Rad Onc Twitter

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PhotonBomb said:
The PRO article implies that programs that try to go against the grain and try to expand or SOAP year after year will only further a self-fulfilling process and it will make it harder and harder for them to match.

I agree with this for sure. On the google doc people are questioning Case for wanting to expand in this climate. talk about self-sabotage

Good luck Case, you filthy animals!

You guys ever see Mitch Machtay try to put a note in himself?
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Hope they match 0 this year
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Any program with a CLOWN BULLY chair is likely not to match this year; they did it to themselves. Expanding BAD, SAD programs like Case should not fill at all. Reason given for expansion by Case is that 8 residents “seems like a good number”. They need to be blocked and forced to contract their bad no good program
 
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GuitarMan123 said:
Actually, "Dr. Chowdhary" sadly only publishes things like this because he tries to publish anything he can. He basically only publishes NCDB research with Kirtesh Patel because they both lack access to doing real research. Just scraping the bottom of the barrel and republishing the same thing at lower and lower impact journals. He, similar to Fumiko Chino, #financialtoxicity#womenwhocurie#virtue, are only interested to make their names by publishing on crap like this because publishing real scientific research with real results requires science and hard work
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I don't understand why the hate towards Chowdhary's work. He's one of the few on twitter with the balls to push back against people oblivious to the job market issues. If it wasn't for him and a few others on twitter, there wouldn't be even a discussion and people like KO would still be blind. You mention lower and lower impact journals but all his residency/job market work is in the red journal and PRO. On top of this all, he's a PGY5 likely looking for a job and he's still fighting the good fight
 
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PhotonBomb said:
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I sincerely appreciate his magnanimity on this matter. It would have been very easy to lump one poster's comment into the SDN "troll factory." Kudos to Dr. Chowdhary for keeping the dialogue open. At this point, I think the vast majority of people recognize that there is a big problem - we now have to focus on solutions.
 
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GuitarMan123 said:
Actually, "Dr. Chowdhary" sadly only publishes things like this because he tries to publish anything he can. He basically only publishes NCDB research with Kirtesh Patel because they both lack access to doing real research. Just scraping the bottom of the barrel and republishing the same thing at lower and lower impact journals. He, similar to Fumiko Chino, #financialtoxicity#womenwhocurie#virtue, are only interested to make their names by publishing on crap like this because publishing real scientific research with real results requires science and hard work
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Our specialty is enough of a dumpster 700-acre-tire-landfill fire already with people like Paul Wallner, Ralph Weichselbaum, and other individuals showing early signs of frontotemporal dementia actively trying to screw over the careers and livelihoods of young rad oncs and community rad oncs based on their unscientifically founded biases that only rad oncs trained in and practicing in large, specialized urban academic centers should provide care to patients (I guess just screw every single patient in the entire state of Wyoming, Montana, North Dakota, and others, right Ralph? Just let em hitchhike to Chicago and live in a cardbord box outside your office while you blast them with protons, right Ralph? (EDIT: Forgot UC doesn't have protons -- probably not safe to delivery curative radiotherapy in outdated centers without protons, the data says that's a fact). Or else they just deserve to die, right Ralph? Beacause chemo and linacs, and MLCs work better in your office than they do in Minot. It's just a fact. The data says so. The "data" right Rallph? You arrogant cocky little... well I digress...). ..

Anyway, our specialty is enough of a 4000 ton pile of flaming pig excrement filled with ebola-infected monkeys hurling maggot-sprinkled feces at each other with the aforementioned leaders without residents going at each other's throats like this. We need to stick together because the senior generation, you know the ones who don't contour or write their own notes, or call patients on their own, or come in after hours or on weekends, and were grandfathered into board certification (the thing that's supposed to be a safety issue, right?). Yeah, those guys. The old boomers that rigged the system in their favor, milked it dry with IMRT over-charging, residency expansion, 340b scams, and predatatory bait-and-switch private practice acquistion, and are actively trying to screw the young generation all over. Yeah, those guys.

So I think you should apologize to Chowdhary. Yeah there's some brown nosing on Twitter. And you have a point about this noxious trend of "academics" wasting resources publishing psuedoscientific garbage, especially when it ironically involves things like "financial toxicity." (Do we really need multiple scholars spending their entire careers trying to figure out if people having to spend a lot of money for medical treatment negatively affects their financial well-being? It's like that study that was conducted to try and figure out why prisoners try to escape from prison). But at least he stuck his neck out on an issue that I think we can all get behind.
 
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thecarbonionangle said:
Any program with a CLOWN BULLY chair is likely not to match this year; they did it to themselves. Expanding BAD, SAD programs like Case should not fill at all. Reason given for expansion by Case is that 8 residents “seems like a good number”. They need to be blocked and forced to contract their bad no good program
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Case was already on the do-not-rank list for other reasons. Two strikes against them now. Keep it up. At least you have those Cleveland winters as a redeeming quality.
 
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KHE88 said:
Our specialty is enough of a dumpster 700-acre-tire-landfill fire already with people like Paul Wallner, Ralph Weichselbaum, and other individuals showing early signs of frontotemporal dementia actively trying to screw over the careers and livelihoods of young rad oncs and community rad oncs based on their unscientifically founded biases that only rad oncs trained in and practicing in large, specialized urban academic centers should provide care to patients (I guess just screw every single patient in the entire state of Wyoming, Montana, North Dakota, and others, right Ralph? Just let em hitchhike to Chicago and live in a cardbord box outside your office while you blast them with protons, right Ralph? (EDIT: Forgot UC doesn't have protons -- probably not safe to delivery curative radiotherapy in outdated centers without protons, the data says that's a fact). Or else they just deserve to die, right Ralph? Beacause chemo and linacs, and MLCs work better in your office than they do in Minot. It's just a fact. The data says so. The "data" right Rallph? You arrogant cocky little... well I digress...). ..

Anyway, our specialty is enough of a 4000 ton pile of flaming pig excrement filled with ebola-infected monkeys hurling maggot-sprinkled feces at each other with the aforementioned leaders without residents going at each other's throats like this. We need to stick together because the senior generation, you know the ones who don't contour or write their own notes, or call patients on their own, or come in after hours or on weekends, and were grandfathered into board certification (the thing that's supposed to be a safety issue, right?). Yeah, those guys. The old boomers that rigged the system in their favor, milked it dry with IMRT over-charging, residency expansion, 340b scams, and predatatory bait-and-switch private practice acquistion, and are actively trying to screw the young generation all over. Yeah, those guys.

So I think you should apologize to Chowdhary. Yeah there's some brown nosing on Twitter. And you have a point about this noxious trend of "academics" wasting resources publishing psuedoscientific garbage, especially when it ironically involves things like "financial toxicity." (Do we really need multiple scholars spending their entire careers trying to figure out if people having to spend a lot of money for medical treatment negatively affects their financial well-being? It's like that study that was conducted to try and figure out why prisoners try to escape from prison). But at least he stuck his neck out on an issue that I think we can all get behind.
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Sir, this is a Wendy’s drive thru.
 
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I think Our specialty is kinda like Jack in the Box late night drive through when they start serving the munchie box. Some people at wheel are drunk, or high or both. Some are having a good time, some a bad night, some will regret this nasty greasy meal the next day at the toilet. We’re all circling the toilet anyways at some point. May as well enjoy this ride so pass me the hot sauce and some pepcid. $hitshow dumpster fire field. Bottoms up!
 
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thecarbonionangle said:
I think Our specialty is kinda like Jack in the Box late night drive through when they start serving the munchie box. Some people at wheel are drunk, or high or both. Some are having a good time, some a bad night, some will regret this nasty greasy meal the next day at the toilet. We’re all circling the toilet anyways at some point. May as well enjoy this ride so pass me the hot sauce and some pepcid. $hitshow dumpster fire. Bottoms up!
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This girl knows how to troll with the best of them! She’s been identified as a key troll on the google doc
 
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PhotonBomb said:
This girl knows how to troll with the best of them! She’s been identified as a key troll on the google doc
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many people are after my head. Very vindictive field, plenty of hate mail. This is why I drop my tunes here on sdn with my crew.
 
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its important to be able to separate the chaff from the wheat. lot of people read here, and they have shown they can do so.
 
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1575240290099.png


He had me in the first half, not gonna lie
 
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Consolidating centers, whether you agree with RW or not, is going to happen. CMS wants it - Canada provides a great model of cost control in this regard, SBRT is very short and staying for 1-2 weeks is very palatable for most (not all) people, and with hypofract and the APM there will be a number of satellites of either academic or private nature which won’t stay financially viable. Changes to direct supervision may help alleviate this but only slightly - the costs of the staff, machine, ct scanner, vault replacement all significantly outweigh the change from 1 to say 0.5 FTE.

Also - no, many people cannot travel for the 6 to 7 week courses of radiation away from home without financial help - but those are also the people who are outraged at the cost of health care. A lot of that cost is the convenience of the US system, and that convenience is the result of investment in multiple, redundant physical plants (rt machine or op center, take your pick) and those margins are going to be hammered hard. How else will we pay for immunotherapy? Our hhs lead is a guy whose life work was maximizing shareholder value at pharma Corp without one regard for societal cost.
 
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I do think expertise matters for some things. If I’m referring a patient out, I look at the rad onc website to see WHEN they graduated. If someone trained before the IMRT era I don’t want them treating my patient with a complex head and neck cancer
 
PhotonBomb said:
I do think expertise matters for some things. If I’m referring a patient out, I look at the rad onc website to see WHEN they graduated. If someone trained before the IMRT era I don’t want them treating my patient with a complex head and neck cancer
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Like I said before, we don’t want to get into each other’s dirty laundry. @PhotonBomb here showing some of the dark side of academics. We know much much more, but out of respect I really don’t want to go there. This will unfortunately lead to mutually self-assured destruction, but with tweets like this not sure if the amicability will last:




Dr. Scott sounds like a nice guy and maybe just a slip on the internet (we’ve all been there), but worrisome nonetheless...
 
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RadOncMegatron said:
Like I said before, we don’t want to get into each other’s dirty laundry. @PhotonBomb here showing some of the dark side of academics. We know much much more, but out of respect I really don’t want to go there. This will unfortunately lead to mutually self-assured destruction, but with tweets like this not sure if the amicability will last:




Dr. Scott sounds like a nice guy and maybe just a slip on the internet (we’ve all been there), but worrisome nonetheless...
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sounds like a lot of these guys are out of touch, having chosen to subspecialize in 1-2 sites soon after residency and being in a large enough metro with a practice that allows them to do that.

those of us practicing in smaller metros don't have that luxury of choosing which cases to treat, and, in fact, enjoy the challenge of a comprehensive practice.

last time I checked, the qualifying oral exam for board certification had 8 sections covering all of rad onc
 
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@cdf95cro

Dave Fuller...smh. How is this current Twitter thread related to what is on SDN or the people who are on it? I am not speaking on behalf of SDN, but I don't think they directly involved in that thread. I'm sure there are people with accounts on both platforms, but I don't think SDN has a sanctioned account in that thread.

Moreover, who cares if RW has the highest h-index in radiation oncology? He is still out of touch from what is happening outside of his chair's office. Is that what they teach you at MDACC? To brown nose like your resident, Eric Brooks, in his tweet in the same thread? I mean, how else did someone who graduated from San Antonio for residency get a job at MDACC?

Capture.PNG
 
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medgator said:
Lol another dense statement
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I mean...before he joined CCF, he was at Moffitt. If all he knows is papers from his former colleagues at Moffitt (Caudell and Torres-Roca, referenced in another tweet), then I believe it illustrates how insulated some people in academics really are. These people couldn't survive in a generalist practice, covering everything from head to toe. Really out of touch, especially in the plight of a lot of patients who don't have the means or logistics to go to the city for 'high-volume' care.
 
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SubserviantToABR said:
I mean...before he joined CCF, he was at Moffitt. If all he knows is papers from his former colleagues at Moffitt (Caudell and Torres-Roca, referenced in another tweet), then I believe it illustrates how insulated some people in academics really are. These people couldn't survive in a generalist practice, covering everything from head to toe. Really out of touch, especially in the plight of a lot of patients who don't have the means or logistics to go to the city for 'high-volume' care.
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agree with all above. At this point of his career and with his words, RW doesn’t deserve devils advocate. He can speak for himself

doesnt need defending. Needs schooling
 
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This whole field is very confused about standards and goals and the ability to value multiple things at once.
 
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RadOncMegatron said:
Like I said before, we don’t want to get into each other’s dirty laundry. @PhotonBomb here showing some of the dark side of academics. We know much much more, but out of respect I really don’t want to go there. This will unfortunately lead to mutually self-assured destruction, but with tweets like this not sure if the amicability will last:




Dr. Scott sounds like a nice guy and maybe just a slip on the internet (we’ve all been there), but worrisome nonetheless...
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If you want to send complex skull base patients to be treated by people who trained before IMRT, go ahead! I would not.

My referrings know me to be good. I am sure you have earned referrals by your general quality as well. i am sure those same referrings know who is old and out of touch, and who knows what they are doing.

It’s quite ignorant to pretend this doesn’t matter.


Old dinosaurs are Out there
 
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medgator said:
Lol another dense statement
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How is this dense? The biggest problem with SDN is an utter lack of nuance. One can look at RW statement and utterly disagree with it and see Scott’s tweet and see the point.

If you say ‘I am a rad onc and my past experience doesn’t matter and it doesn’t matter if I am up to date’ then you really don’t think very highly of yourself or what you do.

Again, there are rad oncs out there that are OLD and I wouldn’t let them radiate my dogs. Why are you in denial about this? I’ve seen you literally post that before, Dr. Gator.
 


Covfefe?

Seriously. Intervention time. How is this person still practicing medicine? I wouldn't allow my neighbor's cat to be treated by this guy, and I hate that thing. Let alone anyone who needs "curative radiotherapy"?

There is a wonderful retirement village down in Fort Myers that Wallner has got staked out just ready for you. Think about it. Sitting on the beach reading articles your residents wrote in your name in the 1970s reliving the glory days.

Props to Emma Holliday on this one. I guess the twitter crowd will even do the right thing when someone says something outlandish enough. They're smart people, after all. It's not like they don't know what the game is.
 
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PhotonBomb said:
How is this dense? The biggest problem with SDN is an utter lack of nuance. One can look at RW statement and utterly disagree with it and see Scott’s tweet and see the point.

If you say ‘I am a rad onc and my past experience doesn’t matter and it doesn’t matter if I am up to date’ then you really don’t think very highly of yourself or what you do.

Again, there are rad oncs out there that are OLD and I wouldn’t let them radiate my dogs. Why are you in denial about this? I’ve seen you literally post that before, Dr. Gator.
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some h&n is complex and some isn't? really?

maybe it wasn't that dense but the point still stands that the day you get that email from the abr after orals saying you passed of the day you're probably best equipped to treat everything.

What h&n was Jacobs referring to? nasopharynx? ok to throw on fields for a glottic but a NP case is too complex?

fwiw, I have sent patients out for second opinions, as well as for protons (reirradiation, chordoma etc).
 
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medgator said:
some h&n is complex and some isn't? really?

maybe it wasn't that dense but the point still stands that the day you get that email from the abr after orals saying you passed of the day you're probably best equipped to treat everything.

What h&n was Jacobs referring to? nasopharynx? ok to throw on fields for a glottic but an NP case is too complex?

fwiw, I have sent patients out for second opinions, as well as for protons (reirradiation, chordoma etc).
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I would trust the old guy trained in the early 90's to treat bread and butter cases glottic, but if I'm choosing to send my patient with the skull base chordoma closer to home, I want to send to someone that knows what they are doing. Nothing to do with academics vs PP or generalist vs specialist. To be honest, even for a standard tonsil IMRT case, I want to send to someone who I would 'guess' knows what they are doing based on when they trained.

I'm an age-ist when it comes to Rad Onc. Sue me. If you trained before IMRT, I don't trust you know what you're doing in head and neck.
 
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PhotonBomb said:
I would trust the old guy trained in the early 90's to treat bread and butter cases glottic, but if I'm choosing to send my patient with the skull base chordoma closer to home, I want to send to someone that knows what they are doing. Nothing to do with academics vs PP or generalist vs specialist. To be honest, even for a standard tonsil IMRT case, I want to send to someone who I would 'guess' knows what they are doing based on when they trained.

I'm an age-ist when it comes to Rad Onc. Sue me. If you trained before IMRT, I don't trust you know what you're doing in head and neck.
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oh I agree, which is why I posted that quote from abro above
 
There is definitely a new era in our field where the academic centers are starting to become more aggressive in regards to getting their numbers. I’ve had 3 instances where a patient was told they needed to have “gamma knife” when they easily could have received “Varian-sword.”

When I spoke to the academic rad onc, he was like sorry pal. Mind you, his center is 2 hrs away. They even tell the patients that only gamma knife is the standard of care for brain mets.This is the current state of our field. Don’t believe me, look at all the MDACC “affiliated” hospitals and all the university satellites popping up everywhere. There used to be a time where academia was where you sent the challenging cases and they were not actively competing for patients, but now there are new “standard of care” theories being presented of where you should go to have your brain mets treated or that only a high-volume center can use “curative radiotherapy.”
 
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RadOncDoc21 said:
There used to be a time where academia was where you sent the challenging cases but now there is an imagined new standard of care of who can treat brain mets and “definitive cases.”
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I think it's important to remember that this was just RW saying this re: curative cases and he was soundly RATIO-ed on twitter.
 
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PhotonBomb said:
I think it's important to remember that this was just RW saying this re: curative cases and he was soundly RATIO-ed on twitter.
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had to look that one up....

www.merriam-webster.com

Wordplay: For the Love of Language | Merriam-Webster

Fascinating facts about the words we use, plus strange and interesting words you'll want to know.
www.merriam-webster.com www.merriam-webster.com

I feel like an old gen Xer listening to my 80s and 90s on the way to work compared to all you tweeting whipper snappers
 
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SubserviantToABR said:
I mean...before he joined CCF, he was at Moffitt. If all he knows is papers from his former colleagues at Moffitt (Caudell and Torres-Roca, referenced in another tweet), then I believe it illustrates how insulated some people in academics really are. These people couldn't survive in a generalist practice, covering everything from head to toe. Really out of touch, especially in the plight of a lot of patients who don't have the means or logistics to go to the city for 'high-volume' care.
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yup. I treat a few nasopharynx cases annually, some of these pts are fairly symptomatic from the get go and wouldn't be able to travel for 33 fx and unlike everything else coming out of radonc academia these days, there is no 5-16 fx regimen I'm aware of yet so pts might even have a shot of leaving the area.

 
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medgator said:
yup. I treat a few nasopharynx cases annually, some of these pts are fairly symptomatic from the get go and wouldn't be able to travel for 33 fx and unlike everything else coming out of radonc academia these days, there is no 5-16 fx regimen I'm aware of yet so pts might even have a shot of leaving the area.
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As you stated, why go through all the hoops of becoming board certified when on day 1 of practicing outside a “high volume center” you’re already and forever will be unqualified?
 
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Oh Lord. Now we're going to debate what is "complex" or not. Well. From a pragmatic standpoint there are three levels of planning in radiation oncology: simple, intermediate, and complex. Every. Single. Curative. H&N. Case. Is. Complex. Ok... you weren't talking universally accepted definitions? You were talking more philosophically complex, or perhaps so-complex-a-limited-IQ-can't-fathom-the-case complex? From that standpoint.... even palliative cases are complex! We can consider doses, long-term effects, patient milieu, family dynamics, sociodemographics, the mechanisms/operation of the linear accelerator, if my therapist has a flu prodrome, etc. It's all pretty damn complex. And these trained-before-IMRT MDs... in the majority of cases, they will have sharp physicists and dosimetrists in their departments. Which nearly always cover a multitude of sins. And beyond that, I used to go out and train these "old guys." It might blow some folks' minds, but many are trainable and right now doing good IMRT. You're never as good, or as smart, or as irreplaceable, or as God's-gift-to-medicine, as you think you are. (EDIT: I have seen far too many academic site-specialized rad oncs do shiznit that is crazy/harmful for me to ever worship at that altar either.)
 
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