Jan 6, 2021
35
305
The single best, and likely only real way, to effectively close or reduce the number of rad onc slots at bad programs is through the ACGME survey. While we would all like to believe that chairs and program directors across the country will take the recent ASTRO statement to heart and voluntarily reduce residency slots (there are some programs who were/are planning to contract before the statement), the fact remains that opening residencies and expanding programs is the best way to get a smart, cheap labor for departments.

The annual ACGME survey is taken very seriously by all programs, as it should be. It is basically the only way to keep your residency accredited. It is truly anonymous and for those at small programs with one resident/year, the ACGME will aggregate the survey results across years, usually at least 4 years, in order to protect the anonymity of responses. The rest of the surveys and feedback you give your program is fluff. People will listen but if you want real change, you really just need a couple residents to answer the lowest score on every single question for a year for the ACGME and thus the program to take notice.

This is not just to help close down or reduce spots. But residents should have a great physics and rad bio course taught physics and rad bio faculty that care, an academic fund that covers ASTRO and other conferences + any educational material that is needed. If your program doesn't have that, the best way is to have the program be given a warning through the ACGME survey for related or un-related issues and ask for these things on top of improving the educational component of residency. It works beautifully and have seen it be very effective. Not only will rotations be re-structured, attendings start to care, etc but residents can finally get their poster, flight, hotel room reimbursed at ASTRO.

Having residents is a privilege and for attendings, having a resident SHOULD BE MORE WORK if that attending is doing it right. Why? Attendings should be reviewing every single contour, putting aside a few hours/week for didactics and reviewing key literature on top their normal clinical duties. This is not the standard and I've seen too many attendings just mail the teaching component in and use the resident to help start their clinic, cover CBCT/SBRTs, be the shield between the nurse and themselves, write notes, contour OARs, and pump out retrospective chart reviews that require zero attending input.

I am sick of how our field has taken advantage of residents so I want to empower residents to fight back in the only way that matters and protects the resident through anonymity. We need to get the word out to residents to start using the survey as a weapon and use it to put bad programs on notice. As far I understand it, the ACGME will issue a warning, then probation, and then as a final step, de-accredit a program. Time varies between each step but the goal is to put programs in the warning stage in order to force them to make changes to improve resident education.

Edit: To clarify my thoughts:
Goal: improve bad programs, if not, put them on the path to contracting and/or closing
How: through the ACGME survey which is truly anonymous - b/c most residencies are small, it only takes one or two residents to answer the lowest score on all the questions. what if the program is doing ok on some things but not others? the most effective thing i've seen is when all scores are trending down in the survey and a warning is issued to the program to improve. in reality, if a couple residents in most programs with ~10 or less residents did this for a couple years, the ACGME would tell the program to improve (may even issue a warning which is great for the residents in terms of getting actual changes), thus bringing the program to the table and actually listen to resident concerns. otherwise, most of the time, departments have very little incentive to improve or do anything that would cost them more $ (e.g. give residents larger academic funds or hire rad bio faculty and start a real rad bio course for residents)
Does it work?: yes, as medgator pointed out, this is how Cornell was shut down when it didn't improve and those residents still at Cornell landed at much better programs
 
Last edited:
  • Like
Reactions: 8 users

fiji128

Junior Member
15+ Year Member
Apr 28, 2005
473
1,225
Status (Visible)
I agree with above in that it should work that way.

I went to one of these hell pit programs where the residents were abused and attendings did as little as possible and never taught. Physics and Rad Bio were technically taught but it was up to you to actually learn the material yourself if you wanted to pass the boards. When I first arrived the residents were actively told to only give the program great reviews on the ACGME surrey's otherwise there would be retaliation. As the I progressed along in the program I always encouraged everyone to fill out these survey's truthfully. The survey numbers really tanked my PGY 4 year and the ACGME got involved. The ACGME never interviewed any of the residents and basically just gave the program a check list of things to do. Nothing really changed. If the ACGME cared to really evaluate the program there were red flags everywhere. It was/is a small program and the attendings did everything they could to retaliate against the residents that they believed were driving the numbers down. It kinda got really ugly for a while actually. My personal take away form the experience was the ACGME exist primarily to protect programs and will do everything they can to protect even terrible programs outside of the most egregious cases.

Maybe that has changed in the past several years.
 
  • Like
Reactions: 1 users
About the Ads
Jan 6, 2021
35
305
fiji128, that sounds terrible. I do believe it has changed.

Residents have so much power, they just don't realize it. Where I'm at, if residents (only takes one or two mediocre evaluations) give an attending a "meh" review, it can actually affect pay and promotion. It is taken very seriously. I love the residents I work with and sincerely desire attendings to truly take their educational duties as an almost sacred mission.

And the fact remains that even if your program was terrible, the effort they spent on making sure the ACGME survey was answered in certain ways is telling. The ACGME survey is really the only thing programs will listen to.

In regards to retaliation, the ACGME batches responses at small programs so it can't be attributed to individual residents. I hope your old program has improved and if not, soon will be closed down as residents truly begin to understand the power of the ACGME survey and use it.
 
  • Like
Reactions: 1 user

evilbooyaa

Staff member
Volunteer Staff
7+ Year Member
Oct 10, 2011
7,025
7,323
Status (Visible)
  1. Attending Physician
The issue is that for the residents present during a shutdown, life is stressful. Imagine being worried about where you were going to have to move to finish your residency if you were a resident in the shutdown of CPMC, Hahnemann, or Cornell. I think if current residents were less concerned about that they'd be more willing to blast a program on the survey.

That being said, I think most (if not all) of the residents from those 3 recently shut down programs ended up at reputable programs in the same city(?) so as long as their funding goes with them (which is a separate issue and a very valid concern) it maybe wouldn't be as big of an issue (unless one didn't have any other residency programs in the same city, in which case they would have to move).

I was taught by my PD and attendings that ACGME surveys were to be answered truthfully - but, if there was a concern, to bring it up to the PD first, and if it was not addressed appropriately, then the program had to deal with less than stellar survey results. Having an open door policy for the PD and a thoughtful group of attendings ensured that the survey results were good from most, if not all, the residents on a year to year basis, at least during my time in residency.
 
  • Like
Reactions: 1 users

ramsesthenice

7+ Year Member
Dec 2, 2011
907
1,276
Status (Visible)
  1. Attending Physician
Having residents is a privilege and for attendings, having a resident SHOULD BE MORE WORK if that attending is doing it right.
Money statement right here. I am far more efficient without residents (juniors at least) than I am with them. I go uncovered about 30% of the time and honestly it’s a nice break sometimes.

These discussions make me feel like the super wholesome home schooled kid that has no idea how the world works. I have to try to understand how residents are cheap labor. I guess if I blindly signed their notes and did literally no teaching or prepping on my own they might open up some more academic time for me but realistically the only thing they routinely save me time with is inpatient consults. More often than not I can complete an outpatient consult on my own in less time than it takes me to listen to a resident presentation and then go see the patient together, gather/confirm key data, and do patient education. Maybe I need to quit wasting time letting them struggle to come up with their own assessments and planning etc?
 
  • Like
Reactions: 4 users

elementaryschooleconomics

Sharp Dissector of the Avascular Plane
Nov 2, 2019
1,108
4,347
Money statement right here. I am far more efficient without residents (juniors at least) than I am with them. I go uncovered about 30% of the time and honestly it’s a nice break sometimes.

These discussions make me feel like the super wholesome home schooled kid that has no idea how the world works. I have to try to understand how residents are cheap labor. I guess if I blindly signed their notes and did literally no teaching or prepping on my own they might open up some more academic time for me but realistically the only thing they routinely save me time with is inpatient consults. More often than not I can complete an outpatient consult on my own in less time than it takes me to listen to a resident presentation and then go see the patient together, gather/confirm key data, and do patient education. Maybe I need to quit wasting time letting them struggle to come up with their own assessments and planning etc?
You are indeed super wholesome and sound like a great attending.

"Seeing a patient together"...what is that? Is that like, when you cross paths in the hallway because the resident has just spent 50 minutes with a single patient and 3 members of their family answering any and all questions and you've been impatiently sitting in your office so you eagerly make your way to the clinic after your resident sends you a text saying the patient is ready for you and then you spend 5 minutes in the room while the resident books the sim?

I often paint in unfairly broad strokes on SDN so I'll leave that "joke" there but...one day, I want to see these departments where attendings are invested in the training and education of the residents to a point where they're not even time-neutral but actually lose time with having resident coverage.
 
  • Like
Reactions: 4 users

fiji128

Junior Member
15+ Year Member
Apr 28, 2005
473
1,225
Status (Visible)
Residents are cheap labor when attendings don't teach, are not capable of seeing patient's by themselves and dictating a sensible note, can't contour, can't see inpatients, can't manage their own service and basically need 100% resident coverage to function. Yes, there are plenty of academic docs out there like this. In these places residents are viewed as a opportunity to be exploited and not as an obligation or privilege.

Ideally programs like these wouldn't exist. At least in the current environment US MDs can easily avoid them.
 
Last edited:
  • Like
Reactions: 1 users

RickyScott

2+ Year Member
Oct 4, 2017
2,125
3,375
Status (Visible)
  1. Attending Physician
Convinced that the real value of residents is to pump out trash research for faculty cvs and to lend prestige to program. If push came to shove, almost all programs would treat their residents like gold if it meant keeping the program, but where would that get you in terms of jobs?

Btw: noticed that Lou potters is head of scadrop. He needs the position and “prestige” and program to cover up for margunal academic achievement, when justifying 1.7 million dollar salary.
 
  • Like
Reactions: 1 user

fiji128

Junior Member
15+ Year Member
Apr 28, 2005
473
1,225
Status (Visible)
Convinced that the real value of residents is to pump out trash research for faculty cvs and to lend prestige to program. If push came to shove, almost all programs would treat their residents like gold if it meant keeping the program, but where would that get you in terms of jobs?

Btw: noticed that Lou potters is head of scadrop. He needs the position and “prestige” and program to cover up for margunal academic achievement, when justifying 1.7 million dollar salary.

Wow the guy that just Twitted programs need to embrace SOAP'ed in residents. Just shows you the total rot that exist at the top of this field.
 
  • Like
Reactions: 1 users
Jan 6, 2021
35
305
The issue is that for the residents present during a shutdown, life is stressful. Imagine being worried about where you were going to have to move to finish your residency if you were a resident in the shutdown of CPMC, Hahnemann, or Cornell. I think if current residents were less concerned about that they'd be more willing to blast a program on the survey.
That's a great point. That is very disruptive.

I am saying though that before it reaches that point, putting programs on the warning track will help institute changes quickly. There will be some outlier programs that just refuse to change and will eventually close (e.g. Cornell). For many programs, being put on warning will help the residents obtain a better education and much more likely to be protected from attendings who are looking to use residents simply for service/scut.
 

thecarbonionangle

5+ Year Member
Aug 23, 2014
1,987
3,038
Status (Visible)
  1. Attending Physician
Agree with the general sentiment. Residents at hellpit places need to and should answer honestly. What often happens in these places is that residents are scared and there is a lot of pressure to answer positively because you would not want to hurt your program. This is often indirect pressure, read in between the lines. The ACGME survey is one of only ways to shut places down or force change. Raising requirements significantly is another
 
Last edited:
  • Like
Reactions: 1 user

evilbooyaa

Staff member
Volunteer Staff
7+ Year Member
Oct 10, 2011
7,025
7,323
Status (Visible)
  1. Attending Physician
That's a great point. That is very disruptive.

I am saying though that before it reaches that point, putting programs on the warning track will help institute changes quickly. There will be some outlier programs that just refuse to change and will eventually close (e.g. Cornell). For many programs, being put on warning will help the residents obtain a better education and much more likely to be protected from attendings who are looking to use residents simply for service/scut.

I do wonder what the denominator of programs that have received warnings (usually unofficial ones) is, as we only think about the numerator that leads to programs that completely closed down.
 

fiji128

Junior Member
15+ Year Member
Apr 28, 2005
473
1,225
Status (Visible)
Part of what makes me believe that the acgme is there to protect programs at the end of the day and not the other way around, is that they do not release any information that would allow applicants to avoid questionable programs. They do not tell you the board pass rate, the number of cases logged, how often programs use the soap to match, what are at least their average acgme survey scores if even averaged over 4 years, how many residents don’t complete training at the program. They have all this information at their fingertips but do not want it available to applicants/residents, while applicants must release every detail about themselves.

Granted there are good programs who take all the acgme stuff seriously as well as their educational mission. But there are plenty of bottom barrel places that the acgme knows about but allows them to carry on. The acgme doesn’t even do regular on-site reviews anymore (edit: I looked it up they now do visits every 10 years). Frankly, it’s the epitome of medical culture to put the onus on residents to speak up and potentially put their futures on the line to basically do the acgme’s job of over seeing these programs.

I will note these comments aren’t specific to rad onc.
 
Last edited:
  • Like
Reactions: 6 users
About the Ads

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.