Hellpits- absolute worst programs in radiation oncology

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Doctorer said:
My guy, I admire your savvy, but you realize “learn to fly so you can commute to a good job” is an absolutely insane suggestion for 99.99% of radoncs right? If anything, it shows how terrible this field has become.
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Can get a linac cheaper than an airplane

Of course, in all states you’re legally allowed to own an airplane as a rad onc… but if you want to own a linac, you may be legally disallowed to buy one depending on the state you live in!
 
DrProtonX said:
Programs are still adding spots?? That’s a whole new level of ignorance…
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"No lessons learned"

For more info:

forums.studentdoctor.net

Programs that have increased/decreased resident numbers and closed 2019 to 2024

Programs that have closed with approved resident spots prior to withdrawal of accreditation; Drexel in 2019 (4), Medical College of Georgia in 2019 (4), California Pacific in 2019 (4) Cornell 2021 (6), NCI in 2023 (6) and University of Tennessee in 2024 (4). Programs to have officially...
forums.studentdoctor.net forums.studentdoctor.net
 
DrProtonX said:
Programs are still adding spots?? That’s a whole new level of ignorance…
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greed, not ignorance. And these same people are by and large running astro. "Leadership" are bad apples and will screw the specialty for their own benefit whether it is resident numbers, payment reform etc. J Michalski from wash u increased resident numbers a year or 2 ago
 
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fiji128 said:
"No lessons learned"

For more info:

forums.studentdoctor.net

Programs that have increased/decreased resident numbers and closed 2019 to 2024

Programs that have closed with approved resident spots prior to withdrawal of accreditation; Drexel in 2019 (4), Medical College of Georgia in 2019 (4), California Pacific in 2019 (4) Cornell 2021 (6), NCI in 2023 (6) and University of Tennessee in 2024 (4). Programs to have officially...
forums.studentdoctor.net forums.studentdoctor.net
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Lets not be the fools here. Lessons were learned. Expansion provides short term benefits to programs and makes SOM administration happy. With essentially no immediate downside to department leadership.
 
This is the same situation with all bureaucrats whether they are in the government, hospitals, or academics. To them, it is all like playing a grand game of Jenga. In the beginning, you can pull out blocks with abandon. There is no problem and you look like a whiz. Eventually you are promoted up the chain and move on to bigger and better things. Eventually, the whole structure will collapse but the blame will be deflected away from the actual culprits.
 
ramsesthenice said:
Lets not be the fools here. Lessons were learned. Expansion provides short term benefits to programs and makes SOM administration happy. With essentially no immediate downside to department leadership.
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i dont disagree, but this applies to all specialties. I am interested in why radiation is uniquely the worst? I guess by definition, one specialty has to be the absolute worst/greediest/self interested. Will ASTRO feature a "masterclass" on leadership this year?
 
RickyScott said:
i dont disagree, but this applies to all specialties. I am interested in why radiation is uniquely the worst? I guess by definition, one specialty has to be the absolute worst/greediest/self interested. Will ASTRO feature a "masterclass" on leadership this year?
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Radiation is particularly bad simply due to the era of current leadership. When this cohort entered residency training, there was a notable lull in applicant quality. At that time, Rad Onc was not held in high esteem, and medicine was happy to dump miscreants into the hospital basement. Thus, the extreme prevalence of Axis 2 disorders in more senior Radiation Oncologists. These are now our "leaders."
 
Gfunk6 said:
This is the same situation with all bureaucrats whether they are in the government, hospitals, or academics. To them, it is all like playing a grand game of Jenga. In the beginning, you can pull out blocks with abandon. There is no problem and you look like a whiz. Eventually you are promoted up the chain and move on to bigger and better things. Eventually, the whole structure will collapse but the blame will be deflected away from the actual culprits.
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You mean like crying and screaming that the other team is spending too much, then immediately cutting tax...I mean revenue when its your turn, only to have them start spending with no abandon when its their turn again (cycle continues)? This is actually more of an economic than political metaphor. So few people actually understand macroeconomics that its incredibly easy to run your mouth and convince people believe anything despite a mountain of evidence to the contrary.
 
RickyScott said:
i dont disagree, but this applies to all specialties. I am interested in why radiation is uniquely the worst? I guess by definition, one specialty has to be the absolute worst/greediest/self interested. Will ASTRO feature a "masterclass" on leadership this year?
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I definitely do not think rad oncs are uniquely greedy. Look around at your hospital.

Honestly the peak of expansion happened for about a decade when rad onc was the hottest thing ever. I don’t think hardly any program director or chair thought there was a single negative thing about it. They were all growing and hiring more faculty as they got bigger and cancer care got more consolidated. It happened before anyone even knew it was too late, imo.
 
drowsy12 said:
I definitely do not think rad oncs are uniquely greedy. Look around at your hospital.

Honestly the peak of expansion happened for about a decade when rad onc was the hottest thing ever. I don’t think hardly any program director or chair thought there was a single negative thing about it. They were all growing and hiring more faculty as they got bigger and cancer care got more consolidated. It happened before anyone even knew it was too late, imo.
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The residency expansion was uniquely excessive . Furthermore, utilization was flat or decreasing and almost certainly grew less than other fields.
 
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ramsesthenice said:
Lets not be the fools here. Lessons were learned. Expansion provides short term benefits to programs and makes SOM administration happy. With essentially no immediate downside to department leadership.
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Yep. I don't buy the degenerate leaders of a certain generation narrative. That's extremely unlikely to be true.

What is true is how radonc appeared to non-radiation oncology administrators (including Deans) in the early to mid 2000-2010s.

1. It was bringing in bank.
2. It was stealing the best med studs from more noble specialties like medicine and surgery.

So of course, expansion seemed remarkably natural. (It wasn't of course, but with a glut of star applicants and a healthy ledger, everyone was willing to play along),

Some chairs (leaders of that generation) even parlayed this ridiculousness into institutional or national leadership.

Like most of the universe...it's luck and timing baby. We just bought high.
 
communitydoc13 said:
Yep. I don't buy the degenerate leaders of a certain generation narrative. That's extremely unlikely to be true.

What is true is how radonc appeared to non-radiation oncology administrators (including Deans) in the early to mid 2000-2010s.

1. It was bringing in bank.
2. It was stealing the best med studs from more noble specialties like medicine and surgery.

So of course, expansion seemed remarkably natural. (It wasn't of course, but with a glut of star applicants and a healthy ledger, everyone was willing to play along),

Some chairs (leaders of that generation) even parlayed this ridiculousness into institutional or national leadership.

Like most of the universe...it's luck and timing baby. We just bought high.
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I shoulda bought index funds.
 
communitydoc13 said:
Yep. I don't buy the degenerate leaders of a certain generation narrative. That's extremely unlikely to be true.

What is true is how radonc appeared to non-radiation oncology administrators (including Deans) in the early to mid 2000-2010s.

1. It was bringing in bank.
2. It was stealing the best med studs from more noble specialties like medicine and surgery.

So of course, expansion seemed remarkably natural. (It wasn't of course, but with a glut of star applicants and a healthy ledger, everyone was willing to play along),

Some chairs (leaders of that generation) even parlayed this ridiculousness into institutional or national leadership.

Like most of the universe...it's luck and timing baby. We just bought high.
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A lot of hot-sht selective fields that are gold mines for hospitals and experienced actual patient growth like Uro, optho, ortho, plastics did not overexpand precisley because their leadership were not degenerate pos. Btw, the EIC of the red journal, Zeitman, often warned that radonc would crater and even compared it to the specialty treating syphilus before advent of antibiotics.
 
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communitydoc13 said:
Yep. I don't buy the degenerate leaders of a certain generation narrative. That's extremely unlikely to be true.
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Radonc and EM expanded more than any other specialty since the turn of the century. EM because of greedy hospital and admins.

Radonc did so without supporting data and did so when it became ultra competitive 🤷🏾

@RickyScott nailed it
 
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RickyScott said:
A lot of hot-sht selective fields that are gold mines for hospitals and experienced actual patient growth like Uro, optho, ortho, plastics did not overexpand precisley because their leadership were not degenerate pos. Btw, the EIC of the red journal, Zeitman, often warned that radonc would crater and even compared it to the specialty treating syphilus before advent of antibiotics.
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Good points.

However…


Did any other specialty experience an explosion in interest like Radonc?

Supply of star med studs created demand.
 
Chartreuse Wombat said:
IMRT explains most things
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Remarkable how easy it was to markedly increase med student interest in an era where a newish intervention was being disseminated and was driving a marked increase in compensation.

It's almost as if when there is a real thing (not necessarily a noble thing, but a creature comfort thing, like good jobs, good pay, good hours) there will be real med student interest.
 
communitydoc13 said:
Remarkable how easy it was to markedly increase med student interest in an era where a newish intervention was being disseminated and was driving a marked increase in compensation.

It's almost as if when there is a real thing (not necessarily a noble thing, but a creature comfort thing, like good jobs, good pay, good hours) there will be real med student interest.
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Just before/along with IMRT was the transition to CT-based, axial-imaging-based, computer-based planning. If we were still using wax pencils on films to create fields I would not have been interested in this specialty.

If you were in medical school during the explosion in imaging (PET, 4D CT, high-resolution MRI, etc) and computing (broadly gestures around) technology it was pretty easy to get excited about radonc.
 
OTN said:
it was pretty easy to get excited about radonc.
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Agree totally, it was an era where the field was making significant technical progress.

Also seemed for a while that the footprint of radonc in definitive management of solid tumors would just continue to increase.

These were real things...not cultural initiatives to increase interest.

Leadership should abandon such initiatives. Focus on the actual job and what it entails/means.
 
RickyScott said:
A lot of hot-sht selective fields that are gold mines for hospitals and experienced actual patient growth like Uro, optho, ortho, plastics did not overexpand precisley because their leadership were not degenerate pos. Btw, the EIC of the red journal, Zeitman, often warned that radonc would crater and even compared it to the specialty treating syphilus before advent of antibiotics.
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I saw his talk on this syphilis analogy also. He saw it coming.
 
Radadabbadoo said:
I saw his talk on this syphilis analogy also. He saw it coming.
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Saw it coming but didn't take the actual bold step of doing something about expansion, hiding behind phantom anti trust lawsuits and holding no one publicly accountable for expansion. I think in ways it's actually worse he saw it coming and did nothing. Yes, I know he can't physically force programs to quit expanding/contract....but certainly could have done more.
 
Radadabbadoo said:
I saw his talk on this syphilis analogy also. He saw it coming.
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discussed on sdn at the time. Steve Hahn and Wallner wrote editorial in red journal (referencing biblical Ruth?) that the field will need to evolve/ combine (maybe with interventional rads) to avoid extinction. Zeitman and Royce had multiple papers expressing concern.

pubmed.ncbi.nlm.nih.gov

Radiotherapy Utilization and Fractionation Patterns During the First Course of Cancer Treatment in the United States From 2004 to 2014 - PubMed

We found a steady decrease in the percent of patients receiving radiotherapy in their first course of treatment, and a global decline in the mean number of fractions delivered per patient receiving EBRT, compared with an increase in systemic therapy and stable surgery utilization. These results...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

pubmed.ncbi.nlm.nih.gov

Whither Thou Goest, I Will Go - PubMed

Whither Thou Goest, I Will Go
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
 
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RickyScott said:
discussed on sdn at the time. Steve Hahn and Wallner wrote and editorial in red journal (referencing biblical Ruth?) that the field will need to evolve/ combine (maybe with interventional rads) to avoid extinction. Zeitman and Royce had multiple papers expressing concern about how the future.

pubmed.ncbi.nlm.nih.gov

Radiotherapy Utilization and Fractionation Patterns During the First Course of Cancer Treatment in the United States From 2004 to 2014 - PubMed

We found a steady decrease in the percent of patients receiving radiotherapy in their first course of treatment, and a global decline in the mean number of fractions delivered per patient receiving EBRT, compared with an increase in systemic therapy and stable surgery utilization. These results...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

pubmed.ncbi.nlm.nih.gov

Whither Thou Goest, I Will Go - PubMed

Whither Thou Goest, I Will Go
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
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Haha so goofy. Does Steve Hahn still goest with Rad Onc?

Its so wild to me that Wallner first authored this editorial and also crashed interest in our field through his remarkably bad management of the ABR crisis in the same year.

These "low quality" residents are now supposed to also dual train in another field?

Sometimes when I talk to leadership folks in our field I feel like I am on the TV show Punk'd.
 
Ashton does demonstrate self awareness and projects an aura of basic competence. Both of these characteristics seem to be in short supply in ASTRO. (Edit spelling)
 
Radadabbadoo said:
Ashton does demonstrate self awareness and projects an aura of basic competence. Both of these characteristics seem to be in short supply in ASTRO. (Edit spelling)
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Leadership is why I can't, in good conscience, recommend this field to anyone interested unless they love rad onc so much that they don't care where they end up working or how much they get paid in the end.

In which case, yeah you'll probably get a job somewhere in the US and it'll probably pay you something in the six figures

Kinda like the Thomas Eichler (former ASTRO prez) definition for graduating with a job out of residency... "The goal is a 'job' "
 
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