Chirag/Royce Editorial, Goodman Article, Potters Response on Job Market 031121

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It's really shocking how bad astro has been on this issue. They have essentially maintained a position that they do not want to seriously study or even know about the number one issue that has the largest effect on its membership for the past 10 years. Instead you get publication of dyi surveys to support whatever it is you want to see, choosing wisely campaigns, RT omission trails and of course anti-trust arguments.
 
fiji128 said:
It's really shocking how bad astro has been on this issue. They have essentially maintained a position that they do not want to seriously study or even know about the number one issue that has the largest effect on its membership for the past 10 years. Instead you get publication of dyi surveys to support whatever it is you want to see, choosing wisely campaigns, RT omission trails and of course anti-trust arguments.
Click to expand...
Repeating. ASTRO is a membership organization. More graduates equals more dues...really very simple. Most ASTRO leadership needs cheap labor (residents) and low salaries...
 
Yes the interest of Astro is more docs so more dues. And astro is run by a club of exclusivity - older, connected physicians, in power, with careers of 5 years or less and enough income and years earned anyway they could retire tomorrow without it effecting them.

Yes it is a hard pill to swallow to not pay ASTRO dues and not have the PAC, but we are so outspent by pharma anyway it barely matters, and the RO APM just proves how uneven cuts will be in the oncology sphere to us.

So I stopped paying. Still buy virtual product, singular, per year. But our own physician organization doesn’t advocate at all for me as a physician in the field. So lesson learned. They will still get all the resident fees from the expanded programs, they still win. SOAPing 40 people is a financial win for Astro, even if it stuffs the field with people who have no interest in oncology care, and some people whose aptitude in medical school was so poor they couldn’t match anywhere else. And the bitterness and divisions in the field will amplify, and the cuts will keep happening to the newer entrants, while the old guard will be unaffected. Leadership is out of touch with the field, because their bottom line and take home pay is improved by taking maximum advantage of us.
 
DebtRising said:
Yes the interest of Astro is more docs so more dues. And astro is run by a club of exclusivity - older, connected physicians, in power, with careers of 5 years or less and enough income and years earned anyway they could retire tomorrow without it effecting them.

Yes it is a hard pill to swallow to not pay ASTRO dues and not have the PAC, but we are so outspent by pharma anyway it barely matters, and the RO APM just proves how uneven cuts will be in the oncology sphere to us.

So I stopped paying. Still buy virtual product, singular, per year. But our own physician organization doesn’t advocate at all for me as a physician in the field. So lesson learned. They will still get all the resident fees from the expanded programs, they still win. SOAPing 40 people is a financial win for Astro, even if it stuffs the field with people who have no interest in oncology care, and some people whose aptitude in medical school was so poor they couldn’t match anywhere else. And the bitterness and divisions in the field will amplify, and the cuts will keep happening to the newer entrants, while the old guard will be unaffected. Leadership is out of touch with the field, because their bottom line and take home pay is improved by taking maximum advantage of us.
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I just don't know what happened now vs 2 decades ago when they actually did try to fix the problem and spots did go down.... guess the boomers just got more selfish...
 
medgator said:
I just don't know what happened now vs 2 decades ago when they actually did try to fix the problem and spots did go down.... guess the boomers just got more selfish...
Click to expand...
It had the potential to affect them then. It won’t now.

Not to belittle RadOncs situation. Radiology is going through it’s own crisis of this sort from boomer groups selling to private equity. Lots of jobs but a lot of them are trash.

of course the ACR says nothing about the predatory groups lying to graduates and then selling to RP or USRS before anyone makes partner.

I’m sure you guys know better than me, but honestly radonc and IR should merge. Or Radonc should close all residencies and become a radiology (or medonc) fellowship.
 
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Despite being a womanwhocuries, I have found some of ASTRO's push on gender issues to be over the top and disingenuous. The silence from the womenwhocurie twitterati on Potters incredibly offensive comments about how women couldn't match before due to competitiveness is deafening.
 
maxxor said:
It had the potential to affect them then. It won’t now.

Not to belittle RadOncs situation. Radiology is going through it’s own crisis of this sort from boomer groups selling to private equity. Lots of jobs but a lot of them are trash.

of course the ACR says nothing about the predatory groups lying to graduates and then selling to RP or USRS before anyone makes partner.

I’m sure you guys know better than me, but honestly radonc and IR should merge. Or Radonc should close all residencies and become a radiology (or medonc) fellowship.
Click to expand...
heard that is what David Beyer's group did in Phoenix, and then last year he is tweeting what a fantastic future our field has after pocketing tens of millions like Michael Steinberg following his own sell out.
 
medgator said:
I just don't know what happened now vs 2 decades ago when they actually did try to fix the problem and spots did go down.... guess the boomers just got more selfish...
Click to expand...

Maybe back then rad onc was never high on the totem pole. The leaders weren't used to cream of the crop residents and weren't making millions? I don't really know.

But now the "leaders" basically had their butts wiped for them and make tons of money and are respected academically. They dont want to give that up.
 
Isn't Sue Yom the editor-in-chief of the Red Journal, who just published the letter from Louis Potters saying that women and minorities now have a chance to match into radiation oncology now. I don't think the editor should be policing every single statement in an article or letter, but what he said was completely egregious without any data or merit.

1616010598241.png
 
Radiation oncology has been a very small and self-selecting field. It became even more self-selecting during the golden age. Some programs have felt the need to match women to improve diversity for years.
Has anybody ever thought that maybe women and URMs didn't want to come nerd out with some weird physics-y bros on the spectrum?

I'd like to see our percentages compared to orthopedics. Maybe I'll be surprised.
 
Let me defend for Sue (to be EIC later ~ Jan 2022) and RedJ...

- A journal, whether it is Am J of Surgery or JAMA or NEJM, is just a platform where people publish their studies or thought process (letters to editors). It is important to have a mix of opinions. Just like our country, it is good to hear from both the Republicans and the Democrats (and the Indy's). The more opinions the better. I thought Goodman et al was spot on. Potters' rebuttal is Potters'. The writings, whether it is scientific or debate on our field oversupply issue, reflect the author(s)' opinions and not those of RedJ. RedJ in a way is like Twitter, it is a platform for sharing info. Your tweets belong to you and reflect what you say, and it does not reflect Twitter's view. Unless you help incite violence on Jan 6, then Twitter will ban you lol...

- So if one has issues with Potter's rebuttal, then write to RedJ or go to Twitter, it does not matter to me where you write it. Potters' writing show the world his true skin color. The absence of white men response on Twitter is deafening...

- URM has nothing to do with oversupply. The issue of URM (which I strongly support) existed in the 1980s, 1990s when we had only 110 PGY-5's/yr. Now with 180 PGY-5's /yr, same issue.

- ASTRO talks about URM bc they need to "look good".

- So Sue is correct.

- I embrace URM a different way. If I see a URM M4 desperate to get into Urology, I pick up the phone and call my buddy Urology PD. If I see a URM M4 desperate to get into Ophthalmology, I pick up the phone and call my buddy Ophthalmologists at Hopkins and all that blah blah blah...You help them in any way you can, and trust me, they will remember you for life...
 
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Radonc90 said:
Let me defend for Sue (to be EIC later ~ Jan 2020) and RedJ...

- A journal, whether it is Am J of Surgery or JAMA or NEJM, is just a platform where people publish their studies or thought process (letters to editors). It is important to have a mix of opinions. Just like our country, it is good to hear from both the Republicans and the Democrats (and the Indy's). The more opinions the better. I thought Goodman et al was spot on. Potters' rebuttal is Potters'. The writings, whether it is scientific or debate on our field oversupply issue, reflect the author(s)' opinions and not those of RedJ. RedJ in a way is like Twitter, it is a platform for sharing info. Your tweets belong to you and reflect what you say, and it does not reflect Twitter's view. Unless you help incite violence on Jan 6, then Twitter will ban you lol...

- So if one has issues with Potter's rebuttal, then write to RedJ or go to Twitter, it does not matter to me where you write it. Potters' writing show the world his true skin color. The absence of white men response on Twitter is deafening...

- URM has nothing to do with oversupply. The issue of URM (which I strongly support) existed in the 1980s, 1990s when we had only 110 PGY-5's/yr. Now with 180 PGY-5's /yr, same issue.

- ASTRO talks about URM bc they need to "look good".

- So Sue is correct.

- I embrace URM a different way. If I see a URM M4 desperate to get into Urology, I pick up the phone and call my buddy Urology PD. If I see a URM M4 desperate to get into Ophthalmology, I pick up the phone and call my buddy Ophthalmologists at Hopkins and all that blah blah blah...You help them in anyway you can, and trust me, they will remember you for life...
Click to expand...
I get it, the authors should have latitude in their publishing as to bring in new ideas and stimulate discussion. I agree with that all day, everyday.

My grievance is that Sue Yom is tweeting data on female representation and percentage of URMs in our field, yet, letting Potters' garbage letter through without any vetting or oversight. Was there a peer review? What is the role of the editor in overseeing these type of letters? Do we just let anyone send a letter in without any type of rigorous review?

The difference between journals and Twitter is that you can say whatever you want (see your Jan 6 example) on Twitter, but our scientific journals should have some scientific integrity. New ideas and pushing the limits of science have their share of controversy but moves the field forward. That's the beauty of science.

If I publish or write something crazy, usually, the referee will ask for data or reference. Potters' comments about women and minorities have no merit whatsoever, as demonstrated by Sue's tweet, and that is my issue with the publication of this piece in RJ.
 
SubserviantToABR said:
Was there a peer review?
Click to expand...
No peer review needed for opinion letters. The main difference between "letters" to a journal and Twitter or anonymous forum like here is that personal professional capital matters in terms of who gets published in journals and matters only in terms of response on Twitter. I prefer anonymous forums because personal professional capital matters none (unless you choose to be identifiable).

Peer review is reserved for original research or reviews based on research.

Potters should apologize. (Not cancel culture BTW, he just said a dumb AF thing.)
 
MegaVoltagePhoton said:
Despite being a womanwhocuries, I have found some of ASTRO's push on gender issues to be over the top and disingenuous. The silence from the womenwhocurie twitterati on Potters incredibly offensive comments about how women couldn't match before due to competitiveness is deafening.
Click to expand...
This is a damned if you do damned if you don’t situation.

See pub below in PRO. It’s saying step 1 scores affect diversity, but it’s written be URM as first author and lauded on Twitter as yea that’s right. When a white chair says the same thing it’s the end of the world. Unfortunately, this is all 100% predictable and 0% surprised. Someone forgot to tell Potters the rules of the game. Now, the DIE crew all up in roar when someone else points out the “step 1 problem.” There is no winning here, especially for Rad Onc. One thing we all agree on though is that using diversity now to recruit URMs at such a low point is despicable.

pubmed.ncbi.nlm.nih.gov

Overemphasis of Step 1 Scores May Affect Application Pool Diversity in Radiation Oncology - PubMed

Overemphasis of Step 1 scores may reduce the diversity of the radiation oncology applicant pool. Further evaluation of practices that counter the stated American Society of Clinical Oncology, American Society of Radiation Oncology, and American College of Radiology diversity missions should be...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
 
RadOncMegatron said:
This is a damned if you do damned if you don’t situation.

See pub below in PRO. It’s saying step 1 scores affect diversity, but it’s written be URM as first author and lauded on Twitter as yea that’s right. When a white chair says the same thing it’s the end of the world. Unfortunately, this is all 100% predictable and 0% surprised. Someone forgot to tell Potters the rules of the game. Now, the DIE crew all up in roar when someone else points out the “step 1 problem.” There is no winning here, especially for Rad Onc. One thing we all agree on though is that using diversity now to recruit URMs at such a low point is despicable.

pubmed.ncbi.nlm.nih.gov

Overemphasis of Step 1 Scores May Affect Application Pool Diversity in Radiation Oncology - PubMed

Overemphasis of Step 1 scores may reduce the diversity of the radiation oncology applicant pool. Further evaluation of practices that counter the stated American Society of Clinical Oncology, American Society of Radiation Oncology, and American College of Radiology diversity missions should be...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
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Per Potters "This is a glass half full that gives us the space needed to fix many aspects of our specialty. It is an opportunity to bring in great clinicians as well as great researchers and to attract more minorities and women."

What space?

In the PRO paper, there is some correlation but not crazy. 40% URM apps over 240 and 2/3 over 220. Those old people (who were like me) were largely MD/PhDs or other dual degree holders and scored as a group very similarly to URMs per the abstract. There was plenty of space in 2015-2018 to emphasize diversity in ranking at roughly the level of MD/PhD.

The PRO paper doesn't say anything offensive IMO. It's an analysis of statistics and concludes that emphasis on a single metric may impact initiatives to improve diversity. Now I will concede that some people may disagree that diversity is itself a value and not agree with such initiatives. While not my opinion, I can respect someone who will honestly state this (and I do agree that cancelling can be a problem here).

Potters says something very different and more nefarious than either 1. That diversity is itself a value and should always be emphasized or 2. That diversity is not in itself a value and that all admissions should be gender/race/other blind .

Something that folks with opposite views on diversity initiatives can agree is bogus.

What Potters is saying is that one should be opportunistic in their emphasis on diversity. When the resource that is resident applicants is rich, diversity should not be emphasized, but when it is poor, emphasizing diversity may serve to increase the resource (number of applicants).

I'm sure Potters is capable of clarifying.
 
CurbYourExpectations said:
Given the numbers of 1 radonc per 100,000 people. Country is currently at 330000000. Average work life of a RadOnc ~40 years.

330000000/100000/40=82.5 spots per year. Let it rest and see where population growth and decreased utilization is going and then reassess in 10 years.
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With some very simple math you can derive some very simple solutions to what at heart is a very simple problem.
 
radonc17 said:
Interestingly when I wrote this paper initially, I felt the amount of grads not receiving a job in their preferred region was pretty high, but I guess it depends on how you read it?

I agree with you @RickyScott @dieABRdie et al - there is significant heterogeneity within regions themselves as well as subregions

For example, much less than 75% of those interested in Pacific (ie California) receiving job offer within that subregion

I am going to write Letter in response to Brower article with subset analysis of subregions
Click to expand...

Hi all,

Just wanted to give an update

Letter to Editor accepted highlighting the significant heterogeneity b/w regions and subregions as we discussed

Be on the lookout in Red J

@RickyScott @dieABRdie
 
Check the response by radiologists to resident shortage in the article below. Not sure what is going in their market, but man do we have to go to congress to decrease spots in rad onc? Say something like "There is an 'alarming' misuse use of resident allocation into radiation oncology. We need to be able to have an external mechanism to close spots other than relying on the arbitrary discretion of chairs."

"Rep. Terri Sewell, D-Ala., introduced the House bill last month alongside Reps. John Katko, R-N.Y., Tom Suozzi, D-N.Y., and Rodney Davis, R-Ill. Sewell noted that the proposal would support an additional 2,000 positions each year from 2023-2029 for a total of 14,000 positions. Absent any legislation action, the U.S. could face a doc shortage of upward of 121,300 by 2030, experts noted."

www.radiologybusiness.com

American College of Radiology backs bipartisan push to address ‘alarming’ resident physician shortages

Lawmakers recently introduced the Resident Physician Shortage Act of 2021 to address doc shortfalls by bolstering the number of Medicare-supported residency positions.
www.radiologybusiness.com www.radiologybusiness.com
 
RadOncMegatron said:
Check the response by radiologists to resident shortage in the article below. Not sure what is going in their market, but man do we have to go to congress to decrease spots in rad onc? Say something like "There is an 'alarming' misuse use of resident allocation into radiation oncology. We need to be able to have an external mechanism to close spots other than relying on the arbitrary discretion of chairs."

"Rep. Terri Sewell, D-Ala., introduced the House bill last month alongside Reps. John Katko, R-N.Y., Tom Suozzi, D-N.Y., and Rodney Davis, R-Ill. Sewell noted that the proposal would support an additional 2,000 positions each year from 2023-2029 for a total of 14,000 positions. Absent any legislation action, the U.S. could face a doc shortage of upward of 121,300 by 2030, experts noted."

www.radiologybusiness.com

American College of Radiology backs bipartisan push to address ‘alarming’ resident physician shortages

Lawmakers recently introduced the Resident Physician Shortage Act of 2021 to address doc shortfalls by bolstering the number of Medicare-supported residency positions.
www.radiologybusiness.com www.radiologybusiness.com
Click to expand...

Maybe if their shortage becomes bad enough they would allow radiation oncologists to do an abbreviated redistribution into diagnostic radiology when we have no jobs left. Cross your fingers folks.
 
metallica81788 said:
Maybe if their shortage becomes bad enough they would allow radiation oncologists to do an abbreviated redistribution into diagnostic radiology when we have no jobs left. Cross your fingers folks.
Click to expand...
Here's my future radiology reads:

"There may or may not be a mass in XYZ organ. It appears to be slightly smaller or bigger, perhaps stable. Clinical correlation is recommended."

Gimme that RVU baby!
 
RadOncMegatron said:
Here's my future radiology reads:

"There may or may not be a mass in XYZ organ. It appears to be slightly smaller or bigger, perhaps stable. Clinical correlation is recommended."

Gimme that RVU baby!
Click to expand...
This would be the correct read for a penile cancer.
 
Re Radiology shortage...

- Is there a shortage of radiologists?

- Radiology and Derm, the 2 visual fields, IMHO, will be affected by Artificial Intelligence the most.
AI can now read low-dose lung screening very well with high accuracy ---> lessening the need for radiologists.
Some Derm AI softwares are very advanced, take a photo of the skin lesion, upload to a program, the diagnosis is very accurate.

- Whatever it is, AI will vastly transform medicine, for better or worse...
 
Radonc90 said:
Re Radiology shortage...

- Is there a shortage of radiologists?

- Radiology and Derm, the 2 visual fields, IMHO, will be affected by Artificial Intelligence the most.
AI can now read low-dose lung screening very well with high accuracy ---> lessening the need for radiologists.
Some Derm AI softwares are very advanced, take a photo of the skin lesion, upload to a program, the diagnosis is very accurate.

- Whatever it is, AI will vastly transform medicine, for better or worse...
Click to expand...
AI probably hard at talking to cancer patients and doesn't respond well to presuit letters.... Right?
 
CurbYourExpectations said:
Do any of you think that reduction in spots will happen before significant unemployment?

Saw CC PD post about how he gave the option to keep residency spots to the applicants, and they voted yes, so he didn't reduce any spots. But, obviously CC will fill, just committing to not SOAP people who had no interest in RadOnc won't work because it's typically the programs that know they will fill. Seems like most programs will fill regardless even with the concerns about the future job market. From the data I've seen it does not look like very many programs (maybe top 5?) should have >=3 residents/year with how many docs are coming and the decreasing needs for radiation, unless there is something that can significantly increased work for radoncs (meds, more indications, truck driving apparently).

I've recently tried Biryani, and it is pretty good. Plz give job to buy more.

To the Radiology topic, I've talked to some pretty well known people in Diagnostic Radiology, none of them seems to think AI will negatively impact their job market.
Click to expand...
Biryani is pretty pretty pretty good.
 
CurbYourExpectations said:
Do any of you think that reduction in spots will happen before significant unemployment?

Saw CC PD post about how he gave the option to keep residency spots to the applicants, and they voted yes, so he didn't reduce any spots. But, obviously CC will fill, just committing to not SOAP people who had no interest in RadOnc won't work because it's typically the programs that know they will fill. Seems like most programs will fill regardless even with the concerns about the future job market. From the data I've seen it does not look like very many programs (maybe top 5?) should have >=3 residents/year with how many docs are coming and the decreasing needs for radiation, unless there is something that can significantly increased work for radoncs (meds, more indications, truck driving apparently).

I've recently tried Biryani, and it is pretty good. Plz give job to buy more.

To the Radiology topic, I've talked to some pretty well known people in Diagnostic Radiology, none of them seems to think AI will negatively impact their job market.
Click to expand...
I do not think that reduction in spots will happen before significant unemployment. MAYBE if the Twitterati had taken notice when the issue was originally brought to light. They did not.

Asking your residents whether or not to expand or contract your residency program makes zero (0) sense to me. Academic leaders are supposed to do just that- lead. Make the tough decisions yourself.
 
OTN said:
I do not think that reduction in spots will happen before significant unemployment. MAYBE if the Twitterati had taken notice when the issue was originally brought to light. They did not.

Asking your residents whether or not to expand or contract your residency program makes zero (0) sense to me. Academic leaders are supposed to do just that- lead. Make the tough decisions yourself.
Click to expand...
Can’t wait for the “masterclass” in leadership at this years Astro. Wasn’t going to attend but would change my mind if they offer one. Few years ago they had a leadership training conference- anyone know if they will be offering it again?
 
RickyScott said:
Can’t wait for the “masterclass” in leadership at this years Astro. Wasn’t going to attend but would change my mind if they offer one. Few years ago they had a leadership training conference- anyone know if they will be offering it again?
Click to expand...
I'd pay money to go to that too, hopefully they have Potters Steinberg and the chair of WVU show up
 
One reason to increase residency program requirements is to prevent HCA from getting involved in rad onc training. These HCA programs have started popping up in radiology, derm, plastics, and even NuSu.
 
aspiring rapper said:
One reason to increase residency program requirements is to prevent HCA from getting involved in rad onc training. These HCA programs have started popping up in radiology, derm, plastics, and even NuSu.
Click to expand...
Why stop at residencies when you can have a medical school and why not a nursing school:

wpln.org

Belmont Announces Intent To Start A Medical School With HCA’s Help

Belmont University has been mulling whether to start a medical school for years, after launching a law school and a college of pharmacy. And with Thursday's ann
wpln.org wpln.org

www.modernhealthcare.com

HCA to acquire majority stake in nursing school's parent company

HCA Healthcare intends to become the majority owner of the parent company of Galen College of Nursing. It will be the health system's third investment in a nursing school.
www.modernhealthcare.com www.modernhealthcare.com

www.businesswire.com

HCA Healthcare Expands Graduate Medical Education, Offering Positions to Record Class of 1,982 Residents and Fellows

HCA Healthcare (NYSE:HCA), one of the nation’s leading healthcare providers, today announced that it has offered 1,982 positions for its July 2021 graduate m...
www.businesswire.com

Let’s be real, we didn’t just pick the wrong fields, we picked the wrong career in medicine. It’s all about business if you want to strive in this country.
 
aspiring rapper said:
One reason to increase residency program requirements is to prevent HCA from getting involved in rad onc training. These HCA programs have started popping up in radiology, derm, plastics, and even NuSu.
Click to expand...

Speaking of which, does anyone know the status of Tulane’s attempt at forming a program?
 
radonconogs said:
Speaking of which, does anyone know the status of Tulane’s attempt at forming a program?
Click to expand...
I don't have any specific knowledge of Tulane, but it would not surprise me AT ALL if a program pops up there in the next couple of years.

From what I'm hearing, it sounds like while a few Chairs (like Potters or BK) are making noises about job market concerns, a silent handful are still actively trying to expand current programs or start new ones. While that should surprise no one who reads SDN regularly, I think there are people who are just coming around to the side of oversupply who think the SCAROP letter etc means something in terms of "action" and "solutions", instead of just "words, words, words".

That being said...I am somewhat heartened by the small group of folks who are now openly engaging in this (source: VVPN). As for me, I'll stick with my Federalist Papers strategy for now.
 
radonconogs said:
Speaking of which, does anyone know the status of Tulane’s attempt at forming a program?
Click to expand...

Nothing on here for accreditation or pre accreditation.

ACGME - Accreditation Data System (ADS)

apps.acgme.org apps.acgme.org

Tulane and its HCA hospital in New Orleans don't come close to meeting the minimum requirements to have a residency program. Even if they partnered with private practice elsewhere in the state (which technically would have to be the main site as Tulane only has 2 rad onc faculty as has been suggested elsewhere in these forums), it would probably still be very hard to meet the minimum requirements set forth by the RRC.
 
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