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It absolutely would help in the case of a mediocre dosimetrist. Could turn a mediocre dosimetrist into a very good one
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won't improvements in portal dosimetry affect the need for physicists?
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Conn Seannery
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Dosimetry has done a very good job in limiting their supply. The "AI will make dosimetry obsolete" argument is not something that will happen in the short term. People say AI will make radiologists obsolete as well - but it won't happen. I do think that the demand for dosimetrists will decrease over time, but the supply pipeline has been narrowed enough to compensate for that. Robert Adams at UNC published quite a bit about this.
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wtf........
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Steps to publish in Red Journal:
- Grab toilet paper
- Wipe the non-hair bearing (and some hair bearing areas, if you'd like
) areas of the anal margin - Submit to: Editorial Manager®
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At least I got a blink182 meme outta thisView attachment 335691
Steps to publish in Red Journal:
- Grab toilet paper
- Wipe the non-hair bearing (and some hair bearing areas, if you'd like
- Submit to: Editorial Manager®
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The IJROBP shall henceforth be referred to as the "Red Urinal"
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Forgot to direct your comment to @sueyom
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Wow... Lisa K knows something about lung cancer or radbio? A biology paper with Lisa K as a co-author should definitely make us wonder what her author contribution was...
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She's an expert in a very important subcategory of radiation biology - failing residents in it
You left something out...View attachment 335691
Steps to publish in Red Journal:
- Grab toilet paper
- Wipe the non-hair bearing (and some hair bearing areas, if you'd like
- Submit to: Editorial Manager®
4) Attach a c-note (ok, fine, $75) to your detritus...THEN AND ONLY THEN can you click submit...
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This paper does validate the importance of knowing radbio...
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If I recall correctly, according to her, comments like this is referred to as 'cyberbullying.'
As part of c/o 2019, I felt this comment in my soul. That was a terrible year in rad onc education, and one of the main reasons why I urge interested medical students to not pursue rad onc. As hard working and smart as one may be, those in power and in charge of education/certification, like Lisa Kachnic and Paul Wallner, do not give a
about you. They will squander all your talents into the toilet...alongside your rejected RJ manuscript, in proper toilet paper formatting, in favor of the crap that LK co-authors.
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Also senior author on hippocampal avoidance. You think she contours that often?
ROforbetterorworse
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Maybe we should all network better
JK we all know it’s all NRG/RTOG BS politics
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“I know how to contour one end so i can contour the other end from 0529 to 0539!!!”Maybe we should all network better
JK we all know it’s all NRG/RTOG BS politics
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0539 was actually helpful in my estimation. 0529 had a weird ass boosting scheme, literally.
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Everyone’s favorite Louis “Two Mil Lou” Potters is just tickled with joy at the response from ACGME from his extremely moderate requests sent on behalf of SCAROP.
However, Dr. Vapiwala and company at ACGME suggest perhaps SCAROP should get their own house in order:
“Therefore, it would seem that the most appropriate forum for further discussions specifically on rotation quality (e.g. with respect to faculty FTE allotment and educational roles, allocation of elective/research time), and on program growth and diversity (e.g. with regard to geographic distribution, residency program complement size, and population density), would be SCAROP.”
TL;DR: no one is going to fix this mess.
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This is basically the RC saying "well we did some stuff already, and it's not our responsibility anyways, it's actually up to SCAROP". They're maybe going to do a tiny little bit with site specific minimums (which is a long time coming), but the fact that they think requiring 15 IC procedures, 10 of which have to be tandem based, is "increasing requirements" sufficiently enough smacks of "well we gave it a solid try lads, sorry it didn't work!"
I do not have any faith in the RRC to take anything close tot he radical steps necessary in terms of increasing requirements to the point of actually requiring programs to contract.
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So US medical students will continue to move away from the field and spots will go unmatched leaving it up to individual programs to SOAP or not. We already have early data showing they won't do the right thing, especially the worst programs.
Rinse and repeat. Nothing to see here.
Rinse and repeat. Nothing to see here.
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I'll do it. Pick me!
The "leaders" get into positions like this by not rocking the boat though.
Because they just want to please their boss
who wants to please his boss
who wants to please his boss
who wants to please his boss
who wants to please his boss
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The human centipede of rad onc
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Watch “The Peter Principle”
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This is at least part of the root of the problem:
"ACGME-accredited radiation oncology residency training programs are reviewed annually (at a minimum) by the RC, which is comprised of volunteer radiation oncologists nominated by the American Board of Radiology, the American College of Radiology, and the American Medical Association’s Council on Medical Education, in addition to a resident member and a nonphysician public member. Beginning this year, the American Society for Radiation Oncology (ASTRO) is now also a nominating organization to the RC. All RC members undergo an extensive nomination, application, and selection process; the RC Chair and Vice Chair are internally nominated and elected positions."
ie the people making these decisions are all entirely from the same ivy tower pedigree/academic club and they only allow other members of the same club to sit on this committee. This has been a well documented issue in rad onc and it is on full display here.
"ACGME-accredited radiation oncology residency training programs are reviewed annually (at a minimum) by the RC, which is comprised of volunteer radiation oncologists nominated by the American Board of Radiology, the American College of Radiology, and the American Medical Association’s Council on Medical Education, in addition to a resident member and a nonphysician public member. Beginning this year, the American Society for Radiation Oncology (ASTRO) is now also a nominating organization to the RC. All RC members undergo an extensive nomination, application, and selection process; the RC Chair and Vice Chair are internally nominated and elected positions."
ie the people making these decisions are all entirely from the same ivy tower pedigree/academic club and they only allow other members of the same club to sit on this committee. This has been a well documented issue in rad onc and it is on full display here.
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1) "As part of our proposed revisions, we recommend that three or more of the following ACGME-accredited residency and/or fellowship training programs be active at the Sponsoring Institution and be directly involved in radiation oncology residency training at the primary clinical site: complex general surgical oncology; gynecologic oncology; hematology and medical oncology; hospice and palliative medicine; interventional radiology; micrographic surgery and dermatologic oncology; musculoskeletal oncology; neurological surgery; otolaryngology - head and neck surgery; pediatric hematology/oncology, thoracic surgery; and urology." ----- It's crazy that any program with a residency shouldn't have all of these. How is the standard pic 3 of 11. That's just sad.
2) "To improve upon the current 51%, the RC is already considering a threshold of 60% for a program with a single main site, or higher threshold for a program with two main clinical sites, with a grace period for affected programs to adjust their clinical rotations in order to meet the new threshold(s)." ------- Ok 51% of time rotating to main site will now be 60%. That's probably immaterial.
3) Basically main site needs someone who is employed in cancer biology to teach rad bio and "must include at least one full-time medical physicist (PhD level or equivalent)." ----- That's a shockingly low standard.
4) "The RC believes any rotation where there is a combination of coverage that exceeds 1.0 clinical FTE equivalent physician should have a clear rationale of why this is in the best interest of resident education, and have a mechanism to prevent excessive clinical work, such as use of an advanced practice provider." Also included under #4 "to the extent that we receive accurate program information and honest survey responses, the ACGME has zero tolerance for violations of this policy." ----- So no resident double coverage. It makes sense to include that. ----- Programs cheat all the time. Probably makes sense to do routine in person audits of some of the more troublesome institutions rather put blind faith into the accuracy of semi anonymous surveys, where it is easy for faculty to relate for resident criticism. I know from my own personal experience that this happens.
5) "The RC fully agrees that brachytherapy is an important component of resident education, and the above-mentioned proposed focused revisions to the Program Requirements include recently modified clinical case minimums to reflect the RC’s assessment of this importance." ----- No one would feel comfortable sending their patients for brachy to a doc who's experience is meeting these almost useless minimum numbers. Why not require something more substantive maybe with input from the ABS?
6) "We agree and have already publicly shared the first step of our initiative last July, when our RC introduced recommended minimums for non-metastatic cases involving select adult disease sites. Data from this recent effort are being used to inform the development of new case log requirements forthcoming as proposed focused revisions of the Program Requirements, with sufficient time for stakeholder engagement prior to official activation." ----- It makes sense to have site specific case minimums.
7) Basically RRC can't take the geographic location of a program into consideration.
8) Programs are required to have 36 months of clinical rotations and can do whatever with the other 12 months. "The remaining 12 months may be spent performing such activities as taking elective rotations, performing research, pursuing an advanced degree, or taking other clinical rotations."
9) "We agree with the addition of resources allowing for the “capability for SBRT/SRS with motion management, image fusion capabilities with PET and MRI scans, IV contrast for CT-simulation, and HDR interstitial and intracavitary brachytherapy.” The RC will include this addition in the proposed focused revisions of the Program Requirements." ----- Wow another shockingly low standard.
10) "Similar to item #2 above, we recognize the vital role the primary clinical site plays in providing a robust clinical and academic environment. The RC will discuss the appropriate clinical volume at the primary clinical site to support approval of a complement increase, commensurate with time spent there, among other measures."
And lastly, "It appears that the SCAROP Executive Committee is particularly concerned with a potential oversupply of radiation oncology residents, and with the distribution of residents (e.g. a large proportion being trained at a limited number of large programs). As mentioned above, neither of these issues are within the authority of the ACGME."
2) "To improve upon the current 51%, the RC is already considering a threshold of 60% for a program with a single main site, or higher threshold for a program with two main clinical sites, with a grace period for affected programs to adjust their clinical rotations in order to meet the new threshold(s)." ------- Ok 51% of time rotating to main site will now be 60%. That's probably immaterial.
3) Basically main site needs someone who is employed in cancer biology to teach rad bio and "must include at least one full-time medical physicist (PhD level or equivalent)." ----- That's a shockingly low standard.
4) "The RC believes any rotation where there is a combination of coverage that exceeds 1.0 clinical FTE equivalent physician should have a clear rationale of why this is in the best interest of resident education, and have a mechanism to prevent excessive clinical work, such as use of an advanced practice provider." Also included under #4 "to the extent that we receive accurate program information and honest survey responses, the ACGME has zero tolerance for violations of this policy." ----- So no resident double coverage. It makes sense to include that. ----- Programs cheat all the time. Probably makes sense to do routine in person audits of some of the more troublesome institutions rather put blind faith into the accuracy of semi anonymous surveys, where it is easy for faculty to relate for resident criticism. I know from my own personal experience that this happens.
5) "The RC fully agrees that brachytherapy is an important component of resident education, and the above-mentioned proposed focused revisions to the Program Requirements include recently modified clinical case minimums to reflect the RC’s assessment of this importance." ----- No one would feel comfortable sending their patients for brachy to a doc who's experience is meeting these almost useless minimum numbers. Why not require something more substantive maybe with input from the ABS?
6) "We agree and have already publicly shared the first step of our initiative last July, when our RC introduced recommended minimums for non-metastatic cases involving select adult disease sites. Data from this recent effort are being used to inform the development of new case log requirements forthcoming as proposed focused revisions of the Program Requirements, with sufficient time for stakeholder engagement prior to official activation." ----- It makes sense to have site specific case minimums.
7) Basically RRC can't take the geographic location of a program into consideration.
8) Programs are required to have 36 months of clinical rotations and can do whatever with the other 12 months. "The remaining 12 months may be spent performing such activities as taking elective rotations, performing research, pursuing an advanced degree, or taking other clinical rotations."
9) "We agree with the addition of resources allowing for the “capability for SBRT/SRS with motion management, image fusion capabilities with PET and MRI scans, IV contrast for CT-simulation, and HDR interstitial and intracavitary brachytherapy.” The RC will include this addition in the proposed focused revisions of the Program Requirements." ----- Wow another shockingly low standard.
10) "Similar to item #2 above, we recognize the vital role the primary clinical site plays in providing a robust clinical and academic environment. The RC will discuss the appropriate clinical volume at the primary clinical site to support approval of a complement increase, commensurate with time spent there, among other measures."
And lastly, "It appears that the SCAROP Executive Committee is particularly concerned with a potential oversupply of radiation oncology residents, and with the distribution of residents (e.g. a large proportion being trained at a limited number of large programs). As mentioned above, neither of these issues are within the authority of the ACGME."
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I think there was some hope that the RRC could be used to raise program/training standards. This will be even more important in the future as programs match/Soap in very marginal candidates some with no prior interest in oncology. Raising standards could even indirectly decrease the number of residents being trained as some low quality training programs fail to meet them. However, it seems there is basically no interest in that amongst our august "leadership."
The current mechanisms insure there can never be any sort of market forces at play regarding the number of people we are training.
The future of the specialty remains dim.
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People in leadership are not not going to tighten requirements significantly to reduce numbers of residents. They all want to keep their expansions. Does Emory, duke really need to expand? Nope but they did. Other offenders on this list like hellpit Columbia.
i would also add an OMFS service at main site. You would be surprised how many places do not have this and this slows down care of head and neck patients.
Aggressive no knock audits of bad programs needs to start. Everyone knows who and where they are. The limits of the ACGME survey and the pressure many places put on residents to respond favorably cannot be ignored. Institutional GMEs are a ruse to protect the bottomline and in cahoots with PD, often leads to retribution. Anybody familar with the process knows this to be true.
things like breath hold and ability to do gating should be mandatory. I would even suggest a minimum proton cases per site rather than just peds. The goal is to cut numbers.
I know some of you laugh at the proton thing but this is a great way to ensure certain places lose residents, a very small
Minority of hellpit places have protons/advanced tech. Our field uses very expensive machines so why shouldnt our children be training in a place where the institution has put significant resources into the cancer radiation program? Is our children learnin’?
The goal is to cut numbers. Cut them down!!! I will see you all at the breadlines.
i would also add an OMFS service at main site. You would be surprised how many places do not have this and this slows down care of head and neck patients.
Aggressive no knock audits of bad programs needs to start. Everyone knows who and where they are. The limits of the ACGME survey and the pressure many places put on residents to respond favorably cannot be ignored. Institutional GMEs are a ruse to protect the bottomline and in cahoots with PD, often leads to retribution. Anybody familar with the process knows this to be true.
things like breath hold and ability to do gating should be mandatory. I would even suggest a minimum proton cases per site rather than just peds. The goal is to cut numbers.
I know some of you laugh at the proton thing but this is a great way to ensure certain places lose residents, a very small
Minority of hellpit places have protons/advanced tech. Our field uses very expensive machines so why shouldnt our children be training in a place where the institution has put significant resources into the cancer radiation program? Is our children learnin’?
The goal is to cut numbers. Cut them down!!! I will see you all at the breadlines.
Last edited:
How it started: "We'll just let the market (medical students) decide" (Zeitman)
How it's going: "The current mechanisms insure there can never be any sort of market forces at play regarding the number of people we are training." (fiji128)
How it's going: "The current mechanisms insure there can never be any sort of market forces at play regarding the number of people we are training." (fiji128)
ROforbetterorworse
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How do we convince more residents to be honest on ACGME surveys?
I know several colleagues who were honest and it led to program citations
only then did programs make dramatic improvements
other programs obviously shut down that didn’t improve
I know several colleagues who were honest and it led to program citations
only then did programs make dramatic improvements
other programs obviously shut down that didn’t improve
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The problem is obvious. Whistle blowing, while good for the specialty as a whole, is bad for the whistle blower, as it devalues the training program that you are hopefully going to graduate from, not to mention the risk of retaliation.
This is not a unique problem, it is true of most workplaces. So the solution is the same, take a page out of OSHA's book. Fine the program and compensate the whistle-blower with a portion of that. If you blow the whistle on violations, and investigation shows it is unfounded, then nothing happens. If the complaint is verified as accurate, then $$$. One could argue that ACGME doesn't have the authority to fine programs. Sure it does. Pay the fine or lose your residency program.
Amount of money involved for potential whistleblowers is puny.
Having said that, opportunities for RadOnc residents relocating laterally are great now, people are no longer afraid, so we'll see more formal ACGME investigations.
Having said that, opportunities for RadOnc residents relocating laterally are great now, people are no longer afraid, so we'll see more formal ACGME investigations.
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Just feel lucky you get A job. Feel lucky it is only 1 hour drive from cultural meccas like Terre Haute and Evansville. Beautiful snow slopes! “Sportsman's paradise”, life will be amazing folks!
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The amount of hidden, not-talked-about, secret handshake, I-know-somebody-who-knows-somebody jobs in RO seem to be becoming the majority of jobs. Which means during your RO residency it'd be nice if you can also do some night classes, in say, private investigation. A job for a RO these days is like a Whitey Bulger to the FBI.
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That’s a beautiful water tower! I’m sure the biryani is good there also.The amount of hidden, not-talked-about, secret handshake, I-know-somebody-who-knows-somebody jobs in RO seem to be becoming the majority of jobs. Which means during your RO residency it'd be nice if you can also do some night classes, in say, private investigation. A job for a RO these days is like a Whitey Bulger to the FBI.
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From my own first-hand experience, the majority of jobs I saw people get this year were either not advertised or were advertised after the candidate had been basically verbally offered the job.The amount of hidden, not-talked-about, secret handshake, I-know-somebody-who-knows-somebody jobs in RO seem to be becoming the majority of jobs. Which means during your RO residency it'd be nice if you can also do some night classes, in say, private investigation. A job for a RO these days is like a Whitey Bulger to the FBI.
The people who seemed most successful, in terms of getting a job in a geographic location with parameters they wanted (academic vs private, salary, etc) had been networking with practices in those areas since PGY-2.
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Back in the day those would all be cheddar 90th+ %ile MGMA jobs begging to get someone. Guessing now you're lucky to see median MGMA at any of them....
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This is spot on. At this point, getting A job is a Herculean effort, let alone THE job. I am more convinced every day that our field is devolving, with more fellowships, employment gigs with no incentives and low base salaries, or long road to partnership (8 years, true story). This is perfect for all of those medical students and recent applicants who says they will be satisfied by the job of a radiation oncologist and that pay and geography doesn't matter. For those that think their networking skills will help them prevail, get some heavy duty knee pads because it will be a bumpy ride. This is coming from someone in an 'academic' practice with a private work load, making 25%ile MGMA with no bonus structure, still expected to pump out research, and teach residents/medical students in my free time.
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Let me clarify the teaching part, before others jump on me. Teaching is a privilege, and I do enjoy it, when I am able to. However, the main emphasis from my current practice and leadership structure is focused on generating revenue (clinical or research grants). You can generate thousands and thousands of wRVUs, and you are bitched at to generate more. To be frank, I spend more time trying to generate new referral streams than teaching because of this. Our residents get the s--- end of the stick, but that is the landscape at my shop. I am in no position to make change because as stated before, I have nowhere else to go because of the current job market climate if I rock the boat.
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This was an initial strategy for me coming out two years ago if I couldn't get geography of choice. Get a high paying job in remote location for 3-5 years and the rest will take care of itself. Others from my program in the past had done the same and done incredibly well for themselves.
Looks like those guys caught last train out. I couldn't find a middle of nowhere, well paying job just two years ago as they were in short supply. Now they are still in short supply and don't pay near well enough anymore.
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Thank Dennis Hallahan
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I have followed this whole thing very closely over the past 5 years or so. There are no avenues available for the specialty to improve the employment prospects of its current/recent grads and those looking for better positions over the next 10 years. Just not going to happen. RRC has publicly declared they are not interested in raising training standards in such a way that would force poor quality programs to close or even from expanding (at least no new ones have been opening lately). So the only forward is for a places to voluntarily reduce their compliment. This may reduce the total number of rad oncs that are trained by about 10 to 20 a year in the most optimistic scenarios. Meanwhile the Emory's and Pittsburg's of the world will continue to soap and chase after bottom tier candidates so they can fill while Columbia increases their resident numbers simply to satisfy the chair's ego.
Employment prospects will continue to dim as the supply of available rad oncs increases while indications and foot print of the specialty trend ever downward. At that's all there is to understand about it. All you can do is see it coming and plan for your exit strategy.
Employment prospects will continue to dim as the supply of available rad oncs increases while indications and foot print of the specialty trend ever downward. At that's all there is to understand about it. All you can do is see it coming and plan for your exit strategy.
Man, academic practices treat physicians so much worse than good private practices these days.
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After watching the oversupply naysayers over the last few years cling to the "low unemployment" argument, my concern for the "most likely scenario" is thus:
1) While the height of expansion fever is probably done, I don't see much contraction happening. I think we will likely continue to produce 175-200 new graduates per year
2) As has been demonstrated by data at the ASTRO 2020 meeting, about 100 RadOncs seem to retire/leave the specialty every year. I imagine this number will remain relatively stable
3) Therefore, there will always be SOME level of full-time jobs available to new grads. Because of this, oversupply detractors will continue to point at anecdotes of new grads getting jobs as "proof" that everything is fine
4) Salary will continue to stagnate or decrease (especially when adjusted for inflation)
5) As has been demonstrated by data, we will continue to see a rise in fellowship positions and the number of new grads entering fellowships
6) There will likely be an increase in instructor positions at academic centers (paying $100-$150k per year) as well as non-partner track associate positions at private practices (either full or part time, also at fixed salary with little to no bonus structure). Everyone is aware that this is a seller's market, and institutions/practices are under no obligation to offer the same opportunities to new grads that they once received, especially with continued hypofrac, lower reimbursement, and APM. This will compliment the ongoing academic satellite process where people are hired/paid for "academic" positions but work as community physicians.
7) With the increase in fellowship, instructor, and part-time employed associate positions, unemployment will be unlikely to rise above 5-10%, which the naysayers will point to as an acceptable number
I'm throwing this prediction onto the internet for me to return to in 10 years to see how close I was to reality.
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Certainly, is very possible, but we will have to vociferously point out that a fellow or 150 k instructor is not “employed” as an attending. This problem, like most stage 4 cancers, will not be “solved.” Must continue to warn medical students.
ROforbetterorworse
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Next step is residency programs lying about job outcomes on their alumni pages.
Illusion:
New York Methodist
-Timmy USPS, Class of 2026
-Harvard
Medical student applicant: What a stud, NY Methodist went to Harvard! Must apply now!
Reality:
Timmy is the sub-fellow to Tommy FedEx (Class of 2025) who is on year 2 of palliative care fellowship
