Rad Onc Twitter

[elementaryschooleconomics]

Memes? Twitter? Or dare you to reply🙃

Honestly, the only way I can see this changing (people conducting "research" on "hot" topics that serves to build their own name more than anything else) is if we can ever move away from how tightly wound publishing is to advancing careers in medicine.

At the student level, it worsens the gap between the people who have the ability to take years off to conduct unpaid work solely for the purpose of CV padding.

At the residency level, it virtually requires people to take significant effort and attention away from learning clinical medicine (which is what the majority of doctors will end up doing for their career).

At the attending/faculty level, it means recruiting students and residents into this feedback loop to continue and worsen this cycle.

At the societal level, it means that a handful of publishing companies make millions of dollars utilizing the unpaid volunteerism of students/residents/faculty (estimated to be worth $1.5 billion per year in the US alone). It also means a significant amount of "noise" is introduced into the literature which makes it hard to discern what publications actually have a positive impact on the health of our patients.

I know everyone is aware of this. I just don't see how we're getting out of this system we've built. I don't think my generation will do it, I suspect it won't even be current medical students, but perhaps the generation of future physicians currently in undergrad/high school?

Who knows.

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[Ray D. Ayshun]

Memes? Twitter? Or dare you to reply🙃

All of our threads ultimately lead to this one.

 

[metallica81788]

All of our threads ultimately lead to this one.

That and stop pumping out so many residents. The two sites of common ground

 

[Ray D. Ayshun]

That and stop pumping out so many residents. The two sites of common ground

that topic ultimately leads here as well.

 

[deleted941485]

Honestly, the only way I can see this changing (people conducting "research" on "hot" topics that serves to build their own name more than anything else) is if we can ever move away from how tightly wound publishing is to advancing careers in medicine.

At the student level, it worsens the gap between the people who have the ability to take years off to conduct unpaid work solely for the purpose of CV padding.

At the residency level, it virtually requires people to take significant effort and attention away from learning clinical medicine (which is what the majority of doctors will end up doing for their career).

At the attending/faculty level, it means recruiting students and residents into this feedback loop to continue and worsen this cycle.

At the societal level, it means that a handful of publishing companies make millions of dollars utilizing the unpaid volunteerism of students/residents/faculty (estimated to be worth $1.5 billion per year in the US alone). It also means a significant amount of "noise" is introduced into the literature which makes it hard to discern what publications actually have a positive impact on the health of our patients.

I know everyone is aware of this. I just don't see how we're getting out of this system we've built. I don't think my generation will do it, I suspect it won't even be current medical students, but perhaps the generation of future physicians currently in undergrad/high school?

Who knows.

There would need to be a catastrophic event that completely upends the existing system which basically assumes excessive interest of students to become doctors. At some point applicants may just say screw it volunteering to do research this much isn’t worth my time

I wish that was the case when I was applying. The amount of free academic work and community volunteering I did just to check a box I probably would have been better off sleeping or having a social life.

Looking back, none of the research I did amounted to anything and quite honestly after seeing the nonsense that goes on in labs academia seemed like a horrible waste of time.

Over I’d say the 5 years that I volunteered my time, if I was paid a wage I’d probably have 10K.

Looking back on the experiences I’ve had, honestly it made me more cynical person and made me want to avoid these kind of projects in the future. You have to be a real lucky duck for these projects to go anywhere

The sheer amount of fake enthusiasm that went into the whole thing looks exhausting in retrospect.

 

[Mandelin Rain]

Memes? Twitter? Or dare you to reply🙃

I don't know this dude, but I think I'd like having a beer with him.

 

[evilbooyaa]

Totally fine by me. It is not standard of care. No reason insurance should pay for it.

But there is a difference between “not standard of care” and “not evidence based.” There is published prospective evidence for focal therapy in reducing progression to radical therapy on AS. Personally I don’t find it compelling. But it exists. And patients ask for it, just like they ask for proton therapy despite lack of evidence.

I would say it is unethical for MD Anderson to push a run of the mill prostate patient into proton therapy. Is it unethical for MD Anderson to treat a patient who is demanding proton therapy because the patient thinks it’s better? I would say not.

I'd be interested in links for the bolded.

In regards to protons for prostate, I mostly agree with you in terms of the cost, but at least I am confident that protons will be equally effective (even if more toxic) to photon RT or RP. With focal therapy we are discussing a therapy that is oncologically inferior to RP or RT.
It would be similarly unethical to do say focal gland brachytherapy off trial in 2021.

Plenty of shysters in all fields. For me, the HIFU/Cryo/focal therapy bandwagon is a relatively small portion. I think what is much more relevant on a day-to-day is the lack of "prostate cancer patient meets with Urologist and Radiation Oncologist" paradigm that should be routine in this country and worldwide, but in reality it's more like 30-50% dependent on where you look.

Also your methods are quaint. Vascular targeted photodynamic therapy and irreversible electroporation FTW!

Ha, those both fall under the ETC of additional "big words" nonsense that has not been proven to have clinical utility similar to the gold standard.

 

[RO28]

Honestly, the only way I can see this changing (people conducting "research" on "hot" topics that serves to build their own name more than anything else) is if we can ever move away from how tightly wound publishing is to advancing careers in medicine.

At the student level, it worsens the gap between the people who have the ability to take years off to conduct unpaid work solely for the purpose of CV padding.

At the residency level, it virtually requires people to take significant effort and attention away from learning clinical medicine (which is what the majority of doctors will end up doing for their career).

At the attending/faculty level, it means recruiting students and residents into this feedback loop to continue and worsen this cycle.

At the societal level, it means that a handful of publishing companies make millions of dollars utilizing the unpaid volunteerism of students/residents/faculty (estimated to be worth $1.5 billion per year in the US alone). It also means a significant amount of "noise" is introduced into the literature which makes it hard to discern what publications actually have a positive impact on the health of our patients.

I know everyone is aware of this. I just don't see how we're getting out of this system we've built. I don't think my generation will do it, I suspect it won't even be current medical students, but perhaps the generation of future physicians currently in undergrad/high school?

Who knows.

yes, 100%, 10/10. We should have a drink together someday. I have so many things to say about all of this. I'm getting to the point where I'm going bald from ripping my hair out (jkjk, just ongoing post-baby hairloss).

 

[RadOncMegatron]

yes, 100%, 10/10. We should have a drink together someday. I have so many things to say about all of this. I'm getting to the point where I'm going bald from ripping my hair out (jkjk, just ongoing post-baby hairloss).

Absolutely. The writing of "academic" articles for the sole purpose of padding the CV is the hidden shame of our field (by that I mean medicine not just rad onc). We know (I am guilty as well) most articles are just for the CV. I was surprised one day when a rad onc friend of mine said, "Hey, I read your article." I was caught off guard and wasn't sure whether to be flattered or be ashamed to know he read my retrospective masterpieces (ie garbage) LOL

 

[RO28]

Absolutely. The writing of "academic" articles for the sole purpose of padding the CV is the hidden shame of our field (by that I mean medicine not just rad onc). We know (I am guilty as well) most articles are just for the CV. I was surprised one day when a rad onc friend of mine said, "Hey, I read your article." I was caught off guard and wasn't sure whether to be flattered or be ashamed to know he read my retrospective masterpieces (ie garbage) LOL

should prob just watermark the last page of my CV with GARBAGE. But yeah, I have the exact same reaction when someone says they read something I wrote.

 

[jondunn]

 

[DoctwoB]

I'd be interested in links for the bolded.

In regards to protons for prostate, I mostly agree with you in terms of the cost, but at least I am confident that protons will be equally effective (even if more toxic) to photon RT or RP. With focal therapy we are discussing a therapy that is oncologically inferior to RP or RT.
It would be similarly unethical to do say focal gland brachytherapy off trial in 2021.

Plenty of shysters in all fields. For me, the HIFU/Cryo/focal therapy bandwagon is a relatively small portion. I think what is much more relevant on a day-to-day is the lack of "prostate cancer patient meets with Urologist and Radiation Oncologist" paradigm that should be routine in this country and worldwide, but in reality it's more like 30-50% dependent on where you look.


Ha, those both fall under the ETC of additional "big words" nonsense that has not been proven to have clinical utility similar to the gold standard.

A Multicentre Study of 5-year Outcomes Following Focal Therapy in Treating Clinically Significant Nonmetastatic Prostate Cancer - PubMed

In this multicentre study of 625 patients undergoing focal therapy using high-intensity focused ultrasound (HIFU), failure-free survival, metastasis-free survival, cancer-specific survival, and overall survival were 88%, 98%, 100%, and 99%, respectively. Urinary incontinence (any pad use) was...

pubmed.ncbi.nlm.nih.gov

5 year failure free survival for mostly GG2 disease was 88%. They define failure as freedom from radical therapy, ADT, or progression. One could argue that is not bad, as most series of AS in similar patients have a progression to radical treatment rate of ~50%.

Of course in the weeds of the article, you see they ignore PSA kinetics, and local recurrence that was retreated with HIFU was not counted as "failure" which is obviously BS. 40 of the 600 something patients had in field recurrence, and 27 had out of field recurrence. Note the real number is almost certainly higher since they only did for cause biopsies, not surveillance.

Anyways. As I've mentioned, I am unimpressed by the data. But it would not be completely unreasonable for someone who is highly motivated to avoid surgery or xrt to look at it and want that topline result.

 

[temujim]

At the societal level, it means that a handful of publishing companies make millions of dollars utilizing the unpaid volunteerism of students/residents/faculty (estimated to be worth $1.5 billion per year in the US alone). It also means a significant amount of "noise" is introduced into the literature which makes it hard to discern what publications actually have a positive impact on the health of our patients.

Do your part to destroy the publishing industry and use sci hub

 

[RickyScott]

Do your part to destroy the publishing industry and use sci hub

Where do you find the latest links?

 

[temujim]

Where do you find the latest links?

oddly wikipedia

 

[jondunn]

 

[jondunn]

Guy was cancelled!

 

[Gfunk6]

Guy was cancelled!

Well, if being cancelled = earning 80-90% of your maximum annual salary for life complete with benefits and perks then sign me up. I also expect to see him pop up soon as a highly-compensated consultant for any number of companies.

 

[elementaryschooleconomics]

Well, if being cancelled = earning 80-90% of your maximum annual salary for life complete with benefits and perks then sign me up. I also expect to see him pop up soon as a highly-compensated consultant for any number of companies.

Yes please sign me up for this cancelling as well. I would also like a Genesis gig in the south of France. Wally, where u at?

 

[deleted941485]

Guy was cancelled!

What really? Wouldn’t surprise me if he was asked politely to retire.

I remember interviewing with him years ago. Nice guy. Probably best he leave though at least he can look back on a decent career that got him to retirement. Jealous I probably won’t be able to say the same.

 

[TheWallnerus]

Yes please sign me up for this cancelling as well. I would also like a Genesis gig in the south of France. Wally, where u at?

I don’t mind the word cancel. It’s “sell” which is not such a bad word. And “can” in front of it which is the opposite of can’t. So “can”… “sell.” It’s pretty refreshing compared with the alternatives.

Now if Randall had given all the residents a tie and t shirt that said “Gettin Lucky in Kentucky” I would be here for it.

 

[jondunn]

What really? Wouldn’t surprise me if he was asked politely to retire.

I remember interviewing with him years ago. Nice guy. Probably best he leave though at least he can look back on a decent career that got him to retirement. Jealous I probably won’t be able to say the same.

Kidding.

He wrote an article about getting cancelled

 

[thecarbonionangle]

Marcus will be moving on to bigger and better grifts. Like the bunny used to say, “well thats all folks!”

MR was CANCELLED by SDN. Many more to come, perhaps?

 

[Ray D. Ayshun]

Marcus will be moving on to bigger and better grifts. Like the bunny used to say, “well thats all folks!”

MR was CANCELLED by SDN. Many more to come, perhaps?

 

[deleted941485]

Marcus will be moving on to bigger and better grifts. Like the bunny used to say, “well thats all folks!”

MR was CANCELLED by SDN. Many more to come, perhaps?

Did RO cancel MR or did MR cancel RO?

 

[elementaryschooleconomics]

 

[thecarbonionangle]

View attachment 346518

I forsee more of these “retirements”. These hellpit places are getting 60 applications if that. Many of them are facing a terrible match prospect for the forseable future. UK already cut the match to 401ks using the pandemic as an excuse. Why would you want to preside over departments who cannot match and employees have decreasing salaries and benefits. Retirement with a sweet pension new grads no longer have access to and continue grift elsewhere opening up clinics in Scotland all of a sudden sounds great. Sneak out the backdoor with tons of cheese before the ship sinks is what our “leaders” do.

 

[jondunn]

#TimesUp?

 

[DoctwoB]

Lot of buzz in Uro Twitter about TAR-200. A sustained release intravesical gemcitabine tube placed into the bladder. Phase 1 trial in the neoadjuvant setting with promising pCR rates in low volume disease prior to cystectomy. Currently accruing phase 2 and 3trials looking at that, bcg unresponsive T1 disease, and most interestingly as an RCT of TAR-200 plus cetrelimab vs chemorads.

TAR-200/Cetrelimab Under Investigation in Muscle-Invasive Bladder Cancer look

Crazy the type/volume of trials you get with pharma money involved. Don’t see that in surgery or radiation.

 

[elementaryschooleconomics]

Lot of buzz in Uro Twitter about TAR-200. A sustained release intravesical gemcitabine tube placed into the bladder. Phase 1 trial in the neoadjuvant setting with promising pCR rates in low volume disease prior to cystectomy. Currently accruing phase 2 and 3trials looking at that, bcg unresponsive T1 disease, and most interestingly as an RCT of TAR-200 plus cetrelimab vs chemorads.

TAR-200/Cetrelimab Under Investigation in Muscle-Invasive Bladder Cancer look

Crazy the type/volume of trials you get with pharma money involved. Don’t see that in surgery or radiation.

If only Johnson & Johnson could put a patent on the use of electrons in medicine, then they could charge for the current in the Bovie, the screen on the Da Vinci, or per the MU for breast boosts.

 

[radOresident]

I forsee more of these “retirements”. These hellpit places are getting 60 applications if that. Many of them are facing a terrible match prospect for the forseable future. UK already cut the match to 401ks using the pandemic as an excuse. Why would you want to preside over departments who cannot match and employees have decreasing salaries and benefits. Retirement with a sweet pension new grads no longer have access to and continue grift elsewhere opening up clinics in Scotland all of a sudden sounds great. Sneak out the backdoor with tons of cheese before the ship sinks is what our “leaders” do.

60 applications may even be a stretch. based on that twitter account, it looks like every pgy2 at ukentucky was a general surgery resident at some point. couldn't even match the people who wanted rad onc in the first place. but hey, as long as their faculty don't have to go uncovered, am i right?

 

[Krukenberg]

This is the type of research I’d like to see more of. Risky trials that have the potential to expand indications. Unfortunately it might only be possible at very high volume centers like mdacc

 

[elementaryschooleconomics]

60 applications may even be a stretch. based on that twitter account, it looks like every pgy2 at ukentucky was a general surgery resident at some point. couldn't even match the people who wanted rad onc in the first place. but hey, as long as their faculty don't have to go uncovered, am i right?

Additionally, at least one of their senior residents transferred programs to finish training elsewhere last year.

 

[deleted1116990]

Additionally, at least one of their senior residents transferred programs to finish training elsewhere last year.

This is not going to end well.

A recruiter recently told me an internist at their hospital went back to residency to "do what I did". She said it like it's something you just sign up for if you want to. I couldn't believe it, but I googled this person and it was true. How did this hospitalist have time to do the multiple away rotations and publish the research needed to match into rad onc? Remember how important that used to be? Some more googling out of curiosity finds people who did internship years ago, never did a residency, and are now training in rad onc.

What can be done to get the message out to people like this poor hospitalist that retraining in rad onc is likely going to leave them in a much worse spot than they were to begin with? Imagine the opportunity cost of losing 4 years of a $400k income + retirement match in a field where you can literally work anywhere to retrain in something only to fail boards, have no reasonable employment prospects and end up struggling to claw your way back into a hospitalist gig in your 40s. Why would someone like this not just complete a far more lucrative and geographically flexible med onc fellowship?

It's like rad onc suddenly became the Caribbean medical school of residency. The applications are all rubber stamped and everyone thinks they are going to be the 1% exception like that guy who went to some island and got an ortho residency and not the 50% who graduated and couldn't get a residency at all.

 

[TheWallnerus]

This is not going to end well.

A recruiter recently told me an internist at their hospital went back to residency to "do what I did". She said it like it's something you just sign up for if you want to. I couldn't believe it, but I googled this person and it was true. How did this hospitalist have time to do the multiple away rotations and publish the research needed to match into rad onc? Remember how important that used to be? Some more googling out of curiosity finds people who did internship years ago, never did a residency, and are now training in rad onc.

What can be done to get the message out to people like this poor hospitalist that retraining in rad onc is likely going to leave them in a much worse spot than they were to begin with? Imagine the opportunity cost of losing 4 years of a $400k income + retirement match in a field where you can literally work anywhere to retrain in something only to fail boards, have no reasonable employment prospects and end up struggling to claw your way back into a hospitalist gig in your 40s. Why would someone like this not just complete a far more lucrative and geographically flexible med onc fellowship?

It's like rad onc suddenly became the Caribbean medical school of residency. The applications are all rubber stamped and everyone thinks they are going to be the 1% exception like that guy who went to some island and got an ortho residency and not the 50% who graduated and couldn't get a residency at all.

What is even more disheartening is that for the hospital admin doing the hiring for rad onc in Elizabethtown KY sees two CVs come in across his desk... one from a 40yo female who is board certified in internal medicine and rad onc, and trained at UK, and a 31yo guy who did a rad onc residency in Manhattan... which CV do you think he will keep and which one will he trash? Spoiler alert: the hospital admin played football at UK and both his kids are in college there.

"But nobody who does a rad onc residency in Manhattan applies for a job in rural Kentucky."

Right.

 

[OTN]

This is not going to end well.

A recruiter recently told me an internist at their hospital went back to residency to "do what I did". She said it like it's something you just sign up for if you want to. I couldn't believe it, but I googled this person and it was true. How did this hospitalist have time to do the multiple away rotations and publish the research needed to match into rad onc? Remember how important that used to be? Some more googling out of curiosity finds people who did internship years ago, never did a residency, and are now training in rad onc.

What can be done to get the message out to people like this poor hospitalist that retraining in rad onc is likely going to leave them in a much worse spot than they were to begin with? Imagine the opportunity cost of losing 4 years of a $400k income + retirement match in a field where you can literally work anywhere to retrain in something only to fail boards, have no reasonable employment prospects and end up struggling to claw your way back into a hospitalist gig in your 40s. Why would someone like this not just complete a far more lucrative and geographically flexible med onc fellowship?

It's like rad onc suddenly became the Caribbean medical school of residency. The applications are all rubber stamped and everyone thinks they are going to be the 1% exception like that guy who went to some island and got an ortho residency and not the 50% who graduated and couldn't get a residency at all.

If that poor hospitalist made his decision in the last 5 years, the message was indeed out there, and that hospitalist has no one to blame but her or himself for making what I do agree would be a poor decision.

We've done all we can in that time. The consequences of that decision are on the hospitalist, not on us anymore.

 

[evilbooyaa]

60 applications may even be a stretch. based on that twitter account, it looks like every pgy2 at ukentucky was a general surgery resident at some point. couldn't even match the people who wanted rad onc in the first place. but hey, as long as their faculty don't have to go uncovered, am i right?

Not necessarily - in recent history, due to the decrease in quality of applicants, a Rad Onc applicant (especially at a non-top program) may match Rad onc with ease but fail to match into a prelim IM or TY program, and thus have to do prelim surg. I remember incoming rad onc residents who were posting on Twitter about how they were unable to secure ANY prelim year (including prelim surg).

 

[fiji128]

Additionally, at least one of their senior residents transferred programs to finish training elsewhere last year.

UK had two residents transfer out last year. In the last several years they have matched FMGs who couldn't get PGY-1 spots. They have picked up multiple prelim surgery interns who did not secure advanced training spots in surgery to fill any open positions. No idea if this had anything to do with their chair leaving. It used to be you needed to be a med student in the top 10% with a great personality and research or a MD Phd to even get a spot at programs of UK's caliber. Now it's just who is willing and able to sign up! I wonder if UK is considering going from 6 to 4 residents, lol.

This is probably representative of what's been going on in many lower tier programs over the past several years.

 

[TheWallnerus]

Not necessarily - in recent history, due to the decrease in quality of applicants, a Rad Onc applicant (especially at a non-top program) may match Rad onc with ease but fail to match into a prelim IM or TY program, and thus have to do prelim surg. I remember incoming rad onc residents who were posting on Twitter about how they were unable to secure ANY prelim year (including prelim surg).

I did a surgery intern year intentionally. But this was back in a time when interns actually got to go to the O.R. a little and do a lot of minor procedures too (at least at the VA!). A month of neurosurgery, urology, CT surgery, ENT, gyn, etc., in your intern year is helpful. But who knows a month in cardiology in your intern year in the future may be VERY helpful.

 

[TheWallnerus]

OH MY GOD RESIDENCY PROGRAM AND CLERKSHIP DIRECTORS AND DEANS CONSIDERING RESIDENCY CAPS IN OB GYN

Has the FBI been called???

 

[thecarbonionangle]

OH MY GOD RESIDENCY PROGRAM AND CLERKSHIP DIRECTORS AND DEANS CONSIDERING RESIDENCY CAPS IN OB GYN

Has the FBI been called???

OB which is not exactly known for a nurturing culture allows for a pgy2 to put their name on such a piece without putting their career at risk. Meanwhile in the rad onc snake pit, a young faculty at Washu is ostracized and unfriended after a hit job by Hallahan and Lee et al for simply sounding the alarm, only to now find himself on top of workforce commission, one of the most visible people in our field. The morale of the story is to stop being a turtle and stick your neck out every once in a while for what you know is right. You might actually amount to something in our putrid swamp of inaction!

 

[GapCalc]

It's like rad onc suddenly became the Caribbean medical school of residency.

This stings.

 

[elementaryschooleconomics]

OH MY GOD RESIDENCY PROGRAM AND CLERKSHIP DIRECTORS AND DEANS CONSIDERING RESIDENCY CAPS IN OB GYN

Has the FBI been called???

I think it's "just" a cap on the number of residency applications and interviews medical students can send/accept, not on the number of residency spots.

However, the point stands - a coordinated effort on the part of physicians (or soon-to-be physicians) to place some kind of limit/restriction on an aspect of the residency system. ASTRO would indeed have labeled this anti-trust a mere 5 years ago.

Is the FBI even enough? I think we should call the FBI, DEA, Homeland Security, the Navy Seals, appoint a special prosecutor, and hold trials on an abandoned cargo ship 26 miles off the coast of Maine.

 

[jondunn]

 

[medgator]

This stings.

Truth hurts. Things come full circle, the next cycle of rad onc being full of Caribbean grads is forthcoming

 

[elementaryschooleconomics]

I was about to reply "that's a shockingly high number", but then I thought - am I really shocked?

No, no I am not.

 

[seper]

Randall’s cancel editorial is the worst paper I’ve ever read. Good riddance

 

[radiation]

I think it's "just" a cap on the number of residency applications and interviews medical students can send/accept, not on the number of residency spots.

However, the point stands - a coordinated effort on the part of physicians (or soon-to-be physicians) to place some kind of limit/restriction on an aspect of the residency system. ASTRO would indeed have labeled this anti-trust a mere 5 years ago.

Is the FBI even enough? I think we should call the FBI, DEA, Homeland Security, the Navy Seals, appoint a special prosecutor, and hold trials on an abandoned cargo ship 26 miles off the coast of Maine.

I think the main reason for the cap is in the era of online interviews, there are too many people in every specialty accepting every interview invitation because there is no airfare barrier. Even rad onc is talking about this

The Game Continues: Seeking Clarity in the Radiation Oncology Match

Though the previous Gaming the Match agreement offered guidance to programs on how best to approach the Match process, guidance for applicants remains inconsistent. Here we review and propose guidelines by which the spirit of the Match may better be achieved for both program directors and...

www.advancesradonc.org

 

[seper]

I think the main reason for the cap is in the era of online interviews, there are too many people in every specialty accepting every interview invitation because there is no airfare barrier. Even rad onc is talking about this

The Game Continues: Seeking Clarity in the Radiation Oncology Match

Though the previous Gaming the Match agreement offered guidance to programs on how best to approach the Match process, guidance for applicants remains inconsistent. Here we review and propose guidelines by which the spirit of the Match may better be achieved for both program directors and...

www.advancesradonc.org

View attachment 346581

What on Earth are they trying to say?

 

[jondunn]