.
 
Krukenberg said:
I mean the key here is that you need money to lobby. ASTRO PAC is open for business so any critic here is more than welcome to donate and simultaneously state what political issues matter to you. The reason those other lobbies have power is their members are willing and able to contribute a lot of money.
Click to expand...


this is exactly right. giving in our specialty to astro pac is pathetic.
 
scarbrtj said:
With an eye toward the past, as best as I can tell:
Most people in ASTRO were completely obtuse re: rad onc's declining utilization (this is aka hypofractionation).
Then it seemed like they were being intentionally ignorant re: residency expansion.
ASTRO leadership skews strongly academic as you know; academic jobs grew at a much more significantly rapid pace than PP over the last ~15 years. No one in ASTRO saw that as any warning sign whatsoever.
Then with the CMS ruling, once we again we saw significant calorie expenditure given over to denying there could be any problems.
I am not a smart man.
But it seems like there's a pattern here.

* one could also go down many "interesting" & stupefying rabbit holes of the past too; see @medgator's allusion to Urorads and the high school drama surrounding that...
Click to expand...

dont worry that dumb academic attending from linked thread will realize rule change when contract isn’t renewed
 
RickyScott said:
Falit is a nonpracticing lawyer. He would know very little/next to nothing, Even a practicing lawyer is not going to know much about a highly specialized area like anti-trust that 99% of lawyers dont deal with. Everything ASTRO says flys in the face of a quick google search on anti-trust being based on what is best for the public.
"Judge Robert Bork's writings on antitrust law (particularly The Antitrust Paradox), along with those of Richard Posner and other law and economics thinkers, were heavily influential in causing a shift in the U.S. Supreme Court's approach to antitrust laws since the 1970s, to be focused solely on what is best for the consumer rather than the company's practices.[45] "
Click to expand...

*wikipedia is the preferred choice of literature review in radiation oncology.
 
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winstonfoot5 said:
ASTRO doesn't represent our interests, I'm going to quit ASTRO -> quits ASTRO -> ASTRO represents even less -> quits ASTRO -> ASTRO represents even less -> quits ASTRO ...

meanwhile

ASTRO PAC doesn't do ****, I'm giving less money -> ASTRO PAC does even less -> give ASTRO PAC less money -> ASTRO PAC does even less -> give less money to ASTRO PAC ...

:rolleyes:

this approach is self destructive

the only option is to increase participation and increase influence. either with time or money or twitter or whatever resources one has available
Click to expand...

this 100%. ASTRO and other advocacy orgs are run by PEOPLE. If PP docs who care about expansion get involved through leadership or $$ they can force change without the burden of worrying about their academic careers being harmed.

the AMA was incredibly powerful on Capitol Hill until docs started dropping their membership. Now they have less money to spend on lobbying and less power because congress knows they only represent something like 20% of all physicians.

Physicians are their own enemies when it comes to political influence.
 
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RadoncPGY5 said:
well we know big pharma is behind med onc- so why is Varian not donating more to support our organization? Oh that’s right, they win no matter what happens to our field. Our industry sponsors are clearly in it for themselves
Click to expand...


Varian adopted strategy to diverse their business to blunt political/regulatory risk effects on the radiotherapy business which seems to have been a good move.
 
RickyScott said:
The EMERGENCY MEDICINE PROFESSIONAL SOCIETY HAD NO PROBLEM RELEASING A POLICY STATEMENT DENOUNCING RESIDENCY EXPANSION!
Click to expand...

The society you’re referring to is the ACRO to our ASTRO. The EM society with the real power is ACEP and they are thoroughly in the pocket of private equity (the perpetrators of expansion in EM). ACEP Home
 
sphinx2019 said:
*wikipedia is the preferred choice of literature review in radiation oncology.
Click to expand...
I get it, but neither is Falit any kind of authority. Need to engage a real big law antitrust lawyer. The point is when ASTRO conflicts with what you read, should you question them?, because as scarbtj pointed it out, they seem to get it wrong all the time.
 
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Krukenberg said:
The society you’re referring to is the ACRO to our ASTRO. The EM society with the real power is ACEP and they are thoroughly in the pocket of private equity (the perpetrators of expansion in EM). ACEP Home
Click to expand...
The point is that a society can take a policy position on residency expansion right? Free speech just doesnt apply?
 
How can it be antitrust if ASTRO takes a position on residency expansion, but not antitrust when they take a position on reimbursement rates? (I guess fixing rates is not antitrust, just residency expansion) This is just silly to say that ASTRO even taking a position is antitrust. That just flies in the face of common sense and freedom of speech.
 
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ASTRO has no authority to regulate residency positions. They can make any statement they want about it without violating anti-trust.
 
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1573572767074.png


The ASTRO leadership is utterly convinced they cannot do anything official.

I believe they interpret issuing a policy statement on residency expansion is construed as "engaging in activities".

I would also believe that issuing a policy statement on CMS, aka "the Government" decisions, is, to them, considered a distinct category than the "free market".

I'm not a lawyer, and I don't agree with it, but I believe this is where they stand.
 
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RickyScott said:
Falit is a nonpracticing lawyer. He would know very little/next to nothing, Even a practicing lawyer is not going to know much about a highly specialized area like anti-trust that 99% of lawyers dont deal with. Everything ASTRO says flys in the face of a quick google search on anti-trust being based on what is best for the public.
"Judge Robert Bork's writings on antitrust law (particularly The Antitrust Paradox), along with those of Richard Posner and other law and economics thinkers, were heavily influential in causing a shift in the U.S. Supreme Court's approach to antitrust laws since the 1970s, to be focused solely on what is best for the consumer rather than the company's practices.[45] "
Click to expand...

Beyond just Falit, this position is endorsed by ASTRO's General Counsel.
 
elementaryschooleconomics said:
View attachment 286013

The ASTRO leadership is utterly convinced they cannot do anything official.

I believe they interpret issuing a policy statement on residency expansion is construed as "engaging in activities".

I would also believe that issuing a policy statement on CMS, aka "the Government" decisions, is, to them, considered a distinct category than the "free market".

I'm not a lawyer, and I don't agree with it, but I believe this is where they stand.
Click to expand...
The 'ol classic Catch-22.
No free market intervention here.
Also see Galbraith's "The Economics of Innocent Fraud" re: govt/non-govt distinctions.... "large corporate interests and leaders (private sector) have become so embedded within government (public sector) that the distinction cannot be maintained."
 
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Waving the antitrust wand. If this is where they stand, it wouldnt surprise me, but they need to make this known to medstudents that they dont plan to act.
 
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If an anti-trust is a reasonable concern on one end, then why is it not a reasonable concern on the other end?

Would a resident that can't find a job not have an anti trust suit for saturating the field and making his/her skill set less valuable for the benefit of the hospital system he/she works for at the cost of the field as a whole?

I think it's likely that neither suit would ever "win" and you'd get attorneys making money without a resolution.

The bottom line is that no one has stepped up to take responsibility. We have a problem that no one wants to take responsibility for due to at best, fear of litigation, or at worst nefarious motivations (ie saturate the market to drive their own costs down). Well, this is why you become a leader, to step up and make the hard decisions. A "market will decide approach" just resulted in even more residents. It's time to be a leader and make the call. I really respect the academic twitter voices that are stepping up to do just this - take action.
 
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RickyScott said:
I get it, but neither is Falit any kind of authority. Need to engage a real big law antitrust lawyer. The point is when ASTRO conflicts with what you read, should you question them?, because as scarbtj pointed it out, they seem to get it wrong all the time.
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Preaching to the choir brotha. I talked about this a long time ago. Can't expect the people benefiting from expansion to give a fair assessment of the legality. BK was all about laws against expansion. Problem is I dont trust any of them.
 
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" It's time to be a leader and make the call. " Did you watch Pual Hariri acceptance speech 2 years ago at ASTRO. His idea of leadership = professional recognition and adulation. Showed numerous pictures of his relatives, and discussed how they were there for him during his ascent to radonc's throne. Struck me as very odd.
 
Harari is a typical radiation oncologist: afraid to stick his head out.
 
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Since we're on the subject of Falit would just like to (re-)point out this past stuff from him:


The Radiation Oncology Job Market: The Economics and Policy of Workforce Regulation
Benjamin P. Falit, MD, JD; Hubert Y. Pan, MD, Benjamin D. Smith, MD, Brian M. Alexander, MD, MPH, Anthony L. Zietman, MD
November 2016

Short of direct congressional action, there are limited solutions to the projected oversupply. As a start, we suggest that SCAROP and ADROP ask all member programs that expanded over the past 10 years to release information about the number of slots that generated additional Medicare funding. If a substantial percentage of the expansion positions received governmental support, then GME funding restrictions may be a sufficient solution to titrate and redistribute residency positions.

Our specialty must also do a better job of collecting and reporting meaningful employment metrics. Data should be available for each training program so that medical students can make well-informed decisions about where to train and whether an alternative career path is in their best interests. Organizations that expand beyond their ability to secure employment for their graduates should be faced with a market penalty (ie, decreased medical student interest and prestige), which is difficult without full transparency. Currently, it is challenging for residents to transfer programs without a compelling personal rationale. This ensures at least a 5-year lag between the release of employment data and any market penalty. SCAROP and ADROP could further improve the efficiency of the market by committing to assist residents who want to transfer out of training programs that fail to secure favorable employment for graduates.

Lastly, the projected oversupply of radiation oncologists and recent rise in fellowship positions raise concern that ACGME's accreditation standards are too liberal. It is plausible that the existing requirements are insufficient to produce radiation oncologists who are competent to independently treat all disease sites. We suggest that the Radiation Oncology Review Committee of ACGME, in conjunction with ADROP and SCAROP, take a close look at current requirements for program accreditation. Importantly, the re-evaluation of accreditation standards must be undertaken in an intellectually honest fashion without an eye toward restricting supply. Any attempt to use the accreditation system as an end run around antitrust law would be inappropriate and illegal.

The projected oversupply of radiation oncologists presents a challenging problem, which has the potential to enrich equipment owners at the expense of both young physicians and society through the misallocation of scarce talent. Training programs will continue to possess a perverse incentive to expand and antitrust law limits our specialty's ability to work collaboratively, but the situation is not hopeless. SCAROP, ADROP, the ACGME, ASTRO, and the Association of Residents in Radiation Oncology can all play a role in perfecting the marketplace for resident talent and ensuring that accreditation standards are appropriate for a rapidly changing specialty with increased reliance on advanced technology. Regardless of who leads the charge and whether change is driven by governmental fiat or improvements in the marketplace, matching supply and demand and rectifying geographic maldistribution represent smart public policy.
 
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Anybody working in a hospital know that surgerons walk at the middle of the of the hallway, their heads up. RadOnc sneak by the walls with their eyes down.
 
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scarbrtj said:
And... why can the American Society of Plastic Surgeons make declarations about workforce needs but the American Society for Radiation Oncology can not?
"The American Society of Plastic Surgeons (ASPS) formed the Plastic Surgery Workforce Task Force to study the size of the plastic surgery workforce and make recommendations about future workforce needs."
(Possible answer: no MD JD plastic surgeons.)
Click to expand...

I mean in fairness, they're saying that there needs to be MORE plastic surgeons (Full abstract below, bold emphasis mine), not less. We have precedence with that as Hallahan said it as has been discussed in the reply to Chirag Shah's 2013 editorial. We also have the under/oversupply studies from Ben Smith, Pan et al, etc. We (as a field) have published on it but the ability to DO anything about it has been where people have been hands off and said 'not my problem' and where we get the specter of anti-trust as something that ties everybody's hands.

Background: The American Society of Plastic Surgeons (ASPS) formed the Plastic Surgery Workforce Task Force to study the size of the plastic surgery workforce and make recommendations about future workforce needs. The ASPS member workforce survey and two supplementary surveys of plastic surgery academic chairs and senior residents were developed to gain insights on current and projected demand for plastic surgery procedures and to find out more about plastic surgeons' current daily practice patterns and plans for the future. Methods: The ASPS member workforce survey was mailed to 2500 randomly selected ASPS active members practicing in the United States, and a second mailing was sent to 388 unique members who practice in an academic setting; a total of 1256 surgeons responded (43.5 percent response rate). The survey of academic chairs was distributed to 103 attendees at the annual meeting of the Association of Academic Chairmen of Plastic Surgery, and 74 returned the survey (71.8 percent response rate). The survey of senior residents was e-mailed to 183 graduating residents, of whom 65 responded (35.5 percent response rate). Results: Useful demographic information regarding the current plastic surgery workforce was obtained from these surveys. In addition, insight into current trends in practice composition and procedural demand was gained. Conclusions: The rapid growth of the U.S. population, combined with a significant number of plastic surgeons approaching retirement and an unchanged number of plastic surgery residency training positions, will lead to a discrepancy between the demand for plastic surgery procedures and the supply of appropriately trained physicians. Without an increase in the number of plastic surgeons trained each year, there will be a significant shortage in the next 10 to 15 years. © 2010 by the American Society of Plastic Surgeons.
Click to expand...
 
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