Boomer attending finally retiring

[Barcelona PSG]

I am a resident at a mid tier program where we had a 70+ attending who was basically non-functional without a PGY-4 or PGY-5 coverage. It started to reach a point where the attending wouldn't even know the name of the patient and sleep off during consults. Despite multiple negative reviews on the ACGME surveys and GME surveys this was brushed away given that the attending is a very famous name in the field. Eventually ,we residents took a stand essentially telling the program that we don't feel safe covering the attending and asked for withdrawal of resident coverage for that attending. The attending is finally retiring within 8 months of pulling coverage and one of the junior attendings was contouring his cases for those eight months. Luckily our leadership was supportive and there was no retaliation with regards to this. This is a hard decision to make and needs the support of all the residents and to an extent the program leadership. Hopefully other programs follow suit.

We felt that this was a right move for the betterment of our specialty and to the patients as well

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[Gfunk6]

His retirement is good for patients and the field but likely he will pull in 80% of his max comp + benefits for life. Plus he will consult with everyone so his influence will continue to be felt.

Still, what you describe above was no easy feat so congrats on pulling it off!

 

[radiationman]

Definitely no easy feat, well done. I'm curious how often others see or know of junior attendings doing contours for senior attendings. Is this a common thing, and how does it affect wRVUs?

 

[deleted1116990]

one of the junior attendings was contouring his cases for those eight months.

I'm going to make a wild assumption here that he was making at least double that of the person who was doing all of his work for him.

Sounds about right.

Get paid 800k as a big name in the field from the 70s and 80s to come and nod off, occasionally fart in chart rounds, and have no idea what's going on or how to write your own notes because you type with your index fingers.

These people won't leave until they are forced out. And why would they? Cushiest set up ever, and lack of insight from senility to understand how dangerous they are.

But this is how this is going to go. He is going to be on the locums circuit in a few months covering West Butthole, Nebraska for $1800/day one week a month. Sad.

 

[NotMattSpraker]

Definitely no easy feat, well done. I'm curious how often others see or know of junior attendings doing contours for senior attendings. Is this a common thing, and how does it affect wRVUs?

Im not sure if I can emotionally handle the answer to this question.

AIIMS you did the right thing, but its unfortunate you had to deal with it at all. You should not have been involved beyond whistleblowing a poor clinical learning environment. The rest is far above your pay grade.

I hope you land in a place with far better leadership.

 

[Ray D. Ayshun]

So you're telling me there's an opening at main campus?

 

[RickyScott]

So you're telling me there's an opening at main campus?

Is probably in prostate or breast

 

[Fpg1245]

I am a resident at a mid tier program where we had a 70+ attending who was basically non-functional without a PGY-4 or PGY-5 coverage. It started to reach a point where the attending wouldn't even know the name of the patient and sleep off during consults. Despite multiple negative reviews on the ACGME surveys and GME surveys this was brushed away given that the attending is a very famous name in the field. Eventually ,we residents took a stand essentially telling the program that we don't feel safe covering the attending and asked for withdrawal of resident coverage for that attending. The attending is finally retiring within 8 months of pulling coverage and one of the junior attendings was contouring his cases for those eight months. Luckily our leadership was supportive and there was no retaliation with regards to this. This is a hard decision to make and needs the support of all the residents and to an extent the program leadership. Hopefully other programs follow suit.

We felt that this was a right move for the betterment of our specialty and to the patients as well

Probably just wanted to get him off the books after looking at the numbers.. His workload probably should be distributed amongst the juniors. They won’t be looking for a replacement or maybe just an NP.

 

[radoncftw]

I'm going to make a wild assumption here that he was making at least double that of the person who was doing all of his work for him.

Sounds about right.

Get paid 800k as a big name in the field from the 70s and 80s to come and nod off, occasionally fart in chart rounds, and have no idea what's going on or how to write your own notes because you type with your index fingers.

These people won't leave until they are forced out. And why would they? Cushiest set up ever, and lack of insight from senility to understand how dangerous they are.

But this is how this is going to go. He is going to be on the locums circuit in a few months covering West Butthole, Nebraska for $1800/day one week a month. Sad.

this made me giggle. i think every academic rad onc dept has 1 of these types of attendings.

 

[Baws]

Anthony V. D'Amico?

 

[RickyScott]

Anthony V. D'Amico?

I am going to go with Bruce minsky.

 

[medgator]

I am going to go with Bruce minsky.

67 already. Geez. Not a bad guess, i guess

Dr. Bruce Minsky, MD - Radiation Oncology Specialist in Houston, TX | Healthgrades

Dr. Bruce Minsky, MD is a radiation oncology specialist in Houston, TX and has over 41 years of experience in the medical field. He graduated from UNIVERSITY OF MASSACHUSETTS / BOSTON CAMPUS in 1982. He is affiliated with The University of Texas MD Anderson Cancer Center.

www.healthgrades.com

 

[TheWallnerus]

67 already. Geez. Not a bad guess, i guess

Dr. Bruce Minsky, MD - Radiation Oncology Specialist in Houston, TX | Healthgrades

Dr. Bruce Minsky, MD is a radiation oncology specialist in Houston, TX and has over 41 years of experience in the medical field. He graduated from UNIVERSITY OF MASSACHUSETTS / BOSTON CAMPUS in 1982. He is affiliated with The University of Texas MD Anderson Cancer Center.

www.healthgrades.com

Bruce hasn’t aged. He’s looked 67 years old since he was 50.

 

[thesauce]

this made me giggle. i think every academic rad onc dept has 1 of these types of attendings.

It’s not just academics that have them

It’s amazing to me that even in the PP/Hospital-based world, other specialists cannot pick up on a radonc who knows nothing. I remember a fellow radonc saying to me “it’s easier to fool people when you’re older”

 

[deleted1116990]

I am going to go with Bruce minsky.

I heard stories about this guy 10 years ago. Based on the stories I heard, would not surprise me. They were wild.

 

[deleted1116990]

Get paid 800k as a big name in the field from the 70s and 80s to come and nod off, occasionally fart in chart rounds, and have no idea what's going on or how to write your own notes because you type with your index fingers.

I was close...

Bruce Minsky worked as a Professor for the University of Texas M.D. Anderson Cancer Center (UT) and in 2021 had a reported pay of $734,538.22 according to public records. This is 910.9 percent higher than the average pay for university and college employees and 994.8 percent higher than the national average for government employees.

https://openpayrolls.com/bruce-minsky-120722797

 

[fiji128]

I am a resident at a mid tier program where we had a 70+ attending who was basically non-functional without a PGY-4 or PGY-5 coverage. It started to reach a point where the attending wouldn't even know the name of the patient and sleep off during consults. Despite multiple negative reviews on the ACGME surveys and GME surveys this was brushed away given that the attending is a very famous name in the field. Eventually ,we residents took a stand essentially telling the program that we don't feel safe covering the attending and asked for withdrawal of resident coverage for that attending. The attending is finally retiring within 8 months of pulling coverage and one of the junior attendings was contouring his cases for those eight months. Luckily our leadership was supportive and there was no retaliation with regards to this. This is a hard decision to make and needs the support of all the residents and to an extent the program leadership. Hopefully other programs follow suit.

We felt that this was a right move for the betterment of our specialty and to the patients as well

Great for you. Obviously a deep seeded problem in our field when completely unsafe people are allowed to practice until the point where they can no longer physically walk in. Says a lot about the rot at the top of field when residents have to pull rank on this type of stuff, potentially putting their careers at risk, while “leadership” tolerates such nonsense.

 

[TheWallnerus]

Great for you. Obviously a deep seeded problem in our field

*deep seated

Although some of the unsafe people in our field seem almost as dumb as a tree

 

[RadOncMegatron]

I am a resident at a mid tier program where we had a 70+ attending who was basically non-functional without a PGY-4 or PGY-5 coverage. It started to reach a point where the attending wouldn't even know the name of the patient and sleep off during consults. Despite multiple negative reviews on the ACGME surveys and GME surveys this was brushed away given that the attending is a very famous name in the field. Eventually ,we residents took a stand essentially telling the program that we don't feel safe covering the attending and asked for withdrawal of resident coverage for that attending. The attending is finally retiring within 8 months of pulling coverage and one of the junior attendings was contouring his cases for those eight months. Luckily our leadership was supportive and there was no retaliation with regards to this. This is a hard decision to make and needs the support of all the residents and to an extent the program leadership. Hopefully other programs follow suit.

We felt that this was a right move for the betterment of our specialty and to the patients as well

What a boss move! It is also so funny that they made a junior attending contour his stuff hahahaha how sad, but it did justify your guys complaints.

This is a problem in our field because unlike surgery where if you are pretending you can cut and you mess up, residents cannot easily bail you out, someone can always do the work for these inept academic big shots and have others double check the plans.

Also, I may be naive, but D’amico didn’t seem that old and seems like someone who can contour a prostate. Don’t tell me he can’t do that I’ve enjoyed many of his lectures. Would make me sad LOL

 

[medgator]

What a boss move! It is also so funny that they made a junior attending contour his stuff hahahaha how sad, but it did justify your guys complaints.

This is a problem in our field because unlike surgery where if you are pretending you can cut and you mess up, residents cannot easily bail you out, someone can always do the work for these inept academic big shots and have others double check the plans.

Also, I may be naive, but D’amico didn’t seem that old and seems like someone who can contour a prostate. Don’t tell me he can’t do that I’ve enjoyed many of his lectures. Would make me sad LOL

D'amico seemed fine when i heard him speak as a visiting professor. Pretty eloquent actually.

 

[medgator]

It’s not just academics that have them

It’s amazing to me that even in the PP/Hospital-based world, other specialists cannot pick up on a radonc who knows nothing. I remember a fellow radonc saying to me “it’s easier to fool people when you’re older”

3 A's..... Some (in fact, many!) would say "in that order"

 

[Ray D. Ayshun]

Nobody's named anyone at a mid tier program fwiw. Beyond that you could have locked in syndrome and safely treat prostate or breast.

 

[RickyScott]

D'amico seemed fine when i heard him speak as a visiting professor.

He struck me as exceptionally smart in my brief interaction.

 

[Chartreuse Wombat]

My guess...Smarba Ssor

 

[RO28]

It’s not just academics that have them

It’s amazing to me that even in the PP/Hospital-based world, other specialists cannot pick up on a radonc who knows nothing. I remember a fellow radonc saying to me “it’s easier to fool people when you’re older”

Yes, I had the same boomer rad onc ask me the same (relatively basic) question three days in a row. Um...how about hand over the patient to me so I can get those SBRT RVUs with improved outcomes...pleaseandthankyou.

 

[deleted1116990]

Yes, I had the same boomer rad onc ask me the same (relatively basic) question three days in a row. Um...how about hand over the patient to me so I can get those SBRT RVUs with improved outcomes...pleaseandthankyou.

I wouldn't have believed you if you had told me an experienced rad onc can't be taught how to do lung SBRT in a couple of hours, but then I saw it with my own eyes. Can't figure out how to draw a target volume and create an expansion despite crystal clear guides. You would think it was a 10,000 hours-to-master art like playing concert violin or something.

 

[RO28]

I wouldn't have believed you if you had told me an experienced rad onc can't be taught how to do lung SBRT in a couple of hours, but then I saw it with my own eyes. Can't figure out how to draw a target volume and create an expansion despite crystal clear guides. You would think it was a 10,000 hours-to-master art like playing concert violin or something.

Not only that, but dose selection for SBRT. Its like dude, how many times have I told you this? and what windows are you using to contour?!?!?!

 

[Fpg1245]

Not only that, but dose selection for SBRT. Its like dude, how many times have I told you this? and what windows are you using to contour?!?!?!

Sounds more like an NP than an MD.

 

[deleted1116990]

Not only that, but dose selection for SBRT. Its like dude, how many times have I told you this? and what windows are you using to contour?!?!?!

Yep yep yep. Seen it all. 1mm PTV margins. 3 fraction abutting central airway, but 5 fraction used in the middle of the periphery. Intentionally trying to keep hotspot down. Don't understand checking films before treatment, motion management, and shifts, etc.

You tell someone margins are always going to be 5mm, but then next time they are 1 mm again. Like seriously how?

 

[deleted1116990]

Sounds more like an NP than an MD.

Is supervising boomers rad onc's version of supervising CRNAs?

 

[TheWallnerus]

I wouldn't have believed you if you had told me an experienced rad onc can't be taught how to do lung SBRT in a couple of hours, but then I saw it with my own eyes. Can't figure out how to draw a target volume and create an expansion despite crystal clear guides. You would think it was a 10,000 hours-to-master art like playing concert violin or something.

Don’t worry AI will do this easily soon enough and teaching this will be a moot point!

 

[Fpg1245]

Don’t worry AI will do this easily soon enough and teaching this will be a moot point!

Literally will be taking bodies off the street and training them to sit there.

 

[RO28]

Yep yep yep. Seen it all. 1mm PTV margins. 3 fraction abutting central airway, but 5 fraction used in the middle of the periphery. Intentionally trying to keep hotspot down. Don't understand checking films before treatment, motion management, and shifts, etc.

You tell someone margins are always going to be 5mm, but then next time they are 1 mm again. Like seriously how?

Boomers gonna boom

(apologies to any boomers on this thread)

 

[RO28]

also, don't EVEN get me started on their use of auto contours.

 

[elementaryschooleconomics]

This might be the most unbelievable thing I've seen on SDN.

A bad/geriatric attending...somehow was actually forced to leave...at least in part due to consistent pressure from residents?

Wow.

But for the rest of this thread:

Dear current and future lurking residents. You know how there are in-service/board questions on insane minutiae? You know that one attending who made you feel like a worthless pile of dog crap because you didn't contour a few pixels in the parotid isthmus that one time?

I can promise you, every day, across the country, the absolute most insane, awful, non-sensical radiotherapy is happening. And it's almost impossible for non-RadOncs to pick up on it.

Even worse, when you are in a position to pick up on it, it's very difficult to "fix" it.

Anyway, it's a fun career. Good luck.

 

[NotMattSpraker]

Boomers gonna boom

(apologies to any boomers on this thread)

I now work with a doc that is very close to retirement and hes great. Hes doing SBRT, multi-target SRS, modern treatments, up on the literature, super friendly and curious on chart rounds, and always reaching out for help with unusual cases. People make suggestions and he takes them. Great role model, this is how I hope to boom one day.

You know that one attending who made you feel like a worthless pile of dog crap because you didn't contour a few pixels in the parotid isthmus that one time?

This is not exclusively a boomer thing and it is very unfortunate. Same with the people that think their way of treating something is the best and there is no debate. Do not be those people.

 

[Gfunk6]

What do the OP and COVID-19 have in common?

Both are boomer removers.

 

[deleted1116990]

This is not exclusively a boomer thing and it is very unfortunate. Same with the people that think their way of treating something is the best and there is no debate. Do not be those people.

It's just laziness/complacency. That's really all there is to it. The averages are going to skew to early career people working their tails off and being extremely nuanced and detail oriented/perfectionist and the end of career people expending minimal effort. There are of course outliers on both ends. I too have seen retirement age rad oncs absolutely crushing it, working 70 hours a week delivering excellent modern care to 40+ patients.

You would think the older cohort would be more in tune with patients as they are much closer to the great beyond themselves and likely will find themselves on a linac table soon, but nope, opposite.

 

[elementaryschooleconomics]

It's just laziness/complacency. That's really all there is to it. The averages are going to skew to early career people working their tails off and being extremely nuanced and detail oriented/perfectionist and the end of career people expending minimal effort. There are of course outliers on both ends. I too have seen retirement age rad oncs absolutely crushing it, working 70 hours a week delivering excellent modern care to 40+ patients.

You would think the older cohort would be more in tune with patients as they are much closer to the great beyond themselves and likely will find themselves on a linac table soon, but nope, opposite.

Totally agree and have seen the same.

I really regret having to talk about this, because I always sound incredibly "agist", but it's the primary common denominator. Any part of the country, any socioeconomic status, any race/gender/ethnicity, any classification or label we place on one another...

"How old is that doc?" is the question that transcends them all.

My primary theory remains "hubris". Obviously, it's a hallmark Boomer trait in general. But I like talking to them about "how it used to be", because medicine changed so rapidly yet we're haunted by legacy.

I would say, up until probably the mid-90s or early 2000s, it really was possible to "memorize" most of Oncology. NCCN guidelines weren't even created till 1996, and the internet was in its infancy.

The explosion of knowledge is tied to technology and was exponential over the last 20 years, which actually isn't a very long time. Because it was possible to "know" most of Oncology, or from what I can piece together, many fields in medicine, admitting you didn't know something was treading in the same space as admitting you weren't a good doctor.

And that inability to admit they had to look something up for fear of ridicule (not that it doesn't happen today, of course) has meant a 30 year career where they come out on the other side not knowing fundamental things, not being able to ask...because we are now several steps down each pathway where they don't even know the questions they need to ask to understand the answer.

VERY VERY broad generalization and perhaps not as applicable as my personal experience suggests it is, but it's my working sketch around the "doctor age problem".

 

[RO28]

I now work with a doc that is very close to retirement and hes great. Hes doing SBRT, multi-target SRS, modern treatments, up on the literature, super friendly and curious on chart rounds, and always reaching out for help with unusual cases. People make suggestions and he takes them. Great role model, this is how I hope to boom one day.



This is not exclusively a boomer thing and it is very unfortunate. Same with the people that think their way of treating something is the best and there is no debate. Do not be those people.

I hope to not reach "boomer age" and hit retirement first. But yes, it is also how I hope to practice as I continue my career as a professional paint-by-numbers artiste!

Even worse, when you are in a position to pick up on it, it's very difficult to "fix" it.

Also, it took me a year or two to really be able to pick up on it. You are so focused on not screwing up and drinking from a fire hose the first year out that it can be not immediately apparent.

 

[Lamount]

What do the OP and COVID-19 have in common?

Both are boomer removers.

I actually said "ouch" out loud when I read this

 

[Lamount]

Totally agree and have seen the same.

I really regret having to talk about this, because I always sound incredibly "agist", but it's the primary common denominator. Any part of the country, any socioeconomic status, any race/gender/ethnicity, any classification or label we place on one another...

"How old is that doc?" is the question that transcends them all.

My primary theory remains "hubris". Obviously, it's a hallmark Boomer trait in general. But I like talking to them about "how it used to be", because medicine changed so rapidly yet we're haunted by legacy.

I would say, up until probably the mid-90s or early 2000s, it really was possible to "memorize" most of Oncology. NCCN guidelines weren't even created till 1996, and the internet was in its infancy.

The explosion of knowledge is tied to technology and was exponential over the last 20 years, which actually isn't a very long time. Because it was possible to "know" most of Oncology, or from what I can piece together, many fields in medicine, admitting you didn't know something was treading in the same space as admitting you weren't a good doctor.

And that inability to admit they had to look something up for fear of ridicule (not that it doesn't happen today, of course) has meant a 30 year career where they come out on the other side not knowing fundamental things, not being able to ask...because we are now several steps down each pathway where they don't even know the questions they need to ask to understand the answer.

VERY VERY broad generalization and perhaps not as applicable as my personal experience suggests it is, but it's my working sketch around the "doctor age problem".

In my limited experience, what folks call "boomerism" is burnout. There are older folks with whom I have worked who are sharp as a tack and give excellent care... and then there are those who have just checked out. Burnout can happen at any age, but -like most survival curves- "burnout-free-survival" will approach zero as the years increase.

I don't think you can judge someone to be a bad doctor merely based upon their age (and we should all do our best to avoid this assumption)... that age varies from doc to doc. However, when it's time, it's time.

 

[elementaryschooleconomics]

In my limited experience, what folks call "boomerism" is burnout. There are older folks with whom I have worked who are sharp as a tack and give excellent care... and then there are those who have just checked out. Burnout can happen at any age, but -like most survival curves- "burnout-free-survival" will approach zero as the years increase.

I don't think you can judge someone to be a bad doctor merely based upon their age (and we should all do our best to avoid this assumption)... that age varies from doc to doc. However, when it's time, it's time.

Ah...yeah, I know that type as well.

I'm talking about a "different breed", not sharp as a tack, not burned out - but not good, and unable to recognize they're not good.

To be super clear, I would NEVER judge someone only based on their age.

Here is how it normally goes:

*someone tells me a story about bad medicine*
Me: "I know this seems random, but let me guess, the doc you dealt with was somewhere in their 50s/60s?"

I regret not keeping track of this, because I would estimate 80% of the time, the answer is "yes".

WHICH OF COURSE...means that 20% of the time, it could be a 36-year-old with an impeccable CV.

 

[TheWallnerus]

I feel like the surgeons in their academic departments self-police mentally and physically declining (older, usually) surgeons better than the rad oncs do in their academic departments.

 

[temujim]

I feel like the surgeons in their academic departments self-police mentally and physically declining (older, usually) surgeons better than the rad oncs do in their academic departments.

know a boomer neurosurgeon that his colleagues describe as a "butcher". Guess it is obvious when the anesthetist, scrub techs, nurses, residents, etc etc are watching them do their thing. but that boomer nsg still going, pompous as ever.

 

[elementaryschooleconomics]

I feel like the surgeons in their academic departments self-police mentally and physically declining (older, usually) surgeons better than the rad oncs do in their academic departments.

I would say this is fairly consistent with my experience too. Not to say there aren't "bad" academic surgeons, just that the level of trainwreck we see in RadOnc isn't apparent because you can't hide a sliced artery the same way you can hide a geometric miss on a linac.

BUT.

Not in the community. I know community butcher surgeons. Worse, I know community butcher surgeons that the entire region knows and openly discusses butchery.

But even if you lose OR privileges in one hospital...there's always another OR down the road.

 

[temujim]

I am a resident at a mid tier program where we had a 70+ attending who was basically non-functional without a PGY-4 or PGY-5 coverage. It started to reach a point where the attending wouldn't even know the name of the patient and sleep off during consults. Despite multiple negative reviews on the ACGME surveys and GME surveys this was brushed away given that the attending is a very famous name in the field. Eventually ,we residents took a stand essentially telling the program that we don't feel safe covering the attending and asked for withdrawal of resident coverage for that attending. The attending is finally retiring within 8 months of pulling coverage and one of the junior attendings was contouring his cases for those eight months. Luckily our leadership was supportive and there was no retaliation with regards to this. This is a hard decision to make and needs the support of all the residents and to an extent the program leadership. Hopefully other programs follow suit.

We felt that this was a right move for the betterment of our specialty and to the patients as well

kudos to you for taking a stand. did something similar when i was a resident... but went nowhere. And that attending practiced at least another 10 years. Maybe even the same one you're discussing who knows.

 

[TheWallnerus]

I would say this is fairly consistent with my experience too. Not to say there aren't "bad" academic surgeons, just that the level of trainwreck we see in RadOnc isn't apparent because you can't hide a sliced artery the same way you can hide a geometric miss on a linac.

BUT.

Not in the community. I know community butcher surgeons. Worse, I know community butcher surgeons that the entire region knows and openly discusses butchery.

But even if you lose OR privileges in one hospital...there's always another OR down the road.

Agree. A “bad” surgeon in the community is worse than a “bad” rad onc in the community.

 

[Lamount]

I feel like the surgeons in their academic departments self-police mentally and physically declining (older, usually) surgeons better than the rad oncs do in their academic departments.

One site where I trained, a well-known surgeon operated until he was in his 80s, and was essentially forced out of the OR because of technical inability. He still went to tumor boards to humiliate the surgical residents.

 

[StIGMA]

This is a great thread because every radiation oncologist can think back on their training and relate.

Here's a photo from my programs first SBRT treatment circa 2012: