per taserlaser it seems a rather growing and frightening amount of Canadian grads have had to enter fellowships as the job market there has worsened. Their current metric is 115 pts/rad onc; ours is 105 and was 145 8y ago.
per taserlaser it seems a rather growing and frightening amount of Canadian grads have had to enter fellowships as the job market there has worsened. Their current metric is 115 pts/rad onc; ours is 105 and was 145 8y ago.
TBH you can't graduate med school and be a potential rad onc match and be "frighteningly stupid," but I'm a benefit of doubt kinda guy. So either the applicants are deliberately information-poor (some people are loathe to get info off the Internet and prefer their own real life info instead; high IQ people can tend to be an "I know best" crew) or have the info (SDN, the published literature, etc.) and deny it as irrational augury. Either way for now this is an unreachable and unteachable cohort. But there's apt to be a tipping point where even the real-life info is going to get non-ignorable.
I think a lot of it comes down to simple sunk cost fallacy.
it should be noted that these Canadian residents went to fellowship even as residency spots were reduced. only 20 graduating residents each year presently. it used to range from 25-30/year.
just flat out disgusting. At least canadians dont have large college and medical school debt.
The component that we care more about is the incidence of cancers that often involve xrt as part of treatment. Incidence of lung cancer going down and in 15 years boomer bubble will have passed. Lung cancer, like many other cancer spikes in early 60s epidemiologically. A lot of this also has to do with age demographics which is not addressed in these pieces.
Eye of the beholder? That’s denial. Sorry but it just is.
www.ncbi.nlm.nih.gov
proportionately within lung cancer that may be true. In terms of absolute numbers, lot less smokers proportionately within us today than in 80s when surgeons found it acceptable to smoke in the or.Its not clear that the incidence of lung cancer that involves xrt as part of treatment is going down. Proportion of pts with early stage disease is going up due to screening. Increased survival of stage IV pts is increasing pool of oligomet/palliative pts.
Trends in the incidence, treatment, and survival of patients with lung cancer in the last four decades - PubMed
In the past four decades, the lung cancer incidence increased initially and then gradually decreased. Surgical rate experienced a fluctuant reduction, while the chemotherapy rate was in upward trend. The 5-year relative survival rate increased with years, but was still low.
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Really disagree here regarding equivalency of potential impact on the field.
Very true. Also, again, we can walk AND chew gum.
Increased screening for a disease whose causative agent incidence is on a steady and significant downward trend will not re-float the boat. And while the incidence of XRT in lung CA is ~20% lower than 40y ago, but on an upswing, think of the incidence of XRT fractions in lung CA. That is on a huge downswing too.
From an epidemiological perspective this is confusing. Why? If you look several decades ago, "most" post-menopausal females were on HRT. And then almost overnight they weren't. And then you'd read news reports claiming breast cancer rates dropped dramatically because women quit HRT. And, now, we say women's cancer rates have been stable. We're still harping on HRT risks (although perhaps estrogen by itself lowers breast cancer risk). Guess that's why I'm not an epidemiologist.
I yet once more think: math. On the whole the "high-tech" SRS and SBRT treatments reimburse less than their high-fraction, non-stereotactic alternatives from 10+ y ago. For example, a lung SBRT reimburses half what a 7-week IMRT/IGRT regimen would (I was doing 80.5 Gy/35 fx w/ IMRT prior to SBRT for Stage I). And SRS? Which is now preferred often in lieu of WBRT? A 3D 10 fx WBRT course reimburses almost triple what SRS can. In America, increased use of SRS for brain and SBRT for lung must mean decreased rad onc reimbursement. (Academic centers will play a different game, I imagine, than the numbers you see below to which the non-academic physicians will be beholden; however, again, the deltas are so big in some instances I'm not sure "billing creativity" can make up the difference.)These are good points, use of SRS for brain mets is certainly increasing
Radiosurgery for Brain Metastases: Changing Practice Patterns and Disparities in the United States
Background: Management of brain metastases typically includes radiotherapy (RT) with conventional fractionation and/or stereotactic radiosurgery (SRS). However, optimal indications and practice patterns for SRS remain unclear. We sought to evaluate national practice patterns for patients with...jnccn.org
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