Rad Onc Twitter

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TheWallnerus said:
Gotta respect the owl. Minerva's owl was her trusted companion, and Minerva was the goddess of as*-kicking and medicine. Good to invoke the owl in medical discussions.

I actually get what he's getting at...

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I really liked Resurrections.... Honestly thought rev was by far the worst of the 4, and obviously nothing will touch the original
 
Mandelin Rain said:
Why are you doing this anyway?

Set the ball contouring tool to 7mm and trace around the vessels, voila.
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That's amateur hour, set the brush to 1.4cm and just drag the mouse through the vessels.

50% less mouse movement!

(editor's note: before you all jump on me, yes, you must also account for vessel size if you do this, so it's usually like 1.6 or 1.7, leave me alone)
 
elementaryschooleconomics said:
That's amateur hour, set the brush to 1.4cm and just drag the mouse through the vessels.

50% less mouse movement!

(editor's note: before you all jump on me, yes, you must also account for vessel size if you do this, so it's usually like 1.6 or 1.7, leave me alone)
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also the vessel margin thing is totally made up. all you need to do is send some dose there.
 
RealSimulD said:
I don’t think 3 field is a box. 3 field is meant to push dose posteriorly, to heat up the rectum / mre / pre sacral space.

In 4 field, the isodose is at center of the uh “box”, and the dose is equal at points equidistant from the iso.
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I would argue that a 3 field technique is meant to spare bowel and bladder (anterior structures), not heat up the rectum. A good 3 field 3dcrt plan can still be fairly homogeneous
 
RadRadRad said:
I would argue that a 3 field technique is meant to spare bowel and bladder (anterior structures), not heat up the rectum. A good 3 field 3dcrt plan can still be fairly homogeneous
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<sheepish>
Yes - that’s the actual answer.
 
jondunn said:
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Dentists have no residency to deal with, option to do a one year fellowship if they want, not sure i see many taking this offer honestly when they can just graduate after 4 years and start making more money than a PCP.

Maybe if he offered some loan repayment on top of it, considering dental school is more expensive than medical school. Sorry Fuller, the dentist job market =/= rad onc job market
 
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To be blunt: this is exactly where Radiation Oncology belongs, even if you think the job market is "OK".

We can just say it aloud - RadOnc was only ever competitive because of the perceived high salary and easy lifestyle. It hasn't done much over the last 20 years to earn/retain how "competitive" it was. Because of the greed of a small handful of individuals in the 2000s, the government has been gunning to reduce our reimbursement for well over a decade. Our best and brightest have been gunning to reduce our footprint in every disease site.

The ERAS/Match data clearly demonstrates the residency and "fellowships" are still being filled with doctors, so no one can try to high-road about this with "who will take care of patients" even if they somehow believe our drop in competitiveness will result in a "shortage" (which would be an incredibly amusing argument to hear, I hope someone tries it).

Canaries, coalmines, competitiveness.
 
medgator said:
No way in hell ent ortho and gu are below #3 gen surg lol. Have heard optho became less competitive over the years after reimbursement cuts
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And guess what even with the cuts Optho is in better shape than us by leaps and bounds.
 
medgator said:
No way in hell ent ortho and gu are below #3 gen surg lol. Have heard optho became less competitive over the years after reimbursement cuts
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GU and ophtho are likely excluded due to being a separate match. Not sure about the other surgical fields.
 
RadsWFA1900 said:
There definitely around any good professional reasons to continue working in this field. I bet if everyone in RO stopped working it wouldn't matter. They would just plow patients with more chemo and I/O and perhaps even more surgery. I sincerely believe that.
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Disagree... Plenty of us with robust practices that have developed with time. A lot of it depends on your setup and referral patterns obviously, but some things just aren't going to replace chemoradiation in lung, h&n and anus, sbrt etc
 
medgator said:
Disagree... Plenty of us with robust practices that have developed with time. A lot of it depends on your setup and referral patterns obviously, but some things just aren't going to replace chemoradiation in lung, h&n and anus, sbrt etc
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I wish I could hang my hat on that but most practices run on prostate and breast. Urologists are taking the int risks to the OR and our own field and med onc are seeing how much systemic agents they can dump into a patient before they don't need RT anymore.

If you whack those two sites out. There isn't enough lung, head and neck, or anal (??) to justify a specialty dedicated to one particular facet of its treatment.
 
medgator said:
for sure, definitely seems to be a wide open job market in my neck of the woods, unlike rad onc
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Same here, I have an Optho colleague looking to work in my area, they have four offers in hand (I saw the contracts). I'm about 45 minutes away from the nearest airport (I wouldn't say truly rural, but definitely not in a city).

Even in this year's "tremendous" RadOnc job market, I'm aware of one, possibly two RadOnc jobs within 1-2 hours of me in any direction. That wasn't the case last year, and I bet it won't be the case next year.

Well, unless another octogenarian finally decides to hang up their grease pencil and open a spot for the class of 2023.
 
jondunn said:
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this makes the owl idea look way more thoughtful. I don't think hypofractionation is driving declining med student interest per se. i would also maybe make harry be sdn, though i know very little about the dynamics of the harry potter universe. I'm thinking Niema is upset with us for taking a dump on his owl epiphany.
 
I do wish the #RaRaRadOnc academicians would take a step back and stop conflating "SDN talking about hypofrac" with "SDN thinks hypofrac is bad" (I'm absolutely not implying Niema is saying that with the meme, it just invariably happens whenever this comes up).

I am, without question, in favor of making our treatments less of a burden on patients while retaining (or improving) efficacy. Literally no one, ever, has made the argument: "I wish we made radiation therapy more difficult for patients".

So, as I try to make this statement on the internet at least once a month: I am completely in favor of reducing or omitting the use of radiation therapy if it means a better quality of life for our patients while providing similar efficacy. Medicine naturally trends in this direction - it's why we're no longer routinely doing Halstead mastectomies on women with 0.4cm hormone receptor-positive breast cancer.

HOWEVER, if you're reducing the use of radiation, and the only thing an entire specialty does is provide radiation, then you don't need as many people working in that specialty.

I know a lot of people have tied their egos to this job, and how competitive we used to be, and somehow find this personally insulting. It's OK to accept that, if all of your research is going into reducing the footprint of radiation therapy, you just don't need as many Radiation Oncologists.

Or, in the words of DJ Khaled:

1643494073890.png
 
elementaryschooleconomics said:
I do wish the #RaRaRadOnc academicians would take a step back and stop conflating "SDN talking about hypofrac" with "SDN thinks hypofrac is bad" (I'm absolutely not implying Niema is saying that with the meme, it just invariably happens whenever this comes up).

I am, without question, in favor of making our treatments less of a burden on patients while retaining (or improving) efficacy. Literally no one, ever, has made the argument: "I wish we made radiation therapy more difficult for patients".

So, as I try to make this statement on the internet at least once a month: I am completely in favor of reducing or omitting the use of radiation therapy if it means a better quality of life for our patients while providing similar efficacy. Medicine naturally trends in this direction - it's why we're no longer routinely doing Halstead mastectomies on women with 0.4cm hormone receptor-positive breast cancer.

HOWEVER, if you're reducing the use of radiation, and the only thing an entire specialty does is provide radiation, then you don't need as many people working in that specialty.

I know a lot of people have tied their egos to this job, and how competitive we used to be, and somehow find this personally insulting. It's OK to accept that, if all of your research is going into reducing the footprint of radiation therapy, you just don't need as many Radiation Oncologists.

Or, in the words of DJ Khaled:

View attachment 349242
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as the math says (plenty of scarb posts), hypofrac and fewer indications mean fewer treatments, and the need for fewer radoncs. In turn, the meme we're talking about is nonsensical as only one of those things, which med students are ignorant of, is a prime mover. IOW,, hypofrac/fewer indications lead to SDN discussing how the math doesn't add up in the long-run, hence adding to "job market fears," which is itself a misrepresentation. more like job market prognosis.
 
elementaryschooleconomics said:
I do wish the #RaRaRadOnc academicians would take a step back and stop conflating "SDN talking about hypofrac" with "SDN thinks hypofrac is bad" (I'm absolutely not implying Niema is saying that with the meme, it just invariably happens whenever this comes up).

I am, without question, in favor of making our treatments less of a burden on patients while retaining (or improving) efficacy. Literally no one, ever, has made the argument: "I wish we made radiation therapy more difficult for patients".

So, as I try to make this statement on the internet at least once a month: I am completely in favor of reducing or omitting the use of radiation therapy if it means a better quality of life for our patients while providing similar efficacy. Medicine naturally trends in this direction - it's why we're no longer routinely doing Halstead mastectomies on women with 0.4cm hormone receptor-positive breast cancer.

HOWEVER, if you're reducing the use of radiation, and the only thing an entire specialty does is provide radiation, then you don't need as many people working in that specialty.

I know a lot of people have tied their egos to this job, and how competitive we used to be, and somehow find this personally insulting. It's OK to accept that, if all of your research is going into reducing the footprint of radiation therapy, you just don't need as many Radiation Oncologists.

Or, in the words of DJ Khaled:

View attachment 349242
Click to expand...

OMG the common sense is too much.

Our specialty just gives radiation —> Our specialty mostly does research that reduces the fractions or indications for radiation —> Our specialty does not reduce the number of radiation oncologists

Due to bias and incentives the academics are blind but med students are not stupid. I am so sad to see what is going on. I’m going to petition the ABR for a new designation Golden Era Radiation Oncologist (GERO): RadOncMegatron, MD, DABR, GERO
 
radoncftw said:
The real question. Where is simul the great headed to next? I hear he may joining Case under Spratt 🙂
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Simple answer is that I wasn’t able to do the three things most important to me 1) spend quality time with my wife 2) spend quality time with my children 3) cook dinner for my family. We are moving home to Detroit and aiming to settle into something that allows me to do all 3 at the highest level possible. Making this decision a few months ago have led to the greatest personal and professional contentment I’ve ever felt. Essentially, I overvalued what I thought was important and undervalued what actually was important.

Complex answer is something we can talk about in person over a cold non-alcoholic beverage 😊
 
RealSimulD said:
Simple answer is that I wasn’t able to do the three things most important to me 1) spend quality time with my wife 2) spend quality time with my children 3) cook dinner for my family. We are moving home to Detroit and aiming to settle into something that allows me to do all 3 at the highest level possible. Making this decision a few months ago have led to the greatest personal and professional contentment I’ve ever felt. Essentially, I overvalued what I thought was important and undervalued what actually was important.

Complex answer is something we can talk about in person over a cold non-alcoholic beverage 😊
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Yes, absolutely great choice. Family >>> Career

I respect you even more.
 
Interesting statistics 2005 vs 2021.
Not that we are surprised by the stats:


 
RickyScott said:
If you are truly dedicated to radonc, you shouldn’t expect to live close to family. Working at an academic satellite in BFE is our calling.
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That’s silly truly dedicated ROs need to cut all ties with family, surrender all possessions, live far away, live an ascetic life, and also eliminate any actual indications.

The finest moment of an ROs life is when he writes an apology letter to the rest of the oncology team for his or her existence in the treatment of cancer and then proceeds to dump kerosine of themselves and self immolate become a plume of smoke and becoming one with the earth.
 
Radonc90 said:
Interesting statistics 2005 vs 2021.
Not that we are surprised by the stats:


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From the recent Goodman et al paper
1643509941659.png

It looked to be 86/86 US MDs in 2021. If you look at the NRMP reports, a sea change happened between 2018 and 2019. I suspect this competitiveness table would've looked the same if 2015 instead of 2005.
 
Ray D. Ayshun said:
It looked to be 86/86 US MDs in 2021. If you look at the NRMP reports, a sea change happened between 2018 and 2019. I suspect this competitiveness table would've looked the same if 2015 instead of 2005.
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It's almost like...up until 2018, everyone was so careful not to be labeled a troublemaker, because you were so grateful to have been granted access to "the club", and as long as you bent the knee to the right people at the right time, you could stay in the club, even though things looked a little different on the other side of the curtain.

Then, something changed like, oh, I dunno, a tremendous number of people failed some board exams, two out of four board exams (more than any other specialty), two exams which test basic science (unlike any other specialty), and the people in charge shrugged, said their black-box process was perfect, said it was the fault of the residents, even said that the quality of residents had been decreasing, made this statement both in-person at a specialty conference and also published it.

It's almost like...in such a small specialty, propped up by the illusion of competitiveness essentially through lore alone, that if the leadership sends clear signals that they do not care about the next generation, people in that generation will actually speak up about their concerns, the information asymmetry between resident and student decreases, and medical students are allowed to make decisions based on data, instead of mystical whispers about the elite status of a specialty built entirely around a modality - and mostly around a single machine.

In a weird way, perhaps we should be thankful of the ineptness of the leadership, because their ham-handed management accelerated the bubble bursting faster than anything else could. Even a manuscript published two years prior projecting oversupply couldn't rock the boat as hard as the ABR telling a group of kids who were 25% MD-PhD, the majority AOA, Step 1 scores far above average, publication numbers far above average - that they weren't quality residents.

1643515213569.png


1643513980230.png
 
Ray D. Ayshun said:
From the recent Goodman et al paper
View attachment 349267
It looked to be 86/86 US MDs in 2021. If you look at the NRMP reports, a sea change happened between 2018 and 2019. I suspect this competitiveness table would've looked the same if 2015 instead of 2005.
Click to expand...
That graph legend with its dual shading to cover two graphs with single lines may be the most confusing data presentation I’ve ever seen.
 
Also - I still can't understand that statement, four years after it was published.

Here is what they cite for their claim of decreasing quality: 2017 Main Residency Match

There is absolutely no data in this report regarding "quality". Quality is, obviously, a nebulous definition in this context. We happen to traditionally think of "quality" in terms of the metrics which are needed to match in "competitive" specialties, which have been USMLE Step 1, AOA, class rank, clinical grades, publications, etc.

None of these things show up in this report. The only mention of "competitiveness" is this:

1643515897509.png


Literally, the example factors which are acknowledged to affect this surrogate endpoint precisely describe Radiation Oncology residency programs.

Well, even knowing this is a very flawed metric, the trend must be really obvious for the American Board of Radiology to claim the residents are of...inferior quality:

1643516130273.png


Hmmm...the 5-year average of the "average number of ranked applicants needed to fill each position" is 5.4, and each year's number 1) is within 0.5 of that average and 2) shows no such trend to back up their claim.

EVEN IF you want to make the argument that going from 4.9 --> 5.7 of this INSANELY FLAWED SURROGATE ENDPOINT is indeed indicative of a "decrease in quality", the people who took the board exams in 2018 were the residency class of 2019. The residency class of 2019 participated in the Match of 2014, which, according to this cited data, was the most competitive class in this five-year cohort.

If I'm interpreting this data wrong, please correct me - because otherwise, I have grave concerns about the ability of the ABR to understand how numbers work.
 
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