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We need an article like this in radiation oncology.
"[...]Is it serious or trivial? It is not a blip, and it is serious, but predicting workforce needs is tricky. [...] I began working in a clinical lab while in premed, finished medical school in 1957, and (after a rotating clinical internship) finished my 4-year pathology residency in 1962, becoming boarded in anatomic and clinical pathology the same year. We always used to say that about 3% of graduating American medical students entered pathology. In 2019, the National Resident Matching Program reported 569 incoming first-year pathology residents, or 3.2% of 17 763 total residents matched. However, only 201 of those were US graduates, filling only 33.4% of all available positions—the lowest, by far, of all specialties with more than 100 graduates entering a comprehensive program. This is all about supply and demand."

 

nkmiami

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posted before, but i have heard this from varian sales. Early in my career I was old told that i general- and this was the pre-hypofractionation era- you needed 100,000 pop for about 15 pts. Do the math and it gets depressing. Ask you varian rep.
 
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I saw 60,000 people per linac at an ARRO presentation in 2008. The math that was done seemed solid.
 

nkmiami

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I saw 60,000 people per linac at an ARRO presentation in 2008. The math that was done seemed solid.
a town of 60,000 can not support a linac even in 2008 with 6 weeks breast and 8 week prostate.
 

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It did seem a little low to me, I agree, though this was back in the pre-hypofractionation/preSBRT era.
 

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a town of 60,000 can not support a linac even in 2008 with 6 weeks breast and 8 week prostate.
Depends on demographics and practice setup. A satellite office in a retiree town sharing the CT sim and dosimetry/physics with the main site with traveling therapists probably can sustain a basic iX/igrt linac, special procedures and CT simulation goes to the main site
 
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nkmiami

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Depends on demographics and practice setup. A satellite office in a retiree town sharing the CT sim and dosimetry/physics with the main site with traveling therapists probably can sustain a basic iX/igrt linac, special procedures and CT simulation goes to the main site
yes, you are right but I am talking about averages which is want counts when its comes to estimating linac requirements for entire us population. 100,000 people maybe 20,000 are retires.
 
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medgator

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yes, you are right but I am talking about averages which is want counts when its comes to estimating linac requirements for entire us population. 100,000 people maybe 20,000 are retires.
I'd think it's higher than that, and the demographics are shifting towards a more aged population. It's still not going to be enough to deal with the oversupply of ROs coming out, obviously.

The RO labor market was in a good place at ~110-120/year. That's where it needs to get back to, when you consider that hypofx and sbrt will allow the existing number of ROs to treat a greater number of patients.
 
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I'd think it's higher than that, and the demographics are shifting towards a more aged population. It's still not going to be enough to deal with the oversupply of ROs coming out, obviously.

The RO labor market was in a good place at ~110-120/year. That's where it needs to get back to
An ~50% decrease in residents graduating every year, with many academic programs attempting to expand, or at minimum, not be the person who has to contract?

I'm not holding my breath.
 
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nkmiami

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14.9 percent

47.8 million. The number of people age 65 and older in the United States on July 1, 2015. This group accounted for 14.9 percent of the total population. The age 65 and older population grew 1.6 million from 2014.Apr 10, 2017

The varian sales people know this. I brought up recently with one, and they mentioned 80,000, and I told him you guys used to say 100,000 and he smiled.

Also, I would be very suspect of ARRO. Lets not forget until a few months ago, ARRO was denying on their website that there was an oversupply issue (despite comments of esteemed attendings on RO hub) and stating that the problem was malcontents on SDN.

Lastly, I would also urge readers to look at the pathology forums on SDN. There are still attendings defending the residency expansion.
 
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medgator

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14.9 percent

47.8 million. The number of people age 65 and older in the United States on July 1, 2015. This group accounted for 14.9 percent of the total population. The age 65 and older population grew 1.6 million from 2014.Apr 10, 2017

The varian sales people know this. I brought up recently with one, and they mentioned 80,000, and I told him you guys used to say 100,000 and he smiled.

Also, I would be very suspect of ARRO. Lets not forget until a few months ago, ARRO was denying on their website that there was an oversupply issue (despite comments of esteemed attendings on RO hub) and stating that the problem was malcontents on SDN.
Imo, increasing hypofx, sbrt and surveillance basically means the same number of docs can treat an increasing population of patients. Which is why I believe this field will continue into the abyss until we get back to <120 ROs graduating a year
 
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Also, I would be very suspect of ARRO. Lets not forget until a few months ago, ARRO was denying on their website that there was an oversupply issue (despite comments of esteemed attendings on RO hub) and stating that the problem was malcontents on SDN.

Lastly, I would also urge readers to look at the pathology forums on SDN. There are still attendings defending the residency expansion.
Agree with both of these points.
 

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From twitter, seems that ARRO peeps and predecessors are pyramid climbers

Note: The moderators have removed the referred to post. The above is the first part of that post and a summary. Please maintain professional language on SDN.
It would be nice if these people were blackballed from the private practice world for their dishonesty/ignorance (depending on how you look at it). I can't wait to see how they react when their only options are satellites paying 200k with plenty of opportunities to "mentor" future satellite monkeys. It's one thing to completely ignore the pyramid scheme, but to actively engage in it is disgusting. I overheard an academic chair at ASTRO gleaming as he explained how he recieved "over 100 applications" for a satellite job he advertised. Meanwhile, look at the GI forum: 3 open jobs for every graduating resident offering >700k in any city. Tell me a GI applicant would've even come close to rad onc in the last 10 years.
 

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It would be nice if these people were blackballed from the private practice world for their dishonesty/ignorance (depending on how you look at it). I can't wait to see how they react when their only options are satellites paying 200k with plenty of opportunities to "mentor" future satellite monkeys. It's one thing to completely ignore the pyramid scheme, but to actively engage in it is disgusting. I overheard an academic chair at ASTRO gleaming as he explained how he recieved "over 100 applications" for a satellite job he advertised. Meanwhile, look at the GI forum: 3 open jobs for every graduating resident offering >700k in any city. Tell me a GI applicant would've even come close to rad onc in the last 10 years.

I share the same skepticism regarding some of the ARRO people. From what i have seen, some are simply sycophants trying to climb up and use their resident rep position to butter up certain people. Good luck to some of these folks when they look for a job!
 
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I will offer a counterpoint on the ARRO folks. Some are climbers, but all who I have interacted with have been polite and professional. Their open letter to the ABR about last year's exam didn't pull any punches. I don't know about everyone else, but I appreciated the nerdy statistical clap back to ABR about the failure rate being due to chance alone as seen in Figure 1 of the letter. Of course, the ABR doesn't have to listen to them, but I appreciate the effort nonetheless.

Just my $0.02...
 

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Yeah. Don't have a serious issue with ARRO at least in recent history. Given that it's a position that rotates 1 to 2 years at a time it's hard to classify it as 'historically' bad or good.
 
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medgator

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yes, you are right but I am talking about averages which is want counts when its comes to estimating linac requirements for entire us population. 100,000 people maybe 20,000 are retires.
A hospital plans on opening a practice with a linac for 10k people :eek:


 

evilbooyaa

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Tons of jobs posted with city populations of 4-10k.... I'm not sure how they're financially solvent.
 
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I will offer a counterpoint on the ARRO folks. Some are climbers, but all who I have interacted with have been polite and professional. Their open letter to the ABR about last year's exam didn't pull any punches. I don't know about everyone else, but I appreciated the nerdy statistical clap back to ABR about the failure rate being due to chance alone as seen in Figure 1 of the letter. Of course, the ABR doesn't have to listen to them, but I appreciate the effort nonetheless.

Just my $0.02...
You certainly cant paint everybody with the same brush. But, as jobs become scarcer, I do expect ARRO and some upwardly mobile junior faculty to take a more lordotic posture when it comes to towing the chairman's line.
 

fiji128

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A hospital plans on opening a practice with a linac for 10k people :eek:


The catchment area would be far larger then just Monroe WI. Could be a good bread and butter community practice with the difficult stuff going to U Wisconsin, if you don't mind living in southern very rural Wisconsin.
 

medgator

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The catchment area would be far larger then just Monroe WI. Could be a good bread and butter community practice with the difficult stuff going to U Wisconsin, if you don't mind living in southern very rural Wisconsin.
Usually the surrounding catchment area is less populated than the center with the linac.... I still don't see how this center treats more than 10-15 pts daily, if that
 
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China is an absolute nightmare for physicians and healthcare professions. It's very telling that these academicians look to them for "the future".

This is true across many of the socialist countries and ex socialist countries (China, Russia). Their docs are treated like garbage. So clearly any system that does this has the full attention of the bean counters and health admin in the US.

It’s pretty telling in the article how messed up it is when they say that poor people are willing to study Medicine because there are literally no other options. That was some how a positive?! Hahahahaha.

I love how they are told to smile after seeing 100 patients a day. Lol!! The one guy is like “how do you expect me to smile after working like this all day”. And workplace violence is common place and people expect it.
 

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On a scale of 0 to 10, with 10 being completely socialized medicine, medicine in America now trends more toward 10 than it does zero. Nothing is an absolute obviously. Just like in Wernicke-Korsakoff syndrome: no patient is purely Wernicke encephalopathic nor any patient purely Korsakoff psychotic. It's a continuum. So it is in the business of medicine: the socialization is a continuum yet farther from Wernicke to Korsakoff we go. The next President, or the one after that, will likely be championing Medicare-for-all for example.
Socialism is a system of society and government-sanctioned exploitation. Everyone tacitly agrees to be exploited equally with a central command center doling out the exploitation mercifully and rationally, ideally. In the NYT article from a few days ago entitled "The Business of Healthcare Depends on Exploiting Doctors and Nurses," the exploitation theme dovetails with socialism, conglomerated central command, etc. You'd be blind not to see it. You'd also be blind, and not a little depressed, not to follow all this out to its logical endpoint.
1) If you're a doctor, you're exploited.
2) Being successful in medicine will depend on yielding to exploitation in the future.
3) Doctors seem to complain about exploitation a lot, but more and more people enter medicine; however "everyone" presumably knows about the exploitation problem in medicine...
4) And if this is true, knowing you'll be exploited—but consciously choosing to be exploited, and then complaining about it⁠—is a form of neurosis.
5) Which means everyone in medicine is already, or increasingly will be, by definition, neurotic.
 

thecarbonionangle

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On a scale of 0 to 10, with 10 being completely socialized medicine, medicine in America now trends more toward 10 than it does zero. Nothing is an absolute obviously. Just like in Wernicke-Korsakoff syndrome: no patient is purely Wernicke encephalopathic nor any patient purely Korsakoff psychotic. It's a continuum. So it is in the business of medicine: the socialization is a continuum yet farther from Wernicke to Korsakoff we go. The next President, or the one after that, will likely be championing Medicare-for-all for example.
Socialism is a system of society and government-sanctioned exploitation. Everyone tacitly agrees to be exploited equally with a central command center doling out the exploitation mercifully and rationally, ideally. In the NYT article from a few days ago entitled "The Business of Healthcare Depends on Exploiting Doctors and Nurses," the exploitation theme dovetails with socialism, conglomerated central command, etc. You'd be blind not to see it. You'd also be blind, and not a little depressed, not to follow all this out to its logical endpoint.
1) If you're a doctor, you're exploited.
2) Being successful in medicine will depend on yielding to exploitation in the future.
3) Doctors seem to complain about exploitation a lot, but more and more people enter medicine; however "everyone" presumably knows about the exploitation problem in medicine...
4) And if this is true, knowing you'll be exploited—but consciously choosing to be exploited, and then complaining about it⁠—is a form of neurosis.
5) Which means everyone in medicine is already, or increasingly will be, by definition, neurotic.
Word "socialism" is used so much that people don't really know what it refers to anymore. is "socialism" and "communism" the same? what exactly is China, if anything? what is scandinavia and rest of Europe? First people need to define what they really mean so people can understand exactly. The US system has many problems, clearly something must be done. I don't have the answer.

I'm a capitalist. Most left leaning people I know believe it is the better system. People in different political spectrum may disagree with market regulation, etc. I've worked in many systems as I have jumped around (many private "fancy" places, VA, underfunded social safety net local places, etc). Ive seen inefficiencies and red tape, terrible things in all these places. I don't see one system as necessarily better than other. Good and bad things in all. What I think, reading that "business of healthcare" article making rounds in all groups over the past week, is that a lot of things are not just driven by the government, although of course some are, but also by this mentality that "if it were just run like a business, it would be better" (our government, our healthcare, etc). The private hospitals has so many business people and administrator bean counters, MBAs, MPHs, useless degreees abound telling us clinicians how to take care of our patients. They do nothing for people, make the money and are completely useless. I walk by the admin lot on the way to work and see much nicer cars than the physician lot....
 
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On a scale of 0 to 10, with 10 being completely socialized medicine, medicine in America now trends more toward 10 than it does zero. Nothing is an absolute obviously. Just like in Wernicke-Korsakoff syndrome: no patient is purely Wernicke encephalopathic nor any patient purely Korsakoff psychotic. It's a continuum. So it is in the business of medicine: the socialization is a continuum yet farther from Wernicke to Korsakoff we go. The next President, or the one after that, will likely be championing Medicare-for-all for example.
Socialism is a system of society and government-sanctioned exploitation. Everyone tacitly agrees to be exploited equally with a central command center doling out the exploitation mercifully and rationally, ideally. In the NYT article from a few days ago entitled "The Business of Healthcare Depends on Exploiting Doctors and Nurses," the exploitation theme dovetails with socialism, conglomerated central command, etc. You'd be blind not to see it. You'd also be blind, and not a little depressed, not to follow all this out to its logical endpoint.
1) If you're a doctor, you're exploited.
2) Being successful in medicine will depend on yielding to exploitation in the future.
3) Doctors seem to complain about exploitation a lot, but more and more people enter medicine; however "everyone" presumably knows about the exploitation problem in medicine...
4) And if this is true, knowing you'll be exploited—but consciously choosing to be exploited, and then complaining about it⁠—is a form of neurosis.
5) Which means everyone in medicine is already, or increasingly will be, by definition, neurotic.
The student government/academic ivory tower twitter crowd will be by any second to defend socialism. And of course to drive-by some identity politics and remind us how we are continuing to systematically conspire to keep women and minorities out of this field and pay them less. Oh, wait no they won't. They'll do that on ROHub and/or Twitter so they can put their face next to their "progressive" comment and dare anyone to present a logical diagreement with it based in you know, facts and objective evidence.

Rural area maldisribution.... whaaaaattt.... Need to recruit more of those that are gonna go to the big cities and provide cheaper labor for the big guys.
 

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The term "exploitation" is an unfortunate one. Much like "burnout", which media loves nowadays. Wasting one's professional life babysitting a LINAC at a busy satellite for the annual salary of $225K is unpleasant. It is not exploitation, compared to, say, manning a general clinic in Mozambique.
 

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Word "socialism" is used so much that people don't really know what it refers to anymore. is "socialism" and "communism" the same?
Yup.


I think the Scandinavians might be the closest to what works. Maybe a bit less here would work. Essentially socialist programs funded by capitalism

 
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Word "socialism" is used so much that people don't really know what it refers to anymore. is "socialism" and "communism" the same?
You should ask this guy. He's got communism figured out.

"Fully automated luxury communism"

Some quality reading from the definitely not-failing New York Times...

 
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The student government/academic ivory tower twitter crowd will be by any second to defend socialism. And of course to drive-by some identity politics and remind us how we are continuing to systematically conspire to keep women and minorities out of this field and pay them less. Oh, wait no they won't. They'll do that on ROHub and/or Twitter so they can put their face next to their "progressive" comment and dare anyone to present a logical diagreement with it based in you know, facts and objective evidence.

Rural area maldisribution.... whaaaaattt.... Need to recruit more of those that are gonna go to the big cities and provide cheaper labor for the big guys.
In reality, they rely on exorbitant monopolistic price gauging, which is actually out of control capitalism. Try telling those departments they should not recover 3-5x what a standalone community hospital takes when it comes to insurance negotiations.
 
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In reality, they rely on exorbitant monopolistic price gauging, which is actually out of control capitalism. Try telling those departments they should not recover 3-5x what a standalone community hospital takes when it comes to insurance negotiations.
Not exactly. This is enabled by the government.
In a truly capitalistic system, payers would choose your shop because you provide better value.
 
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Not exactly. This is enabled by the government.
In a truly capitalistic system, payers would choose your shop because you provide better value.
not if you have a monopoly via geography or reputation. If you are the only game in town, payers need to play ball- they got no choice. Think what would happen if your power company's prices were not regulated. You wouldnt be in a position to argue value,
 
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not if you have a monopoly via geography or reputation. If you are the only game in town, payers need to play ball- they got no choice. Think what would happen if your power company's prices were not regulated. You wouldnt be in a position to argue value,
Again, in a truly capitalistic system, such a scenario would motivate competition to come in, offer a better value, and solve the problem.

Certificate of need states preclude this.

And getting business through reputation is capitalism at its purest. You offer the best service, you get a great reputation. People choose you. Free market at its finest.
 

Ray D. Ayshun

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On a scale of 0 to 10, with 10 being completely socialized medicine, medicine in America now trends more toward 10 than it does zero. Nothing is an absolute obviously. Just like in Wernicke-Korsakoff syndrome: no patient is purely Wernicke encephalopathic nor any patient purely Korsakoff psychotic. It's a continuum. So it is in the business of medicine: the socialization is a continuum yet farther from Wernicke to Korsakoff we go. The next President, or the one after that, will likely be championing Medicare-for-all for example.
Socialism is a system of society and government-sanctioned exploitation. Everyone tacitly agrees to be exploited equally with a central command center doling out the exploitation mercifully and rationally, ideally. In the NYT article from a few days ago entitled "The Business of Healthcare Depends on Exploiting Doctors and Nurses," the exploitation theme dovetails with socialism, conglomerated central command, etc. You'd be blind not to see it. You'd also be blind, and not a little depressed, not to follow all this out to its logical endpoint.
1) If you're a doctor, you're exploited.
2) Being successful in medicine will depend on yielding to exploitation in the future.
3) Doctors seem to complain about exploitation a lot, but more and more people enter medicine; however "everyone" presumably knows about the exploitation problem in medicine...
4) And if this is true, knowing you'll be exploited—but consciously choosing to be exploited, and then complaining about it⁠—is a form of neurosis.
5) Which means everyone in medicine is already, or increasingly will be, by definition, neurotic.
Speak of the devil. One of the two candidates for ASTRO president is from Princess Margaret...
 
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Speak of the devil. One of the two candidates for ASTRO president is from Princess Margaret...
Unless they’re both up for significantly reducing training spots to mid 2000 levels and expanding our role in oncology and have power to take such steps then it may be worth listening to and even putting up with their socialist bent/promotion which they will undoubtedly have.

Otherwise, I don’t see a reason to support them. Just like in Canada, they’re are more than enough US ROs who could step into this role.

Thumbs down
 
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Perhaps instead of ASTRO (American Society for Rad Onc) we should change the name to the Canadian/American Society for (Therapeutic) Radiation Oncology.

CASTRO.


You post a lot of odd stuff on here. Not all winners. Some serious head scratchers sometimes.

Then you go and post something like this.

And totally redeem yourself.

Well done.
 
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Perhaps instead of ASTRO (American Society for Rad Onc) we should change the name to the Canadian/American Society for (Therapeutic) Radiation Oncology.

CASTRO.

Fun fact. One of the highest paid jobs in Cuba outside of the communist party leadership is Cigar Roller! 9 months of rigorous training learning the art of cigar rolling in the workers paradise.

I don’t think I need to mention that Doctors are treated like dirt and sent off to far flung areas like Angola as part of govt good will trips. Of course it’s totally voluntary. If the nyt wants to see exploitation why not take a trip down to the jewel of the Caribbean? I think I already know how the piece would read.
 
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Ray D. Ayshun

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Perhaps instead of ASTRO (American Society for Rad Onc) we should change the name to the Canadian/American Society for (Therapeutic) Radiation Oncology.

CASTRO.

Should really delete the last few posts and close the thread with this.
 

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I do agree that this thread is going off the rails. If you want to discuss political topics, go to the political forums on SDN. I will close the thread if it continues to deviate from questions like radiation oncologist supply/demand, whether there is a mismatch, what can/should be done about it, and who can/will do it.
 

Ray D. Ayshun

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I do agree that this thread is going off the rails. If you want to discuss political topics, go to the political forums on SDN. I will close the thread if it continues to deviate from questions like radiation oncologist supply/demand, whether there is a mismatch, what can/should be done about it, and who can/will do it.
I kind of meant that scarb's post won the internet. On the other hand, if the president of ASTRO works in a medical system different from ours, it may inform how those questions are answered by the powers-that-be.
 
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...especially if the medical system is notorious for having an oversupply of residents even worse than that of the US.
 
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Laura Dawson is definitely an inspiring person. And note that she has had part of her career in the US.

But I also note that neither her or Carol Hahn hint at any RO supply issues, unless you account addressing underutilization which even isn't stated explicitly in the first policy statement.
 
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scarbrtj

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You post a lot of odd stuff on here. Not all winners. Some serious head scratchers sometimes.
You should see my consult notes.

For anyone who cares to think about this, it's an easy calculus in my opinion. The only variables are
1) number of new rad onc patients per year, and rate change thereof
2) number of presently needed rad oncs per year, and rate change thereof

Regarding #1, the incidence is steady or decreasing (see below). Let's assume it's steady, best case scenario. There are 1.7M new cancer cases per year; 50% of these will be rad onc patients, about 850K per year. If we assume on low end 150 new patients per rad onc per year, we need 5667 rad oncs in the US. About right! We need 4250 if we assume 200 new patients per year, maybe a more reasonable/depressing figure but whatever.

All this means that if #1 is steady, or falling, #2 needs to hold steady. It isn't of course. Impacting #2 is the length of time radiation oncologists stay in practice; you can calculate the annual dropout rate by taking one divided by number of years in practice (a 35 year career sounds about right) times number of current rad oncs. Assuming 5000 rad oncs, this is 143 rad oncs leaving practice per year in the US. The dropout rate is about 2.9% therefore; the increase in rad oncs is about 200/5000 or 4% per year. (I believe that the dropout rate is decreasing due to longer careers, and of course the increase rate is increasing.)

Therefore America needs about 4250-5667 rad oncs. It is not foreseen to need more and more, especially if one is intellectually honest about hypofx and decreasing indications and what not. America is losing ~150 rad oncs per year due to retirement. It's gaining more than 200 per year through training. Math is brutal.

 
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You should see my consult notes.

For anyone who cares to think about this, it's an easy calculus in my opinion. The only variables are
1) number of new rad onc patients per year, and rate change thereof
2) number of presently needed rad oncs per year, and rate change thereof

Regarding #1, the incidence is steady or decreasing (see below). Let's assume it's steady, best case scenario. There are 1.7M new cancer cases per year; 50% of these will be rad onc patients, about 850K per year. If we assume on low end 150 new patients per rad onc per year, we need 5667 rad oncs in the US. About right! We need 4250 if we assume 200 new patients per year, maybe a more reasonable/depressing figure but whatever.

All this means that if #1 is steady, or falling, #2 needs to hold steady. It isn't of course. Impacting #2 is the length of time radiation oncologists stay in practice; you can calculate the annual dropout rate by taking one divided by number of years in practice (a 35 year career sounds about right) times number of current rad oncs. Assuming 5000 rad oncs, this is 143 rad oncs leaving practice per year in the US. The dropout rate is about 2.9% therefore; the increase in rad oncs is about 200/5000 or 4% per year. (I believe that the dropout rate is decreasing due to longer careers, and of course the increase rate is increasing.)

Therefore America needs about 4250-5667 rad oncs. It is not foreseen to need more and more, especially if one is intellectually honest about hypofx and decreasing indications and what not. America is losing ~150 rad oncs per year due to retirement. It's gaining more than 200 per year through training. Math is brutal.

This post above needs to be made more conspicuous for medical students. Not buried in the thread below the onslaught of comments.
 
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Oct 4, 2017
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thank you scarbtj. very conservative. How many of us would feel comfortable treating 150 pts per year all comers. Even 200 is low for most in private practice and would amount to less than 20 on treatment. Lastly, to your point of dropouts, still dont know anyone who has strait up retired, most go part time/locums etc. Will arrive at similar numbers with 100,000 population per linac. Lastly, I get the feeling that 50% cancer pts receiving radiation is also presently generous.
 
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Jul 30, 2018
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thank you scarbtj. very conservative. How many of us would feel comfortable treating 150 pts per year all comers. Even 200 is low for most in private practice and would amount to less than 20 on treatment. Lastly, to your point of dropouts, still dont know anyone who has strait up retired, most go part time/locums etc. Will arrive at similar numbers with 100,000 population per linac. Lastly, I get the feeling that 50% cancer pts receiving radiation is also presently generous.
I always thought it was more like 35%. The future will probably be more like 25%.