Columbia

[TheWallnerus]

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[ROforbetterorworse]

Was the videochat with columbia this past friday?

Any update?

 

[aliceandbob]

First time poster on Columbia sycophants: Prior to the board fiasco, which she handled in true character (like her counterpart in wizard of oz) , I did not have a favorable view of LK from when she was in Boston. Columbia had serious issues prior to her arrival and would caution medstudents to stay away from this hot mess.

 

[RickyScott]

“Financially hobbled for life.” Seems to be a theme at Columbia.

Redirect Notice

 

[Conn Seannery]

We recently interviewed some physicists from Columbia. They seem very unhappy with the leadership there.

 

[jondunn]

I wouldn’t let my left nut match at Columbia

 

[StIGMA]

If an institution has >3X med oncs to rad oncs (pick your ratio), that's a problem. Those departments are castrate and are being led by those at a level above the department chair, to suck as much money out of the department as feasible. Glass ceiling hits your knee in those departments. Limited investment for new equipment, etc etc. The institution has made it clear they are biased in which departments they are supporting.

 

[evilbooyaa]

If an institution has >3X med oncs to rad oncs (pick your ratio), that's a problem. Those departments are castrate and are being led by those at a level above the department chair, to suck as much money out of the department as feasible. Glass ceiling hits your knee in those departments. Limited investment for new equipment, etc etc. The institution has made it clear they are biased in which departments they are supporting.

Never heard of this metric... patients need a med/onc on average more than they need a RO.

52 heme/onc physicians in Columbia to 13 RO physicians.

My own institution has a ratio of 5 heme/onc physicians to 1 RO physician. Wide community network for med oncs especially though... Am I at a hellpit? Maybe I am... We did get some new toys recently? Do others feel similarly about the 3x statistic

Another prominent instution I checked has a ratio of 3:1... any prominent academic institutions that aren't 3:1 or higher?

 

[StIGMA]

Never heard of this metric... patients need a med/onc on average more than they need a RO.

52 heme/onc physicians in Columbia to 13 RO physicians.

My own institution has a ratio of 5 heme/onc physicians to 1 RO physician. Wide community network for med oncs especially though... Am I at a hellpit? Maybe I am... We did get some new toys recently? Do others feel similarly about the 3x statistic

Another prominent instution I checked has a ratio of 3:1... any prominent academic institutions that aren't 3:1 or higher?

Random examples-- rough count at Stanford is approximately 2:1. Duke close to 1.5:1. Nationally, it is close to 2 medical oncologists per radiation oncologist. Hard to find very reliable numbers for exact count- I'm not sure ASTRO knows the workforce that well. I think 4:1 is certainly imbalanced (many potential causes, all due to leadership-- could be due to favoring significant medical oncology research effort versus rad onc, less investment in practice development, etc etc.). Metric is my own, but I think it is fair to use. Hospital leadership is generally aware of such things even if it is not defined.

 

[jondunn]

Never heard of this metric... patients need a med/onc on average more than they need a RO.

52 heme/onc physicians in Columbia to 13 RO physicians.

My own institution has a ratio of 5 heme/onc physicians to 1 RO physician. Wide community network for med oncs especially though... Am I at a hellpit? Maybe I am... We did get some new toys recently? Do others feel similarly about the 3x statistic

Another prominent instution I checked has a ratio of 3:1... any prominent academic institutions that aren't 3:1 or higher?

you are right

 

[communitydoc13]

If an institution has >3X med oncs to rad oncs (pick your ratio), that's a problem

Not an expert but seems weird to me. Where I trained, medonc dwarfed radonc, similar to Columbia numbers. Radonc department is always in good standing.

There were innumerable medoncs, including well over a dozen physician/scientists. Many of whom took call 1-2 months/year and had small continuity clinics while devoting themselves almost entirely to research. I believe they were collecting modest salaries compared to radonc.

Heaven forbid we use this metric to expand residency positions (or academic employed positions for that matter).

 

[StIGMA]

Not an expert but seems weird to me. Where I trained, medonc dwarfed radonc, similar to Columbia numbers. Radonc department is always in good standing.

There were innumerable medoncs, including well over a dozen physician/scientists. Many of whom took call 1-2 months/year and had small continuity clinics while devoting themselves almost entirely to research. I believe they were collecting modest salaries compared to radonc.

Heaven forbid we use this metric to expand residency positions (or academic employed positions for that matter).

Probably not fair to universally apply it. But I would consider it when evaluating positions/institutional culture/how the department is considered in the grand scheme of the healthcare system.

No question that residency positions need to be cut >50% across the board.

 

[w00tz]

The ratio is probably a decent rule-of-thumb...

I've seen an 8:1 ratio and yes, the rad oncs are totally anemic at that practice.

But med onc vs rad onc dynamic definitely a little more nuanced than just a ratio. Practices can be arranged in many different ways. In our multi-specialty group (ratio is 4:1), the rad oncs keep just the professional and the technical goes to the company. However, the med oncs know the rad oncs bring a lot to the table with this arrangement. When it came time to get another linac, rad oncs opted for a new TB. Med oncs briefly floated the idea of an used iX or something, but ultimately said, "we trust you, so get whatever you think is best". I guess good rad onc leadership can make up for a crappy ratio?

 

[OTN]

The ratio can also depend on the personalities of the radoncs in the particular multi-D practice. If you have one or two radoncs who want to build a huge practice, work longer hours, etc, then you may need one or even two fewer radoncs overall in the area as a result. If you have docs who want to have more manageable practices, they might be more willing to bring in additional radoncs.

It's nice when each specialty within a multi-d group can choose its own fate when it comes to growth. It's going to allow us in some private practices to continue to drive that ratio higher and higher to maintain our income in the face of APM/hypofractionation/etc.

 

[RickyScott]

Geographically, Columbia is at a big disadvantage for radonc so ratio not surprising . Pts May be willing to go to Spanish Harlem for medonc or surgery but not daily for 5 weeks. Problem with the program is that graduates are not going to land a job in nyc. At least w/ other sh- programs like arkansas, probably have slight advantage looking for a job in that area.

 

[RickyScott]

I’m not one to hide behind pseudonyms or anonymity, so let me be up front about who I am. I’m David Horowitz, the program director for the Columbia University radiation oncology residency. I’ve been in this position for the past year. I’m not here to defend the department against people’s perceptions about what it was in the distant past, or even to try to change anyone’s mind, but I do want to talk about who we are as a program and our vision for the future.

I’m doing this job because I care about our residents; I want to help them to develop into the physicians and people that they want to be. We talk a lot at Columbia about training the next generation of leaders, but to be frank it’s about working with residents to recognize within themselves what they’re truly passionate about, and supporting them as they develop those passions. Those interests go in many directions--whether it’s lab research that we’re supporting with the Holman pathway, NIH-funded work like the intersection of FLASH and immuno-oncology, pursuing a master’s degree in bioethics during their research year, or pursuing a commitment to diversity, equity and inclusion with local, regional and national leadership roles, just to name a few. I think that recognizing and supporting the diverse interests of residents as they develop their true passions have unquestionably paid dividends, with Columbia rad onc residents awarded over $200,000 in grants last year, garnering leadership roles in ARRO, as well as having multiple oral presentations at the upcoming ASTRO meeting.

To be honest, though, I’ve been most influenced by the experience of a resident who instead of pursuing grants and academic plaudits, was truly passionate about being the best damn doctor at treating prostate cancer. Through his incredible devotion and focus, he chose to do additional rotations in prostate brachytherapy, and finished residency training with more than 100 implants. The commitment and leadership that he demonstrated is no less worthy than another resident who received an NIH grant; it just helps to demonstrate the need for genuine support of whatever really makes that resident tick. I feel like it’s my job to try to think differently about what it means to excel in a radiation oncology residency, and make sure that future residents have the support that they need. It’s also about enabling people to take risks, to try new things, without fear of failure causing paralysis.

My commitment to the people who come through the Columbia rad onc residency is that I will work with them as they develop their interests into passions, which will naturally help them become leaders not just as radiation oncologists, but as oncologists who have a seat in the larger medical and scientific community. Because of the diversity of interests we want to continue to foster, we’ve had to completely rethink our mentorship program to be more comprehensive and intentional. Good mentorship is hard, but our associate program director, Fred Wu, has been incredible in developing a mentorship program that takes a holistic view of the residents and works to create a network of both local and national mentors that helps to develop the potential of each individual resident.

We’ve been getting hate for expanding the residency program, and here’s what I’ve got to say about that. While the decision to expand the program predates my tenure as program director, I own it. I think that we provide our residents training that we can be proud of, and I don’t think that we should cede that to other programs just because they decided to expand earlier. But what I won’t do is take residents who aren’t committed to radiation oncology, and that means no SOAPing. If that means we don’t match, so be it. I also think that it speaks to our interest in expanding radiation oncology’s seat at many tables, not just trying to cram more seats into our small table.

Maybe some of you have opinions about my chair, Lisa Kachnic. She doesn’t need to me to defend her or explain her actions. All I’m going to say is this: it is clear to me that she cares deeply about the success of the residents and faculty in her department, and works to bring about that success. More than that, what I’ve seen from her during the worst of the early COVID pandemic in New York City made it 100% clear to me that she cares even more deeply about who we are as people, not just as staff.

I have to admit that it bothers me when the Columbia haters come out on SDN. I don’t care if you mockingly put up a photo of me out with my colleagues (if you want to know which one is me, I’m the good looking one), but I do care about the environment created for residents and students whose “colleagues” disdain them and their place of work. So please, consider having a little empathy.

I’ll be the first to say that we’re far from perfect at Columbia--I certainly have made and will continue to make plenty of mistakes. But there’s room to try new things within radiation oncology training without totally abandoning the successes of the past. So I want to listen to what you have to say. I’m not really one for message board debates, so I’d like to invite anyone who is interested in talking about the good, bad, and ugly of rad onc training (at Columbia or in general) to join me for a zoom chat on Friday, 9/3/21 from 4-5 p.m EDT.

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I’m also always happy to chat at 212-305-7077 or by email at [email protected]



David

David, congrats on filling your expanded program.

 

[RickyScott]

Maybe they should look for a vice chair first before they look for a resident or fellow

Associate/Professor of Radiation Oncology (Physician Leader, Vice Chair of Clinical Operations) in New York, NY for Columbia University Irving Medical Center

Exciting opportunity in New York, NY for Columbia University Irving Medical Center as a Associate...

careers.astro.org

noticed on twitter that James Yu didn’t have very long tenure as vice chair.