Rad Onc Job Market, Supreme Court, and Hyper-Polarization of America

[Gfunk6]

This thread has a good chance of spinning off topic and getting locked, so I will try as hard as I can to keep it laser focused on Rad Onc and not delve into murky political waters. It is a fact that there is a maldistribution of Radiation Oncologists - I don't think anyone would contest that. The highest demand areas, statistically are the large urban metro regions scattered throughout the country. Statistically, the sizable majority of these "desirable" places tend to be blue. However, there is a push to try and convince Rad Oncs to settle and practice in more underserved areas, the sizable majority of which tend to be red.

Assuming that the Supreme Court invalidates Roe v. Wade and leaves it up to the states to decide and also assuming that other comparable events happen (e.g. gay marriage and associated precedents overturned) *and* that there is no political will/majority to codify these to laws by a hyper-polarized Congress -- what happens to Rad Onc?

Will this only serve to exacerbate the current maldistribution? My view is yes as I would assume (without evidence) that most well-educated people tend to skew liberal on social policies.

Discuss.

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[Ray D. Ayshun]

This thread has a good chance of spinning off topic and getting locked, so I will try as hard as I can to keep it laser focused on Rad Onc and not delve into murky political waters. It is a fact that there is a maldistribution of Radiation Oncologists - I don't think anyone would contest that. The highest demand areas, statistically are the large urban metro regions scattered throughout the country. Statistically, the sizable majority of these "desirable" places tend to be blue. However, there is a push to try and convince Rad Oncs to settle and practice in more underserved areas, the sizable majority of which tend to be red.

Assuming that the Supreme Court invalidates Roe v. Wade and leaves it up to the states to decide and also assuming that other comparable events happen (e.g. gay marriage and associated precedents overturned) *and* that there is no political will/majority to codify these to laws by a hyper-polarized Congress -- what happens to Rad Onc?

Will this only serve to exacerbate the current maldistribution? My view is yes as I would assume (without evidence) that most well-educated people tend to skew liberal on social policies.

Discuss.

Was just thinking about this this morning given the reasons you outlined. I practice in a red area, and to some degree live in a red area, but also only 30 mins from a blue city. I'm good with the stability right now, but would be even less inclined to start here in today's America.

 

[ROforbetterorworse]

The grads 5 years from now.....will not be a pretty sight

 

[deleted1111261]

I’ve been saying this (as have others). We have a class of super liberal young docs with views that don’t really align with the values of the middle American regions where we need doctors. It is one thing to be one hour from a metro in a Red area, it’s another to be 6 hours away.

With the oversupply issue, this is definitely going to be interesting. I once tweeted at a UCLA attending talking about these types of jobs, and I asked if he’d be willing to switch with one of the rural docs and let that doc take his job. I didn’t get a response. The hypocrisy from ultra liberal academics about this stuff is so racked with cognitive dissonance.

 

[Ray D. Ayshun]

You really don't have to be ultra-liberal to hate what's going on.

 

[RO28]

Yes, will 100% exacerbate the problem. I will never leave my bubble.

 

[Chartreuse Wombat]

This thread has a good chance of spinning off topic and getting locked, so I will try as hard as I can to keep it laser focused on Rad Onc and not delve into murky political waters. It is a fact that there is a maldistribution of Radiation Oncologists - I don't think anyone would contest that. The highest demand areas, statistically are the large urban metro regions scattered throughout the country. Statistically, the sizable majority of these "desirable" places tend to be blue. However, there is a push to try and convince Rad Oncs to settle and practice in more underserved areas, the sizable majority of which tend to be red.

Assuming that the Supreme Court invalidates Roe v. Wade and leaves it up to the states to decide and also assuming that other comparable events happen (e.g. gay marriage and associated precedents overturned) *and* that there is no political will/majority to codify these to laws by a hyper-polarized Congress -- what happens to Rad Onc?

Will this only serve to exacerbate the current maldistribution? My view is yes as I would assume (without evidence) that most well-educated people tend to skew liberal on social policies.

Discuss.

If you read the draft Alito makes it very clear that he is talking about abortion and only abortion.

Same sex marriage is not on the radar; this is made explicit in the draft.

I wonder whether a liberal or conservative leaked this. Ruth Marcus makes the case for a conservative leak.

https://www.washingtonpost.com/opinions/2022/05/03/alito-roe-leaked-draft-disaster-for-supreme-court/

I doubt this will influence RadOnc but there is no question that our politics is broken.

 

[RickyScott]

Most radoncs are democrats and even the ones who are republican tend to be pro choice.

 

[Chartreuse Wombat]

Most radoncs are democrats and even the ones who are republican tend to be pro choice.

Data? Reference? Not disputing the assertion just keen to see support for the statement.

 

[thecarbonionangle]

The sudden thirst for minorities as in hispanics, AA et al, is really quite astounding. We all remember not so long ago when the only minority which seemed to matter to “leaders” were basically being a woman, often a white woman from a privileged background per my observations. If you were pretty easy on the eye even better folks! Racial minorities were routinely overlooked. Not once did i ever hear a chairman say “we would love to have more racial minorities”. It was almost always that they wanted A woman, among the many binders filled with them. A cursory look at the alumni list of many top programs reveals this large discrepancy of opportunity. Many of these programs have not had a racial minority ever recently or only very recently, a token.
If you are a racial minority ask yourself if you think you would enjoy living “only four hours” away from a major metro, away from anybody with your background, language, religion, culture. There are not enough jobs for everyone in major metros. Academic satellites have kept the job market afloat but you eventually run out of other people’s money as my friends on the other side like to note! There simply ain’t enough jobs for everyone. The people that stand to suffer are these racial minorities now. Enjoy the maga crowd as you did not listen to any of our warnings. Hellpits will continue to hellpit and suck you in, leading you to a job market with declining opportunities. All SOAP spots filled and they took anybody with a pulse, rejects from other specialties with no RO rotation or clear interest.

Declining fools who are “leaders” now wanting and shilling for minorities on twitter are once again failing them. You did not want them back then and they simply don’t f$$$$$$ want you now. Maybe build a time machine and pull your head out of your arse! The breadlines are here for all, the great equalizer.

 

[RickyScott]

Data? Reference? Not disputing the assertion just keen to see support for the statement.

It’s partly anecdotal but I thought there was a red journal article showing vast majority of political donations from radoncs went to democratic candidates.

 

[RickyScott]

The sudden thirst for minorities as in hispanics, AA et al, is really quite astounding. We all remember not so long ago when the only minority which seemed to matter to “leaders” were basically being a woman, often a white woman from a privileged background per my observations. If you were pretty easy on the eye even better folks! Racial minorities were routinely overlooked. Not once did i ever hear a chairman say “we would love to have more racial minorities”. It was almost always that they wanted A woman, among the many binders filled with them. A cursory look at the alumni list of many top programs reveals this large discrepancy of opportunity. Many of these programs have not had a racial minority ever recently or only very recently, a token.
If you are a racial minority ask yourself if you think you would enjoy living “only four hours” away from a major metro, away from anybody with your background, language, religion, culture. There are not enough jobs for everyone in major metros. Academic satellites have kept the job market afloat but you eventually run out of other people’s money as my friends on the other side like to note!. There simply ain’t enough for everyone. The people that stand to suffer are these racial minorities now. Enjoy the maga crowd as you did not listen to any of our warnings.

Declining fools who are “leaders” now wanting and shilling for minorities are once again failing them. You did not want them back then and they simply don’t f$$$$$$ want you now. Maybe build a time machine and pull your head out of your arse! The breadlines are here for all.

Urm and their stay at home spouses will love maga country?

 

[thecarbonionangle]

Urm and their stay at home spouses will love maga country?

They will feel right at home, our “leaders” have their interests at heart!

 

[RickyScott]

They will feel right at home, our “leaders” have their interests at heart!

Especially the women who curie.

 

[Chartreuse Wombat]

It’s partly anecdotal but I thought there was a red journal article showing vast majority of political donations from radoncs went to democratic candidates.

OpenSecrets website

ASTROPAC

Looks like some of the change is related to the majority party at the time of the donation.

 

[jondunn]

If you read the draft Alito makes it very clear that he is talking about abortion and only abortion.

his legal arguments can be used to justify applying to a lot more than just abortion. there is zero reason to believe this just applies to abortion, if you believe what Alito writes.

 

[deleted1111261]

his legal arguments can be used to justify applying to a lot more than just abortion. there is zero reason to believe this just applies to abortion, if you believe what Alito writes.

I think he literally says “this only applies to abortion, JonDunn”

 

[RickyScott]

his legal arguments can be used to justify applying to a lot more than just abortion. there is zero reason to believe this just applies to abortion, if you believe what Alito writes.

What bothered me most was statement that rvw was based on weak reasoning. Implies that 50 years of Supreme Court justices are stupid and don’t have his level of intellect.

 

[Lamount]

At the risk of (always) being the naive optimist… I don’t think our polarization will forever deepen. It’s easy to assume that things will continue as they have recently, but the first derivative only gets you so far. Either we will eventually ease back towards civility, or careen into a civil war… and the former seems far more realistic.


Regarding this SCOTUS leak… if it’s true, I don’t think it is going to go the way conservatives imagine. If Roe v Wade is overturned, I predict ultra-conservative states trying to one-up each other to make the most draconian and callous law, until they go too far and earn the ire of the majority of Americans who are some degree of pro-choice… Maybe this all ends in a national law

 

[Chartreuse Wombat]

his legal arguments can be used to justify applying to a lot more than just abortion. there is zero reason to believe this just applies to abortion, if you believe what Alito writes.

Did you read the draft?

“We emphasize that our decision concerns the constitutional right to abortion and no other right,” Alito writes. “Nothing in this opinion should be understood to cast doubt on precedents that do not concern abortion.”

 

[jondunn]

I think he literally says “this only applies to abortion, JonDunn”

yes but the legal argument he is using does not make sense for it to only apply to abortion, RealSimulD

 

[TheWallnerus]

Most radoncs are democrats and even the ones who are republican tend to be pro choice.

Radoncs pre-2000 were pretty Republican (no data!). But I guess as the bar graph shows above things did change!

 

[jondunn]

Did you read the draft?

“We emphasize that our decision concerns the constitutional right to abortion and no other right,” Alito writes. “Nothing in this opinion should be understood to cast doubt on precedents that do not concern abortion.”

can you explain why legally it should only apply to abortion and not other issues?

Sure I am reassured he says that, but I don't take it for much, as this is now legal precedent, if it goes through. Can easily be applied to anything else that wasnt strictly protected in the constitution.

some of the justices who wrote the majority opinion also said that Roe v Wade was already a settled issue and ESTABLISHED PRECEDENT!, under oath, so excuse me if I don't take the words of the judges as far as I can throw them

 

[Ray D. Ayshun]

Does outlawing abortion mean we can't do 5 fx breast?

 

[Chartreuse Wombat]

yes but the legal argument he is using does not make sense for it to only apply to abortion, RealSimulD

Incorrect. He singles out abortion because (in his mind) there are two lives involved.

 

[TheWallnerus]

Does outlawing abortion mean we can't do 5 fx breast?

Only if a woman wants 5 fx breast. Then we must deny it.

 

[jondunn]

Incorrect. He singles out abortion because (in his mind) there are two lives involved.

I belive you believe this, but yeah, doesn't mean jack.

I think you should read about legal precedent.

 

[jondunn]

'Alito’s word means absolutely nothing.'

Alito’s Plan to Repeal the 20th Century

If the conservative justice’s draft opinion is adopted by the Court, key advances of the past hundred years could be rolled back.

www.theatlantic.com

 

[Chartreuse Wombat]

I belive you believe this, but yeah, doesn't mean jack.

I think you should read about legal precedent.

I have not indicated my belief and your assertion is incorrect.

Google Dred Scott is you want to know about legal precedent.

FWIW think that the Court will decide narrowly 5-4. Roberts will convince one of the Trump appointees to change their vote in the best interest of the institution

 

[deleted1111261]

Remember, everyone, only one person can be right here and they will tell you what to read and believe

 

[Chartreuse Wombat]

'Alito’s word means absolutely nothing.'

Alito’s Plan to Repeal the 20th Century

If the conservative justice’s draft opinion is adopted by the Court, key advances of the past hundred years could be rolled back.

www.theatlantic.com

Hard to argue against non-believers

 

[jondunn]

Remember, everyone, only one person can be right here and they will tell you what to read and believe

I mean rather than petty posts like this, maybe you can actually engage with the actual topic at hand?

1) The majority opinion is that abortion is not protected in the constitution, thus Roe V Wade must be overruled

By this logic and precedent, many other rights not guaranteed by the constitution can be curtailed. You're really satisfied by Alito saying 'don't worry guys, we are only looking at abortion'? (for now)

cool.

 

[thecarbonionangle]

“Banning” something does not get rid of it, it only eliminates safe access to it. The rich folks are still going to travel and quietly have their procedures. It is the economically disadvantaged folk who will suffer. Very sad!

 

[deleted1111261]

No. I just think presuming you’re right and others are wrong on a case that hasn’t been decided yet and acting like you have a law degree or have interned for a judge. The difference is, most of us here have humility and curiosity and don’t resort to “if you don’t agree with me, go read a book”. @Chartreuse Wombat is not a dummy. I’m not a dummy.

Justices are political animals. This is fact. This they will behave like politicians (lie, misrepresent themselves to congress, decide in ways that are incoherent to their actual values). What surprises anyone that lives in America about this?

 

[Mandelin Rain]

Cottage industry of "'bortion by beam"?

 

[deleted1111261]

I belive you believe this, but yeah, doesn't mean jack.

I think you should read about legal precedent.

Like how condescending is this?

“I think you should read about legal precedent”

Just because you were raised without manners doesn’t mean the rest of us have to be pleased with the way you speak to others.

 

[jondunn]

No. I just think presuming you’re right and others are wrong on a case that hasn’t been decided yet and acting like you have a law degree or have interned for a judge. The difference is, most of us here have humility and curiosity and don’t resort to “if you don’t agree with me, go read a book”.

you said Alito said it only applies to abortion, jondunn.

I explained why Alito's argument/statement shouldn't be reassuring, posted one article, can post many others. It seems like wombat is the outlier. but that's enough.

 

[jondunn]

Like how condescending is this?

“I think you should read about legal precedent”

Just because you were raised without manners doesn’t mean the rest of us have to be pleased with the way you speak to others.

My friend, I am quite literally replying to him where he says 'incorrect'. if he wants to throw that around, then yes, I will say I believe you should read about legal precedent.

I know I live rent free in your head, but this is getting incredibly exhausting dude. jesus.

 

[deleted1111261]

My friend, I am quite literally replying to him where he says 'incorrect'. if he wants to throw that around, then yes, I will say I believe you should read about legal precedent.

I know I live rent free in your head, but this is getting incredibly exhausting dude. jesus.

😊 😊

I have sooooo much real estate in my head I’m giving it away for free. Hope you and the rest of the crew living up here get along and don’t destroy any property.

@Chartreuse Wombat - we are so lucky to have learned about precedent here on this forum. Forget ScotusBlog! JD at SDN droppin the law knowledge.

 

[Mandelin Rain]

Our conservative representatives and their appointees are far more conservative than their electorate in many/most cases.

This is becoming an issue.

 

[Chartreuse Wombat]

To repeat. The issue has not been decided and I expect that Roe will not be overturned. Of course I don't know this but I do know that judges change their minds. What is new here is the leak itself.

The problem with stating that you don't believe something that someone wrote is that dialogue/argument becomes impossible.

“He who knows only his own side of the case knows little of that. His reasons may be good, and no one may have been able to refute them. But if he is equally unable to refute the reasons on the opposite side, if he does not so much as know what they are, he has no ground for preferring either opinion... Nor is it enough that he should hear the opinions of adversaries from his own teachers, presented as they state them, and accompanied by what they offer as refutations. He must be able to hear them from persons who actually believe them...he must know them in their most plausible and persuasive form.”​

― John Stuart Mill, On Liberty

 

[jondunn]

To repeat. The issue has not been decided and I expect that Roe will not be overturned. Of course I don't know this but I do know that judges change their minds. What is new here is the leak itself.

I agree with this. it is not decided, and the leak may have been done to prevent it from actually going down.

to the other point - like I said I am reassured that Alito said that (better than nothing) but:

1) if we believed judges, multiple of the majority opinion said under oath that roe v wade was a settled issue. Why did they change their minds? Who is to say that Alito et al don't change their minds about this applying to more than abortion?

2) more importantly to me, what stops a future court from using the same argument (Assuming this does go through and Roe is overturned) from going after another right not protected by the constitution specifically? Genuinely asking!

 

[jondunn]

we are so lucky to have learned about precedent here on this forum. Forget ScotusBlog! JD at SDN droppin the law knowledge.

definitely not a legal expert or anything close to it. just been reading from non-political legal experts online since last night, and there seems to be genuine agreement that just because Alito says he only wants it to apply to abortion doesn't mean that this is the end of this nor that a future court couldn't later on use this as precedent.

im not just making stuff up for the lulz.

 

[medgator]

If you read the draft Alito makes it very clear that he is talking about abortion and only abortion.

Same sex marriage is not on the radar; this is made explicit in the draft.

I wonder whether a liberal or conservative leaked this. Ruth Marcus makes the case for a conservative leak.

https://www.washingtonpost.com/opinions/2022/05/03/alito-roe-leaked-draft-disaster-for-supreme-court/

I doubt this will influence RadOnc but there is no question that our politics is broken.

There's no reason it couldn't go down a slippery slope.

None

 

[medgator]

Our conservative representatives and their appointees are far more conservative than their electorate in many/most cases.

This is becoming an issue.

Tyranny of the minority.... 45 never won the pop vote, stole a couple of SCOTUS seats with Mitch and essentially will invalidate 50 years of precedent and ignore that polling shows nearly 70% of the country supports abortion. Personally a fan of the bill Clinton take on it, myself.

This SCOTUS will only serve to debase its legitimacy and image further and further polarize red and blue states

 

[thecarbonionangle]

T

Tyranny of the minority.... 45 never won the pop vote, stole a couple of SCOTUS seats with Mitch and essentially will invalidate 50 years of precedent and ignore that polling shows nearly 70% of the country supports a abortion. Personally a fan of the bill Clinton take on it, myself

This has always been the best take. It should be rare but safe and available!

 

[Chartreuse Wombat]

I agree with this. it is not decided, and the leak may have been done to prevent it from actually going down.

to the other point - like I said I am reassured that Alito said that (better than nothing) but:

1) if we believed judges, multiple of the majority opinion said under oath that roe v wade was a settled issue. Why did they change their minds? Who is to say that Alito et al don't change their minds about this applying to more than abortion?

2) more importantly to me, what stops a future court from using the same argument (Assuming this does go through and Roe is overturned) from going after another right not protected by the constitution specifically? Genuinely asking!

With respect.

I think that the Trump appointees each said something to the effect

“I accept the law of the land, senator, yes.” That is Gorsuch responding to Senator Durbin.

Logically this is just a tautology. At the time the question was asked it is absolutely true that Roe v Wade stood.

What the Justices did not answer was "Would you consider overturning Roe v Wade?" Of course the Senators tried to ask this but many nominated justices (on both sides) have invoked the "Ginsburg rule".

"A judge sworn to decide impartially can offer no forecasts, no hints for that would show not only disregard for the specifics of the particular case, it would display disdain for the entire judicial process." -RBG

Of course a number of outlets criticized the invocation of the "Ginsburg rule"; most recently with ACB

Example below

Amy Coney Barrett avoided answering questions from senators by citing the 'Ginsburg rule,' but legal scholars say it's not a valid excuse

The truth is that Ginsburg directly answered a number of questions on hotbed topics during her confirmation hearings 27 years ago.

www.businessinsider.com

As Simul has pointed out this is all politics. The Supreme Court is and always has been a political entity. The Berger court was possible because of large Democratic majorities in all other parts of government. The leak makes this impossible to ignore. Roberts has a big job to put the pieces together again

The US system has been remarkably resilient. (after all it survived Trump). I am hopeful that the poster above was right that this will burn out.

 

[udrag14]

There's no reason it couldn't go down a slippery slope.

None

This paragraph is so awful. It basically invalidate years of SCOTUS precedent. Talk about judicial activism.

 

[deleted1111261]

The leak is the story. Why would a 6-3 court decide any other way for this? The entire goal of the Federalist society since the early 1980s was for this outcome.

I am curious about the leak. Lib? Right wing hack? There are many theories!

 

[jondunn]

There are plausible reasons to believe the leak came from either side to be honest. Will be interesting to see if we ever find out.

I have to push back - the leak is certainly interesting but I fundamentally disagree that it is THE story here as compared to the potential undoing of a major 50 year precedent and all of the ramifications of this for the current and future of politics and this country. There have been other leaks

In the history books, the leak is a footnote, unless this ends up being overturned