Rad Onc Twitter

[RickyScott]

I would think after 10-15 years of training AOA type medstudents, it would really raise the bar in the community (not that there arent bad docs here and there) but I see 0 recognition of this at academic centers. Even if we trained another 10 years of top medsutents (which we wont- party is over) I am sure that some academic centers would continue to put down community docs. I can say this- academic centers are more likely to have sh-- dosimetrist (and in some cases physics) Why- because they pay less and most would rather not commute into a large city and would prefer to earn more in the suburbs.
You can get by as a poor dosem or physics in large group but not small group.

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[RadOncDoc21]

My neighborhood academic center tells patients they all need Gamma Knife and/or protons for things like brain mets, breast and prostates. Not saying all the docs are guilty but definitely enough to question their motives.

 

[OTN]

Quite frankly, your juxtaposition is confusing. Of course they are not the same thing. If the MSKCC doctor acted cravenly, greedily, condescendingly etc..., it was wrong (and we don't even know that to be the case). It wouldn't mean that all academics are "scum" (appreciate you calling this out), nor would it mean that all academics are "driving a wedge" into our field. It would mean that a nameless doctor at MSKCC was wrong.

The idea that everyone who works in an NCI cancer center somehow bears responsibility for that one doc who reportedly said a bad thing that one time is, frankly, silly.

We all trained in academic centers. We all saw the disdain that many of them expressed about their pp counterparts. All of them? No. Enough to label it systemic and a problem? Possibly.

I also agree that, over the last 15 years, the med students who went into radonc were the best of the best. To now be told by an older generation who couldn't even have gotten an interview if they applied when it was competitive that we "can't spare a patient's right heart" like they can is infuriating.

 

[Reaganite]

My neighborhood academic center tells patients they all need Gamma Knife and/or protons for things like brain mets, breast and prostates. Not saying all the docs are guilty but definitely enough to question their motives.

used to run into this all the damn time with a certain academic neurosurg group. I went straight to the local insurer we were all dealing with and embarrassed the hell out of them showing how ridiculous (and expensive) their requests were. Their ****-talking stopped pretty quickly after that

 

[radiation]

We all trained in academic centers. We all saw the disdain that many of them expressed about their pp counterparts. All of them? No. Enough to label it systemic and a problem? Possibly.

I also agree that, over the last 15 years, the med students who went into radonc were the best of the best. To now be told by an older generation who couldn't even have gotten an interview if they applied when it was competitive that we "can't spare a patient's right heart" like they can is infuriating.

Here's some philosophical food for thought. What does it say about our field, if after 10-15 years of producing "the best of the best" and "AOA type med students" the field is where it is today. Do we hold this golden generation accountable for any of the criticism levied around these parts? Or does it all lay at the feet of the old stalwarts in their ivory towers?

 

[PhotonBomb]

 

[RadOncDoc21]

So if 76 applicants ask all these questions for one job, how many of them will get the job?

 

[PhotonBomb]

Why 76

 

[medgator]

Why 76

You're right. Could easily be triple digits in the right practice setup and geography. @Gfunk6 was looking a couple of years ago and mentioned being bombarded for a private practice in the Bay area

 

[bluebubbles]

Here's some philosophical food for thought. What does it say about our field, if after 10-15 years of producing "the best of the best" and "AOA type med students" the field is where it is today. Do we hold this golden generation accountable for any of the criticism levied around these parts? Or does it all lay at the feet of the old stalwarts in their ivory towers?

Yes, I agree that during the golden age of IMRT, 2000's to early or even mid 2010's, "the best of the best" former AOA 270's step 1 & 2 med students likely chose between academic jobs and PP partnership-track jobs, and many likely followed the path of least resistance.

I understand your line of thought: the PP docs blaming the academics for expanding residency slots and hospital ACO's and lack of pay parity, and the academics asking if the PP docs are just dead weight for insufficient clinical trial participation and overall doing less to advance the field & expand indications.

Before the brawl continues, I'd like to excuse myself and say that we all live in glass houses (or glass apartment studios for us residents), and not to throw too many rocks.

 

[RadOncDoc21]

Why 76

Because the other 48 applicants were so desperate, they didn’t care to ask any questions. I’m just trying to calculate the odds?

 

[KHE88]

These are horrible questions. It's pretty remarkable how out of touch this is.
Let's analyze them one by one:

1. What are your goals for me?
Your first question is going to be to ask your employer what they want you to do? Really?

2. How do you define me as successful?
Just in case you don't know how to tell on your own if you're successful? i got a pretty good idea, but maybe you could just clarify so we're on the same page?

3. What are hospital goals, metrics?
Just in case we didn't touch on this on my first two totally perfect questions. Redundant questions are always winners.

4. How do I win?
Speaking of winning...
How exactly does one win at radiation oncology?
Has rad onc become so noncompetitive that Charlie Sheen was able to match?

5. Explain workflow, reimbursement?
These things totally have a lot to do with each other. Solid question. But lets make it a three-parter to really strut your stuff: "Explain your workflow, tell me how I get paid, and what's your policy on pet hedgehogs in the office? Go."

6. Has anyone left? How to contact them?
Of course a hospital that is trying to recruit somebody is going to be open about problems with previous staff, admit that someone quit, and not only that, also give you their contact information. This is a totally reasonable expectation and will make you look insightful to your potential employer.

7. Is this is a multi-disciplinary practice?
There is no way that you could know this beforehand, so of course it's totally appropriate to ask this question to your interviewer.

8. What equipment would I need for job?
Most of us spend 4 years of rad onc residency and come out not knowing what tools we need to do our job.

9. Can I see chart rounds?
Also, can I have access to your EMR, look at patient records, maybe do a couple of consults to feel out your patient population.

10. What are responsibilities?
Do I have to clean the bathrooms at the end of the day? Who is responsible for locking up each night? That's my job right? Do I have do my own plans or do you have someone that sets fields and creates plans for me? Do I have to get vitals on my patients. They taught me how to do it in medical school - I can take a blood pressure! Ohh, I'm good at that one.

Seriously. This absurd list of questions immediately brings this to mind:

 

[medgator]

If he wants to help new grads find a job, the best thing he can do is shoot down his own department's attempt to open a new residency program.

Have to agree with khe on this one otherwise, that slide indicates the talk was probably useless

 

[radOresident]

We all trained in academic centers. We all saw the disdain that many of them expressed about their pp counterparts. All of them? No. Enough to label it systemic and a problem? Possibly.

I also agree that, over the last 15 years, the med students who went into radonc were the best of the best. To now be told by an older generation who couldn't even have gotten an interview if they applied when it was competitive that we "can't spare a patient's right heart" like they can is infuriating.

I can't understand how someone could genuinely think this is not a problem. Everyone who has been a part of an academic center has heard the same poo-pooing and negativity toward private practice docs for years. Unfortunately, there exists a group of people who drink the kool-aid and continue the cycle once they themselves go into academics.

We have multiple fantastic private practice groups within our catchment area but listening to academics when patients ask about going to one of them because it's more convenient you'd think they all still used betatrons and hadn't reviewed any literature since the 50s.

 

[PhotonBomb]

absolutely disagree with KHE

When I applied I basically asked all of those questions plus or minus. Not sure why you wouldn't when evaluating a practice.

One can argue you don't need a talk to tell this to you, but that's what most career/residency application/fellowship application/med school application advice stuff is like. For some people they see it as common sense and some people like having some direction because they aren't good at stuff like this. My guess is people seeking out a talk like this or others are ones who are apt to want advice. The same type of people who seek out leadership training, etc, other 'soft science' advice. Works for some not for others.

but the advice isn't bad/wrong. I know some of you can't get past the one note 'THERE ARE NO JOBS' but take a breath and move past that and for the rest of us living in day to day reality who recently or are going through the job process, these are all things to care about

I have multiple friends who are applying this year and they have all called me prior to interviews starting over the past 2 months and asked general advice such as this - what to look for on the site visits, what to ask, what are red flags.

 

[RadOncDoc21]

absolutely disagree with KHE

When I applied I basically asked all of those questions plus or minus. Not sure why you wouldn't when evaluating a practice.

One can argue you don't need a talk to tell this to you, but that's what most career/residency application/fellowship application/med school application advice stuff is like. For some people they see it as common sense and some people like having some direction because they aren't good at stuff like this. My guess is people seeking out a talk like this or others are ones who are apt to want advice. The same type of people who seek out leadership training, etc, other 'soft science' advice. Works for some not for others.

but the advice isn't bad/wrong. I know some of you can't get past the one note 'THERE ARE NO JOBS' but take a breath and move past that and for the rest of us living in day to day reality who recently or are going through the job process, these are all things to care about

I have multiple friends who are applying this year and they have all called me prior to interviews starting over the past 2 months and asked general advice such as this - what to look for on the site visits, what to ask, what are red flags.

Ok man we get it, everything is awesome, and you’re cool!

 

[OTN]

Here's some philosophical food for thought. What does it say about our field, if after 10-15 years of producing "the best of the best" and "AOA type med students" the field is where it is today. Do we hold this golden generation accountable for any of the criticism levied around these parts? Or does it all lay at the feet of the old stalwarts in their ivory towers?

Unless we start with the term limits that Dr. Jagsi suggested, those old stalwarts aren't going anywhere and have been the ones making the decisions. No one who graduated residency ten years ago is a chair already.

 

[scarbrtj]

I can't understand how someone could genuinely think this is not a problem. Everyone who has been a part of an academic center has heard the same poo-pooing and negativity toward private practice docs for years. Unfortunately, there exists a group of people who drink the kool-aid and continue the cycle once they themselves go into academics.

We have multiple fantastic private practice groups within our catchment area but listening to academics when patients ask about going to one of them because it's more convenient you'd think they all still used betatrons and hadn't reviewed any literature since the 50s.

I generally chalk up the anti-pp sentiment/mindset to human nature. And maybe what might be called an anchoring bias. I'm of the general opinion that if you become board certified in rad onc, you're smart. So this should allow some benefit of the doubt right? But just ponder how different these two statements (imagine like you're talking to another colleague) look and feel on paper:

"I saw MD Anderson do something I've never really heard about before and it sounds weird. They're giving 30 Gy to the elective neck."
versus
"I saw Dr. Bob in Poughkeepsie do something I've never really heard about before and it sounds weird. He gave 30 Gy to the elective neck."

Our bias is to think if someone does something different in PP it's crazy. But if someone does something different in academics it hits the brain with a certain force of authority cancelling out any nascent negative thoughts almost instantaneously. For example, when Nancy Lee said proton centers would continue to use protons regardless of negative trials, for a moment I thought "Well there is that Bragg peak thing." And when it came to light that MSKCC does EKGs pre-tx on all XRT patients no matter what, for a split second I considered the ramifications of doing that in my own practice. I'm kind of sad I even had those last two thoughts.

 

[RadOncDoc21]

I generally chalk up the anti-pp sentiment/mindset to human nature. And maybe what might be called an anchoring bias. I'm of the general opinion that if you become board certified in rad onc, you're smart. So this should allow some benefit of the doubt right? But just ponder how different these two statements (imagine like you're talking to another colleague) look and feel on paper:

"I saw MD Anderson do something I've never really heard about before and it sounds weird. They're giving 30 Gy to the elective neck."
versus
"I saw Dr. Bob in Poughkeepsie do something I've never really heard about before and it sounds weird. He gave 30 Gy to the elective neck."

Our bias is to think if someone does something different in PP it's crazy. But if someone does something different in academics it hits the brain with a certain force of authority cancelling out any nascent negative thoughts almost instantaneously. For example, when Nancy Lee said proton centers would continue to use protons regardless of negative trials, for a moment I thought "Well there is that Bragg peak thing." And when it came to light that MSKCC does EKGs pre-tx on all XRT patients no matter what, for a split second I considered the ramifications of doing that in my own practice. I'm kind of sad I even had those last two thoughts.

To be fair, I give them that privilege because that is their role just as long as they can provide data to support their treatment. A doc outside of academics should be able to practice at the very minimal, the standard of care or an alternative approach that is reasonable and documented as such. Most places have some form of peer review as well.

It’s the “non-academic docs can’t hit a T1 larynx since they don’t have protons” claim that boggles my mind. Or that a community doc can’t treat a left-sided breast cancer remark. I mean we all for the most part trained at an academic center and took our boards. Now asking me to treat a medulloblastoma in a 5 yr old is another story!

 

[radiaterMike]

Unless we start with the term limits that Dr. Jagsi suggested, those old stalwarts aren't going anywhere and have been the ones making the decisions. No one who graduated residency ten years ago is a chair already.

not entirely true (chair at Kansas) and some are close (chairs at NYU, Mayo, Irvine)

 

[OTN]

To be fair, I give them that privilege because that is their role just as long as they can provide data to support their treatment. A doc outside of academics should be able to practice at the very minimal, the standard of care or an alternative approach that is reasonable and documented as such. Most places have some form of peer review as well.

It’s the “non-academic docs can’t hit a T1 larynx since they don’t have protons” claim that boggles my mind. Or that a community doc can’t treat a left-sided breast cancer remark. I mean we all for the most part trained at an academic center and took our boards. Now asking me to treat a medulloblastoma in a 5 yr old is another story!

Outside of peds, I'm completely comfortable treating anything with any technique, save for IORT (which I don't do). I never have and never will understand the "I'm going to refer this out to an academic because I can't do it" mentality, unless you don't have the training/experience. As long as you have the training and hardware (and we do), a good radonc should be able to treat more or less anything in the adult population.

I don't like the "well they can do T1 larynx or left-sided breast ok I guess" compromise at all. Good private practitioners can treat complex stuff just as well as academicians, full stop. Again, remember that over the last 15 years some of the best med students in the country joined our specialty. Maybe it's just applicable to that generation, but all of us in my group now, save one older radonc who is very good and knows his limitations, are in that generation and can- and do- treat anything.

 

[RickyScott]

absolutely disagree with KHE

When I applied I basically asked all of those questions plus or minus. Not sure why you wouldn't when evaluating a practice.

One can argue you don't need a talk to tell this to you, but that's what most career/residency application/fellowship application/med school application advice stuff is like. For some people they see it as common sense and some people like having some direction because they aren't good at stuff like this. My guess is people seeking out a talk like this or others are ones who are apt to want advice. The same type of people who seek out leadership training, etc, other 'soft science' advice. Works for some not for others.

but the advice isn't bad/wrong. I know some of you can't get past the one note 'THERE ARE NO JOBS' but take a breath and move past that and for the rest of us living in day to day reality who recently or are going through the job process, these are all things to care about

I have multiple friends who are applying this year and they have all called me prior to interviews starting over the past 2 months and asked general advice such as this - what to look for on the site visits, what to ask, what are red flags.

These are horrible questions. It's pretty remarkable how out of touch this is.
Let's analyze them one by one:

1. What are your goals for me?
Your first question is going to be to ask your employer what they want you to do? Really?

2. How do you define me as successful?
Just in case you don't know how to tell on your own if you're successful? i got a pretty good idea, but maybe you could just clarify so we're on the same page?

3. What are hospital goals, metrics?
Just in case we didn't touch on this on my first two totally perfect questions. Redundant questions are always winners.

4. How do I win?
Speaking of winning...
How exactly does one win at radiation oncology?
Has rad onc become so noncompetitive that Charlie Sheen was able to match?

5. Explain workflow, reimbursement?
These things totally have a lot to do with each other. Solid question. But lets make it a three-parter to really strut your stuff: "Explain your workflow, tell me how I get paid, and what's your policy on pet hedgehogs in the office? Go."

6. Has anyone left? How to contact them?
Of course a hospital that is trying to recruit somebody is going to be open about problems with previous staff, admit that someone quit, and not only that, also give you their contact information. This is a totally reasonable expectation and will make you look insightful to your potential employer.

7. Is this is a multi-disciplinary practice?
There is no way that you could know this beforehand, so of course it's totally appropriate to ask this question to your interviewer.

8. What equipment would I need for job?
Most of us spend 4 years of rad onc residency and come out not knowing what tools we need to do our job.

9. Can I see chart rounds?
Also, can I have access to your EMR, look at patient records, maybe do a couple of consults to feel out your patient population.

10. What are responsibilities?
Do I have to clean the bathrooms at the end of the day? Who is responsible for locking up each night? That's my job right? Do I have do my own plans or do you have someone that sets fields and creates plans for me? Do I have to get vitals on my patients. They taught me how to do it in medical school - I can take a blood pressure! Ohh, I'm good at that one.

Seriously. This absurd list of questions immediately brings this to mind:

Applicants really dont have much in the way of choice. Best advice is to be as agreeable as possible you really cant afford to be that selective as you are in a somewhat desperate position with little leverage.

 

[PleaseRemainCalm]

Ok fair enough but how is this implemented? How do you tell 80 yo clown bully chair that he has had a pretty good run?

There are medical schools that put term limits on their department chairs and I think it's a very good thing. Nobody HAS to be a chair for 20 years

 

[evilbooyaa]

not entirely true (chair at Kansas) and some are close (chairs at NYU, Mayo, Irvine)

But if they are then they just started. Expecting them to have already saved the field from boomers is asking a bit much, no? What fraction of current chairs, especially those at academic programs, graduated within the past 10-15 years?

 

[CaesarRO]

Unless we start with the term limits that Dr. Jagsi suggested, those old stalwarts aren't going anywhere and have been the ones making the decisions. No one who graduated residency ten years ago is a chair already.

Vinay Prasad (Hem Onc) also talked about this:

'Making Room' for a New Generation of Medical Leaders

Vinay Prasad outlines 10 ways that senior faculty members can help junior researchers advance professionally.

www.medscape.com

I want to be very clear. I believe that as long as they are of sound mind, individuals should be free to work as long as they choose. At the same time, given limited opportunities in academic medicine and the need to cultivate the next generation of leaders, I propose that distinguished faculty voluntarily embrace an attitude of "making room" for the next generation.

...

Here I suggest 10 voluntary actions that would "make room" for junior physicians. I propose that any faculty member who has held the rank of professor for more than 10 years strongly consider adopting these. Please note that I am careful to define distinguished faculty not by age, but by years holding the full professor title.

Sent from my Pixel 2 XL using Tapatalk

 

[PhotonBomb]

Ok man we get it, everything is awesome, and you’re cool!

Didn’t say everything is awesome. Keep missing the point!

 

[RickyScott]

Vinay Prasad (Hem Onc) also talked about this:

'Making Room' for a New Generation of Medical Leaders

Vinay Prasad outlines 10 ways that senior faculty members can help junior researchers advance professionally.

www.medscape.com

Sent from my Pixel 2 XL using Tapatalk

Outside of medicine, in major academic departments, dont chairs serve for 2-3 year terms?

 

[PhotonBomb]

Outside of peds, I'm completely comfortable treating anything with any technique, save for IORT (which I don't do). I never have and never will understand the "I'm going to refer this out to an academic because I can't do it" mentality, unless you don't have the training/experience. As long as you have the training and hardware (and we do), a good radonc should be able to treat more or less anything in the adult population.

I don't like the "well they can do T1 larynx or left-sided breast ok I guess" compromise at all. Good private practitioners can treat complex stuff just as well as academicians, full stop. Again, remember that over the last 15 years some of the best med students in the country joined our specialty. Maybe it's just applicable to that generation, but all of us in my group now, save one older radonc who is very good and knows his limitations, are in that generation and can- and do- treat anything.

agreed that this has evolved over the last 10-15 years or so with good modern training pumping people out into the workforce.

other key I learned during residency when referring people closer to home is knowing who is scrupulous and who is not. if it happens a few too many times that the patient calls back and says 'Doc you said 5 or 10 treatments to my hip but this guy/gal is saying 13 or 15 or 20 or 25, is that okay????' and I stopped sending patients there

 

[RadOncDoc21]

Didn’t say everything is awesome. Keep missing the point!

But you are cool!

 

[PhotonBomb]

But you are cool!

Too kind!

 

[radiaterMike]

But if they are then they just started. Expecting them to have already saved the field from boomers is asking a bit much, no? What fraction of current chairs, especially those at academic programs, graduated within the past 10-15 years?

I never said that they will or would save the field - I only mentioned that the claim that there are no chairs that graduated in the past 10-15 years is false.

 

[RadDoc11]

Just had pt treated for calvarial mets at MSKCC who was told they couldnt possibly do good job with mask at home. Made them stay for a week in nyc. I am sure they were just trying to limit financial toxicity...

An attending from MSKCC who was treating prostate told me a few years ago that at one point when their volume had dipped a little they were instructed not to send any patients to the satellites closer to their homes and also not to recommend active surveillance. I am
not making this up. Shameful.

 

[medgator]

An attending from MSKCC who was treating prostate told me a few years ago that at one point when their volume had dipped a little they were instructed not to send any patients to the satellites closer to their homes and also not to recommend active surveillance. I am
not making this up. Shameful.

Imagine what the places with proton centers do (Sloan didn't back then iirc).

Even our local shady urologists back in the day were aware of the aggressive, questionable marketing of proton therapy to prostate patients

 

[PhotonBomb]

An attending from MSKCC who was treating prostate told me a few years ago that at one point when their volume had dipped a little they were instructed not to send any patients to the satellites closer to their homes and also not to recommend active surveillance. I am
not making this up. Shameful.

weird - it would make sense (wouldn't be right necessarily but would make sense) if they were saying to keep in the MSKCC satellite network - but why would they say not to send to satellite closer to home? it's all the same pot.

 

[PleaseRemainCalm]

weird - it would make sense (wouldn't be right necessarily but would make sense) if they were saying to keep in the MSKCC satellite network - but why would they say not to send to satellite closer to home? it's all the same pot.

It's not always the same pot. The details of the financial arrangement can be such that the academic attendings as a group stand to gain if patient is treated at main campus vs satellite. For example the satellite revenue may not be factored into a communal bonus. Or main campus may pay the rad onc attendings at a satellite but local hospital may take a big chunk of the technical fees. Or the satellite may have different deals with insurance companies that presumably could be less favorable.

 

[medgator]

It's not always the same pot. The details of the financial arrangement can be such that the academic attendings as a group stand to gain if patient is treated at main campus vs satellite. For example the satellite revenue may not be factored into a communal bonus. Or main campus may pay the rad onc attendings at a satellite but local hospital may take a big chunk of the technical fees. Or the satellite may have different deals with insurance companies that presumably could be less favorable.

Same reason why Nancy Lee is still going to treat with protons regardless of what the data ends up showing

 

[RadOncDoc21]

Same reason why Nancy Lee is still going to treat with protons regardless of what the data ends up showing

Right, sometimes the satellites are there to feed the mothership. Those docs may be the best referral source to getting more patients to receive protons. It’s a dirty game in which it all comes down to one thing... C.R.E.A.M (dollar dollar bills ya’ll!)

 

[RickyScott]

Right, sometimes the satellites are there to feed the mothership. Those docs may be the best referral source to getting more patients to receive protons. It’s a dirty game in which it all comes down to one thing... C.R.E.A.M (dollar dollar bills ya’ll!)

academic veneer, but all about the money. Really need inurance rate transparency to expose what these centers are charging.

 

[PhotonBomb]

Admins are admins and their job is to care about money. Nothing more, nothing less.

Weird that people seem surprised

 

[RadDoc11]

Admins are admins and their job is to care about money. Nothing more, nothing less.

Weird that people seem surprised

But physicians have a responsibility to their patients and if a section head or department chair is pressuring docs to ask patients to unnecessarily commute longer distances to receive the same care available to them closer to their home or to forego evidence based guidelines (active surveillance), we have a real issue. This was a request from a physician in leadership, not an admin.

 

[PhotonBomb]

But physicians have a responsibility to their patients and if a section head or department chair is pressuring docs to ask patients to unnecessarily commute longer distances to receive the same care available to them closer to their home or to forego evidence based guidelines (active surveillance), we have a real issue. This was a request from a physician in leadership, not an admin.

oh of course I agree that physicians have responsibility to patients.

will say that in my experience, easier to do stuff that is not business-friendly but better for a patient in academic center than a place like Texas Oncology. Admins at Texas Oncology are empowered to 'guide' your hand. some more aggressive than others.

 

[medgator]

Admins at Texas Oncology are empowered to 'guide' your hand. some more aggressive than others.

Have heard the exact opposite actually. Doctors practice freely in those setups and are self employed

 

[deleted947887]

oh of course I agree that physicians have responsibility to patients.

will say that in my experience, easier to do stuff that is not business-friendly but better for a patient in academic center than a place like Texas Oncology. Admins at Texas Oncology are empowered to 'guide' your hand. some more aggressive than others.

LOL

 

[PhotonBomb]

Have heard the exact opposite actually. Doctors practice freely in those setups and self employed

Lol. Admins at Texas onc def def def def have strong opinions on how to ‘gently guide’ you to their way.

 

[Chartreuse Wombat]

Wow. This tweeter is the kind of person that thinks everything is wonderful, magical, beautiful, etc. Life is wonderful

oh of course I agree that physicians have responsibility to patients.

will say that in my experience, easier to do stuff that is not business-friendly but better for a patient in academic center than a place like Texas Oncology. Admins at Texas Oncology are empowered to 'guide' your hand. some more aggressive than others.

Said one admin to a newly minted employee "active surveillance is not an option in prostate cancer"

 

[medgator]

Lol. Admins at Texas onc def def def def have strong opinions on how to ‘gently guide’ you to their way.

And zero power to enforce it, since they don't employ you.

Very different relationship than being employed by your chair at an NCI center

 

[PhotonBomb]

And zero power to enforce it, since they don't employ you.

Very different relationship than being employed by your chair at an NCI center

I don’t think you quite understand the Topa model....

 

[medgator]

I don’t think you quite understand the Topa model....

Says the guy still in training lol

 

[PhotonBomb]

Says the guy still in training lol

What? No I’m not. Literally what?

 

[medgator]

What? No I’m not. Literally what?

Well it certainly sounds like it. Have you actually spoken with someone that works in TOPA?