Columbia

[deleted1111261]

isnt contracting from 8 to 7 still a 1 net expansion?

They are approved for 8, and if they take 7, they are doing more than other programs are.

7 is better than 8. At least in my math.
Take a W when it comes …

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[TheWallnerus]

Hi Simul,

Again, I appreciate the thoughtful comments that you and everyone have been bringing. I’m glad that we can have a conversation where we don’t all agree with each other, but still can have an exchange of ideas to help understand each other’s perspective to ultimately help improve our field. Like I said from the beginning, I’m not here to try to change opinions about rad onc or about my program. But I am here to listen and try to work to improve our residency and the training experience for our residents at Columbia.

As you and the SDN community are focused on always be contracting as one approach to help our field, I am focused on creating new training pathways to foster individualized talent and create new types of leaders. This includes developing and celebrating people who “just” want to be great doctors, which is frankly the most important thing we do.

I agree with you that creating new training pathways, developing the next generation of leaders, and expansion do NOT have to go hand in hand. I have actually been working with Dr. Kachnic and the residents at Columbia, and we will contract our residency from 8 to 7 until the current environment improves. Having taken this step, what we do need is help from you and other private practice rad oncs, in addition to chairs and other PDs, to work with us to develop a curriculum or pathway for those who want to go into the community to be the best damn doctors possible. Trainees wanting to be extraordinary in patient care should have a “Namloh” pathway to celebrate and develop their passion, as research scientists have with Holman.

I like your recommendation of going back to the basics and I have already implemented changes that I have control over. The APD and I have reached out to some colleagues in the community and have received helpful recommendations, including developing a practical Physics/Dosi/QA curriculum, a billing/coding and APM literacy program, a practical leadership development series, and building a support network of alumni in the community to help residents. But we need more.

I agree the conversation on the blog is changing so let’s talk offline. I need your help and the help of anyone else who wants to try to be part of the solution. Having the narrow view of someone who has stayed in academia, I know I will need help from the community for broad perspectives if the goal is to improve training for real success in all aspects of post-residency practice. I hope to hear from you in the near future. Feel free to email me at your earliest convenience. And anyone else who wants to join as we work constructively, please email me at [email protected].

Thanks,

David

You buried the lede!

 

[thecarbonionangle]

ok so don’t let perfect be the enemy of good. I get the general premise and agree . However we cant ignore the fact that they are still overall net expanding, so i wouldn’t sing them any praises.

both NYP programs still standing (NYM and Columbia) and Cornell (thankfully shut down for now) were and are terrible. Yes you are in NYC but i would not recommend anybody go to these places for training. Nobody has any business expanding wether you are columbia or duke.

 

[deleted1111261]

ok so don’t let perfect be the enemy of good. I get the general premise and agree . However we cant ignore the fact that they are still overall net expanding, so i wouldn’t sing them any praises.

both NYP programs still standing (NYM and Columbia) and Cornell (thankfully shut down for now) were and are terrible. Yes you are in NYC but i would not recommend anybody go to these places for training. Nobody has any business expanding wether you are columbia or duke.

You would give the same response if they went to 9 then them going to 7.

 

[deleted1111261]

And, coming to “hostile” environment and continuously asking for non-academics advice on how to improve residency.. I have a lot of respect for that.

 

[thecarbonionangle]

My level of frustration with this field has reached a boiling point yeah. If people want to be “bold af” please:

1) do not expand and frankly consider contracting
2) help fix the burdensome board process
3) commit to stop doing trials which eliminate radiation and promote expansion of indications for our field
4) think outside the box regarding expanding the spectrum of our field (IO?, biopsies? etc etc)

 

[Neuronix]

Having taken this step, what we do need is help from you and other private practice rad oncs, in addition to chairs and other PDs, to work with us to develop a curriculum or pathway for those who want to go into the community to be the best damn doctors possible. Trainees wanting to be extraordinary in patient care should have a “Namloh” pathway to celebrate and develop their passion, as research scientists have with Holman.

Radiation oncology residency training is designed to make great clinicians. Those who want to pursue a physician-scientist pathway can elect for Holman pathway.

If a program is not making great clinicians already, it is failing its primary objective.

 

[RickyScott]

Hi Simul,

Again, I appreciate the thoughtful comments that you and everyone have been bringing. I’m glad that we can have a conversation where we don’t all agree with each other, but still can have an exchange of ideas to help understand each other’s perspective to ultimately help improve our field. Like I said from the beginning, I’m not here to try to change opinions about rad onc or about my program. But I am here to listen and try to work to improve our residency and the training experience for our residents at Columbia.

As you and the SDN community are focused on always be contracting as one approach to help our field, I am focused on creating new training pathways to foster individualized talent and create new types of leaders. This includes developing and celebrating people who “just” want to be great doctors, which is frankly the most important thing we do.

I agree with you that creating new training pathways, developing the next generation of leaders, and expansion do NOT have to go hand in hand. I have actually been working with Dr. Kachnic and the residents at Columbia, and we will contract our residency from 8 to 7 until the current environment improves. Having taken this step, what we do need is help from you and other private practice rad oncs, in addition to chairs and other PDs, to work with us to develop a curriculum or pathway for those who want to go into the community to be the best damn doctors possible. Trainees wanting to be extraordinary in patient care should have a “Namloh” pathway to celebrate and develop their passion, as research scientists have with Holman.

I like your recommendation of going back to the basics and I have already implemented changes that I have control over. The APD and I have reached out to some colleagues in the community and have received helpful recommendations, including developing a practical Physics/Dosi/QA curriculum, a billing/coding and APM literacy program, a practical leadership development series, and building a support network of alumni in the community to help residents. But we need more.

I agree the conversation on the blog is changing so let’s talk offline. I need your help and the help of anyone else who wants to try to be part of the solution. Having the narrow view of someone who has stayed in academia, I know I will need help from the community for broad perspectives if the goal is to improve training for real success in all aspects of post-residency practice. I hope to hear from you in the near future. Feel free to email me at your earliest convenience. And anyone else who wants to join as we work constructively, please email me at [email protected].

Thanks,

David

Overall Contraction is Certainly in Columbia’s interest. From the sounds of it, you genuinely want to build a nurturing program. Unfortunately, almost all competent medstudents are compelled to a top 10 program in this market. If I was looking at radonc right now, I would choose solely based program reputation and how it would help me in the job market. This is 180 degree turn from when I applied, when I looked at program location, education, experience- all the things that you probably think matter.

 

[RadOncDoc21]

I feel like I’m talking with one of my admins in which I ask for something and like 1 year later I get 0.1% of what I’ve initially requested with 100 meetings and wasted time. I guess the lesson I’ve always learned is to value time and to not ask for anything. I want my time back reading the PD’s responses!

 

[seper]

I wonder if chairs will soon break into 2 competing camps: contracting vs. deniers. We know where Columbia stands

 

[SubserviantToABR]

Radiation oncology residency training is designed to make great clinicians. Those who want to pursue a physician-scientist pathway can elect for Holman pathway.

If a program is not making great clinicians already, it is failing its primary objective.

I agree. What rad onc has evolved to over the past decade, during peak rad onc, is an arms race in regards to choosing research over other qualities that makes a great physician. We do need, although probably not many, physician-scientists to help move the field forward and expanding indications for our field, not shooting each other in the back with omission type of trials, intentionally overlooking the cost-effective benefits of RT.

What we ended up doing is upped the competitiveness of rad onc, trained them at programs of varying quality, and sent them to die out in the community, begging for referrals with declining reimbursements.

I wonder if chairs will soon break into 2 competing camps: contracting vs. deniers. We know where Columbia stands

Unfortunately, I think the size of the two camps will be significantly lopsided. I think Columbia and pretty much 97% of places have not and will not pay attention to the job market, no matter if it is Twitter, SDN, or Fields/Kavanagh bringing attention to it. It has and will continue to be a race to the bottom.

#AlwaysBeContracting

 

[Gfunk6]

I think we can draw logical analogies between the RO job situation and global climate change. In the latter case, the damage is already done and it is irreversible. If we make significant and radical changes now, scientists say, we can reach a "new normal" circa 2060 or so.

The RO job market is in a similar scenario. The warning bells sounded years ago and were unheeded. Even now leadership begrudgingly acknowledges that it may be an issue and is taking decidedly lukewarm steps to counter it.

One day, someone in the ivory tower will wake up and see direct evidence of all of the under-represented minorities who were proudly recruited into this field are becoming un- or under-employed. If they take radical steps then, maybe we will see a turnaround in a decade or two but it will be too late for those poor souls.

I think our constructive energy could be better spent preparing for the catastrophic inevitability rather than screaming at a toppling brick wall.

 

[RickyScott]

I agree. What rad onc has evolved to over the past decade, during peak rad onc, is an arms race in regards to choosing research over other qualities that makes a great physician. We do need, although probably not many, physician-scientists to help move the field forward and expanding indications for our field, not shooting each other in the back with omission type of trials, intentionally overlooking the cost-effective benefits of RT.

What we ended up doing is upped the competitiveness of rad onc, trained them at programs of varying quality, and sent them to die out in the community, begging for referrals with declining reimbursements.

Unfortunately, I think the size of the two camps will be significantly lopsided. I think Columbia and pretty much 97% of places have not and will not pay attention to the job market, no matter if it is Twitter, SDN, or Fields/Kavanagh bringing attention to it. It has and will continue to be a race to the bottom.

#AlwaysBeContracting

I can see them moving the goal posts- now celebrating a cutesy ms4 hugging a stuffed animal or small dog who declares her love for diversity/inclusion, all things woke, and her newly found BFFs in the radonc department. And, someone who eats up seminars (especially if they involve role playing) on mentorship and leadership.

 

[Mandelin Rain]

No amount of tinkering with a residency program gives anyone a pass on basic math.

It's great lip service and promotional material for medical students viewing this thread.

But, it does not defeat math. The math is what matters here. 7 < 8, but also, 7 > 6. That brutal calculus is what's killing medical student interest in the field and subsequent career opportunities. This program is part of the problem, not solution despite many eloquent paragraphs of (borrowing from Ralph) "feel good hoo ha".

 

[Mandelin Rain]

What drove high-level medical student interest in the first decade of the 2000s?

High demand for doctors and high salaries.

Those were the compelling factors. If PDs get their attention back to those (very important) factors, you'll quickly get back to selecting from the best 250 med students American MD programs have to offer for the 100 needed residency positions offered.

 

[seper]

Unfortunately, I think the size of the two camps will be significantly lopsided. I think Columbia and pretty much 97% of places have not and will not pay attention to the job market, no matter if it is Twitter, SDN, or Fields/Kavanagh bringing attention to it. It has and will continue to be a race to the bottom.

#AlwaysBeContracting

I work with a medium-sized program and close enough to the chairman to notice that his inability to recruit outside of SOAP hurts him. So he is "paying attention", whatever it's worth

 

[Mandelin Rain]

I work with a medium-sized program and close enough to the chairman to notice that his inability to recruit outside of SOAP hurts him. So he is "paying attention", whatever it's worth

Advise him to close the residency. No more problems.

 

[RickyScott]

What drove high-level medical student interest in the first decade of the 2000s?

High demand for doctors and high salaries.

Those were the compelling factors. If PDs get their attention back to those (very important) factors, you'll quickly get back to selecting from the best 250 med students American MD programs have to offer for the 100 needed residency positions offered.

Geography is the single biggest factor for most medical students and surveys back this up.

 

[Mandelin Rain]

Geography is the single biggest factor for most medical students and surveys back this up.

You definitively need the "demand" piece. Salary alone will only get you so far.

 

[TheWallnerus]

But, it does not defeat math. The math is what matters here. 7 < 8, but also, 7 > 6. That brutal calculus is what's killing medical student interest in the field and subsequent career opportunities.

The brutalest IMHO in two graphs. Evicore could mandate 5 fraction breast any time; APM could make you love it.

 

[elementaryschooleconomics]

(borrowing from Ralph) "feel good hoo ha".

YOU RANG?

 

[TheWallnerus]

YOU RANG?

View attachment 342888

 

[DoctwoB]

I've used this exactly ZERO times in my clinical practice. Like protons, would need substantial clinical evidence to implement into routine clinical practice. I know Max Diehn, and I think his work is solid. Just not prime time yet.

Will soon be primetime in bladder cancer post-cystectomy. RCT of adjuvant immunotherapy showed big response in cTC positive not in cTC negative.

But will mostly be used to stratify patients who need some sort of adjuvant therapy with the idea of treating fewer, not more patients.

 

[RickyScott]

Will soon be primetime in bladder cancer post-cystectomy. RCT of adjuvant immunotherapy showed big response in cTC positive not in cTC negative.

But will mostly be used to stratify patients who need some sort of adjuvant therapy with the idea of treating fewer, not more patients.

It’s also going prime time in colorectal. Only matter of time before phase 3 trial omitting xrt in breast in pts who are negative after lumpectomy. Of course, they will still get systemic.

 

[deleted941485]

It’s also going prime time in colorectal. Only matter of time before phase 3 trial omitting xrt in breast in pts who are negative after lumpectomy. Of course, they will still get systemic.

Yeah I think i've had it with RO. Cool that CUMC will be cutting. not gonna matter but thanks for the token effort. My friend who did NSX took a new job in a nice suburb they are rolling out the red carpet for him and they have spine patients ready and waiting to be operated on. Must be nice to be in demand haha. I'm in mid to late 30's now and couldn't stomach a serious residency like that but still I think its time to just GTFO to retrain stop trying to prop up this house of cards.

 

[elementaryschooleconomics]

Yeah I think i've had it with RO. Cool that CUMC will be cutting. not gonna matter but thanks for the token effort. My friend who did NSX took a new job in a nice suburb they are rolling out the red carpet for him and they have spine patients ready and waiting to be operated on. Must be nice to be in demand haha. I'm in mid to late 30's now and couldn't stomach a serious residency like that but still I think its time to just GTFO to retrain stop trying to prop up this house of cards.

Come on now, I'm SURE Neurosurgery has similar issues as RadOnc!

I would bet, with all my money, that a huge subset of their research focuses on how many times they need to use a Bovie during a procedure, and an immense amount of manpower has been dedicated to Bovie reduction.

Surely, the academic Neurosurgeons love to extol how few times they use a Bovie on each patient, and tell wide-eyed medical students all about the evil community Neurosurgeons who only care about money and how they use the Bovie too many times.

However, I'm absolutely certain that many academic Neurosurgeons secretly use a Bovie the conventional number of times, and the other surgeons only discover this when a patient comes to them for some other reason and records are requested. "Oh my!", the evil community surgeon proclaims, "Dr. Ivy League used the Bovie FORTY FOUR TIMES."

Alas, the evil community surgeon is not considered a KOL because he has not spent 15 years coercing medical students and residents in the Academic Multi-Level Marketing Environment™ to publish >200 manuscripts plumbing the depths of the National Bovie Use Database to support the use of a Bovie 28 times compared to 44 times, so he has no platform to tell anyone. Plus, he's too busy treating...actual patients to get wrapped up in mudslinging. So, he goes about his day.

That's how Neurosurgery works, right? Do they also go to Spine Surgery Board meetings at 7AM and listen to the referring docs (non-surgeons, of course) question the need for the Bovie whenever ANY patient older than 70 is presented? They must, right?

 

[deleted941485]

Come on now, I'm SURE Neurosurgery has similar issues as RadOnc!

I would bet, with all my money, that a huge subset of their research focuses on how many times they need to use a Bovie during a procedure, and an immense amount of manpower has been dedicated to Bovie reduction.

Surely, the academic Neurosurgeons love to extol how few times they use a Bovie on each patient, and tell wide-eyed medical students all about the evil community Neurosurgeons who only care about money and how they use the Bovie too many times.

However, I'm absolutely certain that many academic Neurosurgeons secretly use a Bovie the conventional number of times, and the other surgeons only discover this when a patient comes to them for some other reason and records are requested. "Oh my!", the evil community surgeon proclaims, "Dr. Ivy League used the Bovie FORTY FOUR TIMES."

Alas, the evil community surgeon is not considered a KOL because he has not spent 15 years coercing medical students and residents in the Academic Multi-Level Marketing Environment™ to publish >200 manuscripts plumbing the depths of the National Bovie Use Database to support the use of a Bovie 28 times compared to 44 times, so he has no platform to tell anyone. Plus, he's too busy treating...actual patients to get wrapped up in mudslinging. So, he goes about his day.

That's how Neurosurgery works, right? Do they also go to Spine Surgery Board meetings at 7AM and listen to the referring docs (non-surgeons, of course) question the need for the Bovie whenever ANY patient older than 70 is presented? They must, right?

Thats it. Im emailing PDs today!

 

[TheWallnerus]

My friend who did NSX took a new job in a nice suburb they are rolling out the red carpet for him and they have spine patients ready and waiting to be operated on.

TOP 10 ROLLING OUT THE RED CARPET SCENARIOS FOR NEW RAD ONC HIRES

10. Relocation expenses easily covered the biggest U-haul I could get
9. Dept admin introduced me to everyone in HR when I got my ID badge made
8. Came to work first day with one PC monitor on my desk; left work that day with two
7. Got to postpone diversity & inclusion training 'til 2022
6. Senior partner offered to see last Friday's afternoon cord compression
5. Pathologist gave me a warm-hearted intro at the first week's tumor board
4. Contract "mistake" gave me 4 instead of 3 weeks vacation my first year... they let it slide
3. Busiest med onc in town texted me his personal cell number
2. Nurses keep the drawers in my exam rooms stocked with fresh lube without me asking
1. They let me bring food and drink into dosimetry

 

[DebtRising]

It is worth noting that no other field has as much effort spent on minimizing its use as radiation does. And that is a frustrating point as technology gets better and better and toxicity less and less.

The bar is always higher to add and lower to cut us. So having record size residency classes is unsustainable for those seeking to enter.

The data for immunotherapy post cystectomy is after another almost identical trial with a similar agent was completely negative. So either by chance and having more trials / agents / companies to fund them, the positive trial outweighs the negative trial. And to the physician, it doesn’t matter which agent they use, their practice is maintained. This is a completely different style compared to radiation and should require careful oversight to ensure a healthy but not exploited workforce. Editorials are a great first step, but the pace of increasing drugs and decreasing radiation is happening much quicker

 

[communitydoc13]

This is a completely different style compared to radiation

No way to compare the two. Functionally so different. XRT market share seemed great when limited systemic options and initial efforts at evidence based medicine included diverse and unselected populations. Both personalized medicine and systemic therapy development working against our relative prominence. With systemic therapy trials, the trial is itself a way to get the drug to patients and nearly all the work is done for you. The incentives and practicalities of XRT trials are just so different. In fact, enrolling in an XRT trial is typically a pain in the ass for the radonc relative to their usual practice and there is typically nothing novel provided to the patient that couldn't be offered off of protocol.

As I've said before, we need to start giving drugs. Start by owning endocrine therapy for breast/prostate. It would free up your community hemoncs (who really are in demand). Think we can't handle it?

 

[deleted1111261]

Have thought about it… prescribing ET requires worrying about bone health and other side effects. TMZ means watching counts and making sure PCP is prophylaxed. Any other of the “hard core” sensitizers - could require admitting privileges.

All this maybe reasonable and feasible, but not what I had signed up for.

 

[communitydoc13]

not what I had signed up for

Not what I signed up for either, but at some point justifying our salaries to the hospital is going to get tough. I also signed up for pretty darn good compensation and am willing to be flexible to demonstrate value to my (functional-service contract) employer.

 

[thecarbonionangle]

If a path to giving some systemic therapy opened up, i would strongly consider this. I know many others who would as well. Someone needs to make this happen.

 

[RickyScott]

Not what I signed up for either, but at some point justifying our salaries to the hospital is going to get tough. I also signed up for pretty darn good compensation and am willing to be flexible to demonstrate value to my (functional-service contract) employer.

would rather not see 20 patients a day and prescribe drugs, but that is probably our only wat forward as a specialty. Attitudes will change as un/underemployment becomes more widespread.

 

[RickyScott]

It’s also going prime time in colorectal. Only matter of time before phase 3 trial omitting xrt in breast in pts who are negative after lumpectomy. Of course, they will still get systemic.

Strong work Chelaine! ( this was 3 years ago) now she and Wendy Woodward can take this to the next level. Going to be so much personalization and precision coming to radiation.

THURSDAY, May 3, 2018 (HealthDay News) -- Circulating tumor cell status is predictive of radiotherapy (RT) benefit in early-stage breast cancer, according to a study published online May 3 in JAMA Oncology.

Chelain R. Goodman, M.D., Ph.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues included data from the National Cancer Database (NCDB; 1,697 patients) and the SUCCESS clinical trial (1,516 patients) to examine whether CTC status is predictive of radiotherapeutic benefit in early-stage breast cancer.

The researchers detected CTCs in 23.5 and 19.4 percent of the NCDB and SUCCESS cohorts, respectively. The correlation of RT with survival was dependent on CTC status in the NCDB cohort; in the SUCCESS cohort, the correlation with disease-free survival was dependent on CTC status. RT correlated with longer OS in patients with CTCs in the NCDB cohort (time ratio [TR], 2.04), but not in patients without CTCs. CTC-positive patients treated with RT had longer local recurrence-free survival, disease-free survival, and overall survival in the SUCCESS cohort (TRs, 2.73, 3.03, and 1.83, respectively). For patients from both cohorts who underwent breast-conserving surgery, RT correlated with longer OS in those with CTCs (TR, 4.37), but not in those without. There was no correlation for RT with overall survival after mastectomy in CTC-positive or CTC-negative patients.

"These results are hypothesis generating; a prospective trial evaluating CTC-based management for RT after breast-conserving surgery in women with early-stage breast cancer is warranted," the authors write.

 

[Noober]

I am a former trainee of Dr. Lisa Kachnic. I will start by saying that I was in the audience at the ASTRO 2018 ARRO resident meeting. The second I walked into the room, we all can agree the tension was palpable and the meeting was not going to be a positive encounter no matter what.

Personally, I was upset too with the 30 percent failure rate in 2018. Not acceptable. I viewed this primarily as a failing of the ABR. Presenting data of subsets of programs that failed was likely not the best approach at the time by the ABR and Dr. Kachnic. I told her personally my impressions and she can read that again here; however she was the spokesperson of a large volunteer board. I do want to comment about the posts that Lisa states radiation residents are less than brilliant. I know that she never thinks this, and more to come on this below.

Anyway, I respect that people will have different opinions about what should've or could've been done from ABR leadership, and perhaps exam and educational curriculum enhancements have resulted from this 2018 mess. I write instead to primarily point out that we all come to our opinions from a different perspective and to realize that a continued negative lens should not be cast on a person from a single event. Having had and continue to have extensive personal interactions with Dr. Kachnic, I can certify that Lisa is a wonderful physician, chair, and mentor.

I love open discussion and debate. I do not mind being critical of actions. I always encourage people to speak their thoughts. We all naturally do that. But what hurts me is to see people write blatantly offensive and frankly incorrect things about a good person. Being critical of actions, or words is one thing, but straight up ad hominem attacks is not fair about someone you do not know.


As her trainee, she is one of the best attendings I have ever encountered. I will speak to her compassion first. I believe one of the most special things about training in medicine is we get to incorporate the best of what we saw. I certify that Dr. Kachnic was exceptionally compassionate to her patients. Despite race, gender, religion, nationality, social status (including homeless with painful anal malignancy), LGBTQ+, she treated everyone as a VIP. It is always inspiring when you see a busy chair spend as much time as is needed to help out her patients. She essentially gives her cell phone to all of her patients, and answers questions at any hour or on weekends. She even keeps up communications with former patients. When she left Vanderbilt, her patients were always on her mind as she often was checking in on them. One follow-up patient mentioned she loved that Dr. Kachnic was still there for her despite leaving the area.


I will be honest, when I first met her, I was afraid she would be judgmental of my lack of knowledge as a young trainee. However, I quickly saw that she is a very warm person despite how appearances may be up at a podium. She cared so much for my education and I saw her "pimping" actually was gentle and inspired me to push things to my best limit. I struggled with self confidence as a junior resident, and felt shy to discuss my interests with anyone but anything I ever mentioned for my career was instantly met with her support. I have heard of chairs out there, that make their resident do everything (some who supposedly do not even know how to contour) but she always found time to sit with me and review every contour I had slice by slice (not every attending did that). My co-residents also thought she was the best teacher, and we presented her with the ARRO teacher of the year award before she left Vanderbilt after an honest convo in the resident that she was the most deserving. In fact, I am in my first year as an attending. . On a side note, she also took an interest in our wellness as residents, and we enjoyed monthly group trivia outings, where often she was the only attending that would balance time to come.

I am a fair person. I understand people were upset on this 2018 ABR event and from the view of not knowing Lisa. I can only speak to witnessing the compassionate, intelligent attending who trained me well, and helped build me up.


David, I will happily be on the call, and hope that we can use this time positively to globally enhance residency programs and education.

Again, I do not mind if people disagree with me. I just felt obligated to speak my voice just as I always encourage others to speak theirs.

 

[SubserviantToABR]

I am a former trainee of Dr. Lisa Kachnic. I will start by saying that I was in the audience at the ASTRO 2018 ARRO resident meeting. The second I walked into the room, we all can agree the tension was palpable and the meeting was not going to be a positive encounter no matter what.

Personally, I was upset too with the 30 percent failure rate in 2018. Not acceptable. I viewed this primarily as a failing of the ABR. Presenting data of subsets of programs that failed was likely not the best approach at the time by the ABR and Dr. Kachnic. I told her personally my impressions and she can read that again here; however she was the spokesperson of a large volunteer board. I do want to comment about the posts that Lisa states radiation residents are less than brilliant. I know that she never thinks this, and more to come on this below.

Anyway, I respect that people will have different opinions about what should've or could've been done from ABR leadership, and perhaps exam and educational curriculum enhancements have resulted from this 2018 mess. I write instead to primarily point out that we all come to our opinions from a different perspective and to realize that a continued negative lens should not be cast on a person from a single event. Having had and continue to have extensive personal interactions with Dr. Kachnic, I can certify that Lisa is a wonderful physician, chair, and mentor.

I love open discussion and debate. I do not mind being critical of actions. I always encourage people to speak their thoughts. We all naturally do that. But what hurts me is to see people write blatantly offensive and frankly incorrect things about a good person. Being critical of actions, or words is one thing, but straight up ad hominem attacks is not fair about someone you do not know.


As her trainee, she is one of the best attendings I have ever encountered. I will speak to her compassion first. I believe one of the most special things about training in medicine is we get to incorporate the best of what we saw. I certify that Dr. Kachnic was exceptionally compassionate to her patients. Despite race, gender, religion, nationality, social status (including homeless with painful anal malignancy), LGBTQ+, she treated everyone as a VIP. It is always inspiring when you see a busy chair spend as much time as is needed to help out her patients. She essentially gives her cell phone to all of her patients, and answers questions at any hour or on weekends. She even keeps up communications with former patients. When she left Vanderbilt, her patients were always on her mind as she often was checking in on them. One follow-up patient mentioned she loved that Dr. Kachnic was still there for her despite leaving the area.


I will be honest, when I first met her, I was afraid she would be judgmental of my lack of knowledge as a young trainee. However, I quickly saw that she is a very warm person despite how appearances may be up at a podium. She cared so much for my education and I saw her "pimping" actually was gentle and inspired me to push things to my best limit. I struggled with self confidence as a junior resident, and felt shy to discuss my interests with anyone but anything I ever mentioned for my career was instantly met with her support. I have heard of chairs out there, that make their resident do everything (some who supposedly do not even know how to contour) but she always found time to sit with me and review every contour I had slice by slice (not every attending did that). My co-residents also thought she was the best teacher, and we presented her with the ARRO teacher of the year award before she left Vanderbilt after an honest convo in the resident that she was the most deserving. In fact, I am in my first year as an attending. . On a side note, she also took an interest in our wellness as residents, and we enjoyed monthly group trivia outings, where often she was the only attending that would balance time to come.

I am a fair person. I understand people were upset on this 2018 ABR event and from the view of not knowing Lisa. I can only speak to witnessing the compassionate, intelligent attending who trained me well, and helped build me up.


David, I will happily be on the call, and hope that we can use this time positively to globally enhance residency programs and education.

Again, I do not mind if people disagree with me. I just felt obligated to speak my voice just as I always encourage others to speak theirs.

I'm glad she was a good mentor, attending, and chairperson to you. But...

The ABR has been historically known to be filled with a bunch of misfits, taking bi-annual Hawaii vacations at resorts to the tune of $1200 per night, with a separate account for their spouses. It is unacceptable to do that to our annual dues. But that is a separate conversation.

As far as the 2018 debacle is concerned, she had a great responsibility with the ABR and is the face of the ABR. It is part of what you take on if you take on that role and responsibility. You can't just take the glory without taking the criticism. Heavy is the head that wears the crown.

Everyone likes to say that the ABR is a volunteer organization, which it is, but part of that volunteering entails taking that responsibility seriously. We do not need volunteers who do a half-baked job when there are thousands of physicians that not only compasses radiation oncology but diagnostic and interventional radiology. Moreover, a lot of the board members are paid salaries larger than your current salary with no apparent benefit to the membership.

Fact of the matter is that 2018 was a seriously anomalous year (you can see the latest pass rates in another post). Things happen, and we get that. The anger came from how everything was handled.

For all of us, we did not train at Vanderbilt or Columbia so most of us have never, ever met Lisa Kachnic. However, she handled the situation poorly. There are citations with her name on it saying that the quality of the recent cohort of residents have been declining. She stood at the podium (you can review the Virtual Meeting again if you'd like) and basically said that she was being cyberbullied and that it was not fair to her. Many of our colleagues failed, and the takeaway from her talk was too bad, so sad, you went to a small program, so it is on you, not the ABR. Next year, the ABR told you to read Khan and Weinberg and miraculously, the pass rate shot up to the upper 90s, which still persists to this day.

I get that she was a good attending to you, and I can't comment to that whatsoever. But she had a separate and important responsibility at the ABR with ALL of us, and she did a completely abysmal job at it. She may be a warm person any other day, but that day, she was cold as ice.

 

[ROforbetterorworse]

I'm glad she was a good mentor, attending, and chairperson to you. But...

The ABR has been historically known to be filled with a bunch of misfits, taking bi-annual Hawaii vacations at resorts to the tune of $1200 per night, with a separate account for their spouses. It is unacceptable to do that to our annual dues. But that is a separate conversation.

As far as the 2018 debacle is concerned, she had a great responsibility with the ABR and is the face of the ABR. It is part of what you take on if you take on that role and responsibility. You can't just take the glory without taking the criticism. Heavy is the head that wears the crown.

Everyone likes to say that the ABR is a volunteer organization, which it is, but part of that volunteering entails taking that responsibility seriously. We do not need volunteers who do a half-baked job when there are thousands of physicians that not only compasses radiation oncology but diagnostic and interventional radiology. Moreover, a lot of the board members are paid salaries larger than your current salary with no apparent benefit to the membership.

Fact of the matter is that 2018 was a seriously anomalous year (you can see the latest pass rates in another post). Things happen, and we get that. The anger came from how everything was handled.

For all of us, we did not train at Vanderbilt or Columbia so most of us have never, ever met Lisa Kachnic. However, she handled the situation poorly. There are citations with her name on it saying that the quality of the recent cohort of residents have been declining. She stood at the podium (you can review the Virtual Meeting again if you'd like) and basically said that she was being cyberbullied and that it was not fair to her. Many of our colleagues failed, and the takeaway from her talk was too bad, so sad, you went to a small program, so it is on you, not the ABR. Next year, the ABR told you to read Khan and Weinberg and miraculously, the pass rate shot up to the upper 90s, which still persists to this day.

I get that she was a good attending to you, and I can't comment to that whatsoever. But she had a separate and important responsibility at the ABR with ALL of us, and she did a completely abysmal job at it. She may be a warm person any other day, but that day, she was cold as ice.

be easier to like kachnic if she just says she was wrong and apologizes

thus far just deflections, double downs or silence though

Wallner not redeemable on the other hand

 

[elementaryschooleconomics]

Despite race, gender, religion, nationality, social status (including homeless with painful anal malignancy), LGBTQ+, she treated everyone as a VIP.

The rest of the post aside - I am disheartened that you felt the need to highlight this. Treating everyone equally, in your capacity as a physician, isn't something notable. It should be the bare minimum.

Is this something I need to be doing in the current climate? "Sir, I want to assure you, that even though you're a Mormon, I will do my best to keep your cord dmax below 50 Gy!"

 

[Noober]

I'm glad she was a good mentor, attending, and chairperson to you. But...

The ABR has been historically known to be filled with a bunch of misfits, taking bi-annual Hawaii vacations at resorts to the tune of $1200 per night, with a separate account for their spouses. It is unacceptable to do that to our annual dues. But that is a separate conversation.

As far as the 2018 debacle is concerned, she had a great responsibility with the ABR and is the face of the ABR. It is part of what you take on if you take on that role and responsibility. You can't just take the glory without taking the criticism. Heavy is the head that wears the crown.

Everyone likes to say that the ABR is a volunteer organization, which it is, but part of that volunteering entails taking that responsibility seriously. We do not need volunteers who do a half-baked job when there are thousands of physicians that not only compasses radiation oncology but diagnostic and interventional radiology. Moreover, a lot of the board members are paid salaries larger than your current salary with no apparent benefit to the membership.

Fact of the matter is that 2018 was a seriously anomalous year (you can see the latest pass rates in another post). Things happen, and we get that. The anger came from how everything was handled.

For all of us, we did not train at Vanderbilt or Columbia so most of us have never, ever met Lisa Kachnic. However, she handled the situation poorly. There are citations with her name on it saying that the quality of the recent cohort of residents have been declining. She stood at the podium (you can review the Virtual Meeting again if you'd like) and basically said that she was being cyberbullied and that it was not fair to her. Many of our colleagues failed, and the takeaway from her talk was too bad, so sad, you went to a small program, so it is on you, not the ABR. Next year, the ABR told you to read Khan and Weinberg and miraculously, the pass rate shot up to the upper 90s, which still persists to this day.

I get that she was a good attending to you, and I can't comment to that whatsoever. But she had a separate and important responsibility at the ABR with ALL of us, and she did a completely abysmal job at it. She may be a warm person any other day, but that day, she was cold as ice.

We agree 2018 was a mess. ABR does need to be held accountable I wish we could break free from them. Clearly with pass rates improving maybe they revisited what was minimally required knowledge. I personally wish board certified attendings were forced to take these exams again cold. That could be the metric of minimally required knowledge or w/e the metric is. Yea I can't defend all the actions, nor do I think doing so would be productive at this point. Hopefully through one form or another ABR realized they were clearly in the wrong hence much improved pass rates? As a subsidiary of them we need to hold them accountable to us so that type of failure never happens again as some normal variation.

I can only address that some vicious things have been posted on here about her(personal attacks)are just not fair or accurate nor fair. That is cyber bullying and I am passionately against bullying. Hence I share my narrative.

 

[Noober]

The rest of the post aside - I am disheartened that you felt the need to highlight this. Treating everyone equally, in your capacity as a physician, isn't something notable. It should be the bare minimum.

Is this something I need to be doing in the current climate? "Sir, I want to assure you, that even though you're a Mormon, I will do my best to keep your cord dmax below 50 Gy!"

Funny joke. Yes Of course it is a bare minimum! Just extra nice to see this as many others do not do that!! Giving a cell and being there all the way (fully accessible even weekends) for the patients is not a minimum though.

 

[SubserviantToABR]

Clearly with pass rates improving maybe they revisited what was minimally required knowledge.

Do you remember the Angoff conversations and the issues behind closed doors with the exam committees? It was admittedly a subjective exam with an arbitrary cut point for passing. The response to that? Too bad, so sad. That's why the ABR published a whole diatribe on the life of an exam question, to double down on what happened.

I recently took oral boards this past May. Albeit heresay, but I heard, from a trusted source, that Paul Wallner told the examiners to go easy on grading this time around since it was the 2018 group. That is the ABR in a nutshell.

The value, quality, and execution of the board certification process is debated in a separate thread, but for a bunch of volunteers, it is as subjective and arbitrary as it gets.

 

[SubserviantToABR]

We agree 2018 was a mess. ABR does need to be held accountable I wish we could break free from them. Clearly with pass rates improving maybe they revisited what was minimally required knowledge. I personally wish board certified attendings were forced to take these exams again cold. That could be the metric of minimally required knowledge or w/e the metric is. Yea I can't defend all the actions, nor do I think doing so would be productive at this point. Hopefully through one form or another ABR realized they were clearly in the wrong hence much improved pass rates? As a subsidiary of them we need to hold them accountable to us so that type of failure never happens again as some normal variation.

I can only address that some vicious things have been posted on here about her(personal attacks)are just not fair or accurate nor fair. That is cyber bullying and I am passionately against bullying. Hence I share my narrative.

To be clear, I think my class has moved on from 2018, but when the Columbia PD and a recent trainee comes on to defend, it is important to not ignore what has happened in the past.

In the end, the certification process is one issues, but ultimately, we will need to contract, Columbia, included, with LK there or not. Always be contracting.

 

[evilbooyaa]

I am a former trainee of Dr. Lisa Kachnic. I will start by saying that I was in the audience at the ASTRO 2018 ARRO resident meeting. The second I walked into the room, we all can agree the tension was palpable and the meeting was not going to be a positive encounter no matter what.

Personally, I was upset too with the 30 percent failure rate in 2018. Not acceptable. I viewed this primarily as a failing of the ABR. Presenting data of subsets of programs that failed was likely not the best approach at the time by the ABR and Dr. Kachnic. I told her personally my impressions and she can read that again here; however she was the spokesperson of a large volunteer board. I do want to comment about the posts that Lisa states radiation residents are less than brilliant. I know that she never thinks this, and more to come on this below.

Anyway, I respect that people will have different opinions about what should've or could've been done from ABR leadership, and perhaps exam and educational curriculum enhancements have resulted from this 2018 mess. I write instead to primarily point out that we all come to our opinions from a different perspective and to realize that a continued negative lens should not be cast on a person from a single event. Having had and continue to have extensive personal interactions with Dr. Kachnic, I can certify that Lisa is a wonderful physician, chair, and mentor.

I love open discussion and debate. I do not mind being critical of actions. I always encourage people to speak their thoughts. We all naturally do that. But what hurts me is to see people write blatantly offensive and frankly incorrect things about a good person. Being critical of actions, or words is one thing, but straight up ad hominem attacks is not fair about someone you do not know.


As her trainee, she is one of the best attendings I have ever encountered. I will speak to her compassion first. I believe one of the most special things about training in medicine is we get to incorporate the best of what we saw. I certify that Dr. Kachnic was exceptionally compassionate to her patients. Despite race, gender, religion, nationality, social status (including homeless with painful anal malignancy), LGBTQ+, she treated everyone as a VIP. It is always inspiring when you see a busy chair spend as much time as is needed to help out her patients. She essentially gives her cell phone to all of her patients, and answers questions at any hour or on weekends. She even keeps up communications with former patients. When she left Vanderbilt, her patients were always on her mind as she often was checking in on them. One follow-up patient mentioned she loved that Dr. Kachnic was still there for her despite leaving the area.


I will be honest, when I first met her, I was afraid she would be judgmental of my lack of knowledge as a young trainee. However, I quickly saw that she is a very warm person despite how appearances may be up at a podium. She cared so much for my education and I saw her "pimping" actually was gentle and inspired me to push things to my best limit. I struggled with self confidence as a junior resident, and felt shy to discuss my interests with anyone but anything I ever mentioned for my career was instantly met with her support. I have heard of chairs out there, that make their resident do everything (some who supposedly do not even know how to contour) but she always found time to sit with me and review every contour I had slice by slice (not every attending did that). My co-residents also thought she was the best teacher, and we presented her with the ARRO teacher of the year award before she left Vanderbilt after an honest convo in the resident that she was the most deserving. In fact, I am in my first year as an attending. . On a side note, she also took an interest in our wellness as residents, and we enjoyed monthly group trivia outings, where often she was the only attending that would balance time to come.

I am a fair person. I understand people were upset on this 2018 ABR event and from the view of not knowing Lisa. I can only speak to witnessing the compassionate, intelligent attending who trained me well, and helped build me up.


David, I will happily be on the call, and hope that we can use this time positively to globally enhance residency programs and education.

Again, I do not mind if people disagree with me. I just felt obligated to speak my voice just as I always encourage others to speak theirs.

Almost all criticizing LK have not met her in person.

The vast majority of criticism directed towards her is in response to:
1) Her role in the ABR boards fiasco of 2018
2) Her deciding to expand her residency at Columbia in a time where that may not be the smartest move in terms of currying favor, especially on SDN.

Other points are small and I think insinuating that someone anonymous on the internet made a drive-by comment about a Rad Onc chair, who is essentially a public figure for something that is not 1 or 2 is pretty rare.

I'm open to seeing examples of cyberbullying that are not for her role in 1 or 2. I promise to have a respectful discussion about it.

 

[deleted1111261]

Almost all criticizing LK have not met her in person.

The vast majority of criticism directed towards her is in response to:
1) Her role in the ABR boards fiasco of 2018
2) Her deciding to expand her residency at Columbia in a time where that may not be the smartest move in terms of currying favor, especially on SDN.

Other points are small and I think insinuating that someone anonymous on the internet made a drive-by comment about a Rad Onc chair, who is essentially a public figure for something that is not 1 or 2 is pretty rare.

I'm open to seeing examples of cyberbullying that are not for her role in 1 or 2. I promise to have a respectful discussion about it.

If I have cyber bullied, please present that. Most of us have been fact-driven. If it upsets you that people are mad that she and Paulie said the quality of residents has declined, that’s not bullying. That’s a disagreement. You agree with her. We do not.

 

[SubserviantToABR]

If I have cyber bullied, please present that. Most of us have been fact-driven. If it upsets you that people are mad that she and Paulie said the quality of residents has declined, that’s not bullying. That’s a disagreement. You agree with her. We do not.

There was also all of the letters sent by the ABR that were reportedly emailed to female junior attendings (regarding breastfeeding and family planning) and maybe some others that prompted an emergency board meeting.

 

[radoncopotamus]

The rest of the post aside - I am disheartened that you felt the need to highlight this. Treating everyone equally, in your capacity as a physician, isn't something notable. It should be the bare minimum.

Is this something I need to be doing in the current climate? "Sir, I want to assure you, that even though you're a Mormon, I will do my best to keep your cord dmax below 50 Gy!"

Sad to say not my experience to see Chairs act this way. Usually a lot more brown nosing/over the top attention done for perceived local "VIPs." Others have to wait 90+ minutes for the chair to be done with meetings.

 

[TheWallnerus]

I am a former trainee of Dr. Lisa Kachnic. I will start by saying that I was in the audience at the ASTRO 2018 ARRO resident meeting. The second I walked into the room, we all can agree the tension was palpable and the meeting was not going to be a positive encounter no matter what.

Personally, I was upset too with the 30 percent failure rate in 2018. Not acceptable. I viewed this primarily as a failing of the ABR. Presenting data of subsets of programs that failed was likely not the best approach at the time by the ABR and Dr. Kachnic. I told her personally my impressions and she can read that again here; however she was the spokesperson of a large volunteer board. I do want to comment about the posts that Lisa states radiation residents are less than brilliant. I know that she never thinks this, and more to come on this below.

Anyway, I respect that people will have different opinions about what should've or could've been done from ABR leadership, and perhaps exam and educational curriculum enhancements have resulted from this 2018 mess. I write instead to primarily point out that we all come to our opinions from a different perspective and to realize that a continued negative lens should not be cast on a person from a single event. Having had and continue to have extensive personal interactions with Dr. Kachnic, I can certify that Lisa is a wonderful physician, chair, and mentor.

I love open discussion and debate. I do not mind being critical of actions. I always encourage people to speak their thoughts. We all naturally do that. But what hurts me is to see people write blatantly offensive and frankly incorrect things about a good person. Being critical of actions, or words is one thing, but straight up ad hominem attacks is not fair about someone you do not know.


As her trainee, she is one of the best attendings I have ever encountered. I will speak to her compassion first. I believe one of the most special things about training in medicine is we get to incorporate the best of what we saw. I certify that Dr. Kachnic was exceptionally compassionate to her patients. Despite race, gender, religion, nationality, social status (including homeless with painful anal malignancy), LGBTQ+, she treated everyone as a VIP. It is always inspiring when you see a busy chair spend as much time as is needed to help out her patients. She essentially gives her cell phone to all of her patients, and answers questions at any hour or on weekends. She even keeps up communications with former patients. When she left Vanderbilt, her patients were always on her mind as she often was checking in on them. One follow-up patient mentioned she loved that Dr. Kachnic was still there for her despite leaving the area.


I will be honest, when I first met her, I was afraid she would be judgmental of my lack of knowledge as a young trainee. However, I quickly saw that she is a very warm person despite how appearances may be up at a podium. She cared so much for my education and I saw her "pimping" actually was gentle and inspired me to push things to my best limit. I struggled with self confidence as a junior resident, and felt shy to discuss my interests with anyone but anything I ever mentioned for my career was instantly met with her support. I have heard of chairs out there, that make their resident do everything (some who supposedly do not even know how to contour) but she always found time to sit with me and review every contour I had slice by slice (not every attending did that). My co-residents also thought she was the best teacher, and we presented her with the ARRO teacher of the year award before she left Vanderbilt after an honest convo in the resident that she was the most deserving. In fact, I am in my first year as an attending. . On a side note, she also took an interest in our wellness as residents, and we enjoyed monthly group trivia outings, where often she was the only attending that would balance time to come.

I am a fair person. I understand people were upset on this 2018 ABR event and from the view of not knowing Lisa. I can only speak to witnessing the compassionate, intelligent attending who trained me well, and helped build me up.


David, I will happily be on the call, and hope that we can use this time positively to globally enhance residency programs and education.

Again, I do not mind if people disagree with me. I just felt obligated to speak my voice just as I always encourage others to speak theirs.

Looks like a very negative LK review got deleted today? Stars not yet updated I guess.

 

[RadOncDoc21]

I don’t know her, really don’t care to at this point in my career but even if she was an angel (I doubt she is one), it still doesn’t address any of the issues in the field.

Same goes for the PD or any other person spouting off on how great somebody is and how they will lead the greatest rad onc program in the history of the world.

 

[RadOncDoc21]

Looks like a very negative LK review got deleted today? Stars not yet updated I guess.

How do I request a return and my money back?