Rad Onc Twitter

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Didn’t Mack Roach have data that if you had prostate cancer and underwent a prostatectomy you had better survival than those in the real world with the exact same comorbities but without prostate cancer? It’s like being diagnosed with cancer improves overall survival (as long as a surgeon deems you fit for a surgery). I have never seen this data first hand but my chair would always reference it.
 
xrt123 said:
Didn’t Mack Roach have data that if you had prostate cancer and underwent a prostatectomy you had better survival than those in the real world with the exact same comorbities but without prostate cancer? It’s like being diagnosed with cancer improves overall survival (as long as a surgeon deems you fit for a surgery). I have never seen this data first hand but my chair would always reference it.
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I think Mack was referring to an old Mayo paper from Horst Zincke. Single institution series of T3 prostate cancer treated with RP with better survival than age matched population.

pubmed.ncbi.nlm.nih.gov

Extended experience with radical prostatectomy for clinical stage T3 prostate cancer: outcome and contemporary morbidity - PubMed

An excellent survival rate with low treatment related morbidity can be achieved by performing primary radical prostatectomy with adjuvant therapy in the patient with clinical stage T3 prostate cancer.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

It is evident that, compared to the larger population, patients treated with proton therapy are richer, more educated, healthier and better insured.
 
TheWallnerus said:
Totally schoolmarmy in rad onc. I like that observation. Everyone wants to police everyone else. Sue Yom went totally School of Rock factotum on Dan. If I'm Dan it doesn't bother me though and I sure don't tweet delete. But I guess that's why Dan is chair. The MedNet once deleted a great (and tame) prostate DRE cartoon I posted because of many user complaints. So it doesn't surprise.

Rad onc culture versus other specialties' culture. For consideration: this month's Journal of Surgical Research. Can you imagine a cover like this on the Red Journal. Or a lead article like this...


O8RXAW6.jpg


Q9XuVCw.png
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You should mosy on over to the NEJM this issue had a similar animation but I guess did not want to disrupt the traditional front page of their journal.
 
Chartreuse Wombat said:
I think Mack was referring to an old Mayo paper from Horst Zincke. Single institution series of T3 prostate cancer treated with RP with better survival than age matched population.

pubmed.ncbi.nlm.nih.gov

Extended experience with radical prostatectomy for clinical stage T3 prostate cancer: outcome and contemporary morbidity - PubMed

An excellent survival rate with low treatment related morbidity can be achieved by performing primary radical prostatectomy with adjuvant therapy in the patient with clinical stage T3 prostate cancer.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

It is evident that, compared to the larger population, patients treated with proton therapy are richer, more educated, healthier and better insured.
Click to expand...
I couldn't find the actual data in that paper... could have missed it in the non-searchable PDF.

Here is another study that does suggest this: Patients undergoing radical prostatectomy have a better survival than the background population
 
I had a Stage II lung cancer consult this week and she does not want to do anything about it, 70 yo female, KPS 100. Essentially refusing all options. Oddly enough she is not getting protons or willing to go to MD Anderson as well. But Urology is going to do a prostatectomy. Real World Data!
 
xrt123 said:
I had a Stage II lung cancer consult this week and she does not want to do anything about it, 70 yo female, KPS 100. Essentially refusing all options. Oddly enough she is not getting protons or willing to go to MD Anderson as well. But Urology is going to do a prostatectomy. Real World Data!
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Is this the same patient? She has a prostate? 😛
 
dieABRdie said:
Rad Onc research... Med Oncs are developing novel targeted agents and immunotherapies leading to ever expanding indications for treatment. We are busy shoving things up peoples rectums.

Less assplay more innovation please...
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The only reason I still get lunch is because of med onc. Anybody wanna here about 3rd line treatment for mCRC and the 4 month difference in median OS? Varian doesn't even bother lol Space OAR haha. Gotta hand it to med onc.
 
RadsWFA1900 said:
The only reason I still get lunch is because of med onc. Anybody wanna here about 3rd line treatment for mCRC and the 4 month difference in median OS? Varian doesn't even bother lol Space OAR haha. Gotta hand it to med onc.
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Xofigo and optune reps show the love once in awhile but yes it can't touch the big pharma food parade
 
RealSimulD said:
I was against pharma/device company lunches until I was for them. Now, bring it on. My staff needs the food. I like reps. It’s win-win!
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Any worry about ending up on the Medicare website with Sunrise Act info about all that money being shuffled your way? I personally think it's silly to worry about that, but I know as medical students we had it ingrained that accepting money (or a meal, usually with a significant 'upcharge' from the pharma folks) = bad
 
evilbooyaa said:
Any worry about ending up on the Medicare website with Sunrise Act info about all that money being shuffled your way? I personally think it's silly to worry about that, but I know as medical students we had it ingrained that accepting money (or a meal, usually with a significant 'upcharge' from the pharma folks) = bad
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It’s RadOnc. Ends up being a few hundred bucks a year at most. But, maybe I’m not so popular with the reps.
 
evilbooyaa said:
Any worry about ending up on the Medicare website with Sunrise Act info about all that money being shuffled your way? I personally think it's silly to worry about that, but I know as medical students we had it ingrained that accepting money (or a meal, usually with a significant 'upcharge' from the pharma folks) = bad
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In this day and age with revenue ever tightening and more trainees than positions, I think it should be a mark of honor as to how much money you can milk from alternative sources. More and more academic centers are limiting their faculty options for dipping their finger in the proverbial honey jar.

Get it while the getting is good! Consult, do speaker programs, whatever . . .
 
Gfunk6 said:
In this day and age with revenue ever tightening and more trainees than positions, I think it should be a mark of honor as to how much money you can milk from alternative sources. More and more academic centers are limiting their faculty options for dipping their finger in the proverbial honey jar.

Get it while the getting is good! Consult, do speaker programs, whatever . . .
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I've seen RadOncs give talks on xofigo, optune and even libtayo (??). Get while the getting is good
 
This is such a good point. Med oncs give every bone met patient Xgeva and no one from insurance says no…but try to SBRT that bone met and youve got a peer to peer battle. No OS advantage with Xgeva (over bisphosphonate) sothe bar for SBRT shouldn’t need to be that high. The SC 24 trial seems to be a good juxtaposition metric for SBRT like Xgeva - preventing “events/pain.”



We have got to have the worst lobby and so little stroke it’s painful.


 
BobbyHeenan said:
This is such a good point. Med oncs give every bone met patient Xgeva and no one from insurance says no…but try to SBRT that bone met and youve got a peer to peer battle. No OS advantage with Xgeva (over bisphosphonate) sothe bar for SBRT shouldn’t need to be that high. The SC 24 trial seems to be a good juxtaposition metric for SBRT like Xgeva - preventing “events/pain.”



We have got to have the worst lobby and so little stroke it’s painful.


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More rad oncs sitting around doing nothing willing to sell their collective souls to the likes of HealthHell and Evilcore.

Med oncs are still looking at a reasonably healthier job market so less of an opportunity to stray to the dark side
 
For this year, ASCO and ACS (Am College of Surg) have been virtual.
Last year, I paid some ? $740 for the virtual meeting. I hated the "Zoom" concept...basically sitting in front of the computer all day long.

So far, ASTRO is "brave" and they plan the in-person meeting.
I plan to attend it in person (will be driving to Chicago).
But it looks like the sentiment of many radoncs ---> anti-in-person meeting...

 


Appreciate the salary transparency in this posting.

But also, 325-375k 1.0 FTE for a job in CO springs? This is an academic satellite / glorified community practice right? So I wonder how these docs are expected to get promoted to Associate Prof…
 
The salary transparency is mandated by state law. I'm sure they would not want to share those mediocre salary numbers if they didn't have to.

The associate prof salaries listed for that position are well below AAMC benchmarks. We have been discussing this in private forum.

Welcome to the front range. That market is tight as a duck's butt.

I wish I knew who the agitators were on Twitter who could point out how low that advertised associate salary is for a generalist rad onc in a freestanding center, particularly for a fully clinical 1.0 FTE experienced rad onc at a satellite who should be making MGMA sorts of numbers.

I'm sure BK's response will be some nonsense about total compensation. There's no way you're getting from 350k/year base compensation to 25th percentile AAMC total comp associate without large bonuses. Even this would be underpaid for such a position anyway.

That BK is leader of ASTRO is telling. This is academic ASTRO leadership in a nutshell. You all make too much. Give us 25-50% of your professional revenue as "dean's tax" and be happy you have a job as we continue to expand into satellites funded by underpaid rad oncs who are desperate for jobs as we continue the oversupply.
 
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Neuronix said:
The salary transparency is mandated by state law.

The associate prof salaries listed for that position are well below AAMC benchmarks anyway. We have been discussing this in private forum.
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I just reviewed all that data again that you've graciously collated again.

Today's takeaway for aspiring med student oncologists...

The median rad onc was paid 89% of the money they collected from patients.
The median med onc was paid 135% of the money they collected from patients.

You can either skim or be skimmed in this life. Choose wisely.
 
Mandelin Rain said:
I just reviewed all that data again that you've graciously collated again.

Today's takeaway for aspiring med student oncologists...

The median rad onc was paid 89% of the money they collected from patients.
The median med onc was paid 135% of the money they collected from patients.

You can either skim or be skimmed in this life. Choose wisely.
Click to expand...
while we can talk about the issues with rad onc, i think its a fallacy to give med students this false dichotomy between rad onc and med onc. The current compensation for med onc is likely unsustainable and is more likely than not to decrease in the 7 years when they finish their training. The footprint of current med onc salary will likely come under scrutiny - its not a matter of if, but when
 
radiation said:
while we can talk about the issues with rad onc, i think its a fallacy to give med students this false dichotomy between rad onc and med onc. The current compensation for med onc is likely unsustainable and is more likely than not to decrease in the 7 years when they finish their training. The footprint of current med onc salary will likely come under scrutiny - its not a matter of if, but when
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Sure but at the end of the day, they still have better job prospects in more part of the country. Both specialties face dropping pay
 
radiation said:
while we can talk about the issues with rad onc, i think its a fallacy to give med students this false dichotomy between rad onc and med onc. The current compensation for med onc is likely unsustainable and is more likely than not to decrease in the 7 years when they finish their training. The footprint of current med onc salary will likely come under scrutiny - its not a matter of if, but when
Click to expand...
If you're interested in oncology, there are only so many options.
 
radiation said:
while we can talk about the issues with rad onc, i think its a fallacy to give med students this false dichotomy between rad onc and med onc. The current compensation for med onc is likely unsustainable and is more likely than not to decrease in the 7 years when they finish their training. The footprint of current med onc salary will likely come under scrutiny - its not a matter of if, but when
Click to expand...

It may or may not be unsustainable for med onc, but the basic idea holds true. The start of the referral chain/driver of services to the hospital (imaging, surgeries, infusions, etc.) are worth more then their salary to the hospital and will get subsidized if needed based on market forces. End of the referral chain will get as much of their cut squeezed from them as the market will tolerate.
 
DoctwoB said:
It may or may not be unsustainable for med onc, but the basic idea holds true. The start of the referral chain/driver of services to the hospital (imaging, surgeries, infusions, etc.) are worth more then their salary to the hospital and will get subsidized if needed based on market forces. End of the referral chain will get as much of their cut squeezed from them as the market will tolerate.
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Breast surgeons are really the best example of this. If you just look at the pro fees they generate, even the busiest breast surgeons will struggle to earn what they are being paid in compensation and benefits. However, if you look at the downstream ancillary revenue they generate it is VAST. Between MO/RO referrals, infusion revenue, diagnostic imaging (including surveillance MRIs of the breast), labs, long-term follow-ups, etc. they more than carry their weight financially.

That's the benefit at being at the start of the referral chain rather than the end.
 


I like Sushil Beriwal, so this is not a knock on him...but would it be so hard for rad onc leadership to pledge on fixing the oversupply problem in our field? Or are these just feckless tweets on trendy topics?
 
Cleveland Clinic is approved for 12 resident positions but only has 11 filled (no idea if they didn't fill or some one left). Gotta reach out with more med student exposure and mentoring. Anything but acknowledge the reality on the ground and cut some un-needed positions.
 
The greed of the academic community paired with its intentional ignorance of job market difficulties and all data points showing we have an oversupply is staggering.

At least they aren’t pretending with the “society needs more of us” anymore and going right to coercion of medicinal students directly.

There cannot be a coexistence of record resident numbers paired with falling indications for radiation(hello post op lung, espoh trials, breast omission), falling fractions per treatment, less supervision requirements for satellite sites, and mandatory bundled payments and pretend it’s a good picture for those guys in the photo. So infuriating for the thousandth time to have a field obsessive about minutiae, non clinically relevant data but ignore the well being of the younger generation of physicians by ignoring any sense of supply, demand, and regulation.
 
While going through the ACGME - Accreditation Data System (ADS) I just noticed the University of Virginia is approved for 6 resident positions and has 6 filled despite being in the SOAP for 2 positions in 2020 and 1 in 2021. VCU is approved for 8 residents positions and has 7 filled despite being in the SOAP for 2 positions in 2020 and 1 in 2021.

Rad Onc chairs and program directors are basically like the sleezy used car salesman of the graduate medical education world now. "What can I do to get you into this sweet residency program today?"
 
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