Rad Onc Twitter

[Old rad onc]

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.

When I was a med student, Opthalmology was the highest paid field and many AoA types were disappointed when cataract reimbursement got cut. It is a reason why you should not chase a field. Derm and ortho good, rad onc and path bad. But it may all change. Go into a field because you like the work, not for money or security. Most MDs that are boomers have kids that are not doctors. They are chasing business school or tech. I have always been contrarian in most things and it has worked well..... especially stocks and real estate.

Academic centers have realized PP are competition so you do what’s necessary as a business. I don’t take it personally but I also do what I need to compete. We all know chairs that are not great doctors but are good administrators and speakers. The competitive and financial aspects of our work are not ideal but are a reality of the times. Both academics and privates are important and neither is going away.

Also Boomers vs smart 40s and younger docs are similar. Neither can claim superiority.... it’s like Tom Brady and Drew Brees vs Lamar Jackson as to who is better.... ok Brady sucks this year but maybe not his fault. You cannot force docs out and you young attendings will see the same thing 10-15 years from now if someone tried to force you out. So smarter and more technologically advanced does not always mean better compared to wisdom and experience. But I’ll admit sometimes it does.

One things for sure. Our field is going to change. But Radiation is not dead. It’s just feeling a bit hormone resistant. And Protons are definitely not going to help with that!

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[RadOncDoc21]

When I was a med student, Opthalmology was the highest paid field and many AoA types were disappointed when cataract reimbursement got cut. It is a reason why you should not chase a field. Derm and ortho good, rad onc and path bad. But it may all change. Go into a field because you like the work, not for money or security. Most MDs that are boomers have kids that are not doctors. They are chasing business school or tech. I have always been contrarian in most things and it has worked well..... especially stocks and real estate.

Academic centers have realized PP are competition so you do what’s necessary as a business. I don’t take it personally but I also do what I need to compete. We all know chairs that are not great doctors but are good administrators and speakers. The competitive and financial aspects of our work are not ideal but are a reality of the times. Both academics and privates are important and neither is going away.

Also Boomers vs smart 40s and younger docs are similar. Neither can claim superiority.... it’s like Tom Brady and Drew Brees vs Lamar Jackson as to who is better.... ok Brady sucks this year but maybe not his fault. You cannot force docs out and you young attendings will see the same thing 10-15 years from now if someone tried to force you out. So smarter and more technologically advanced does not always mean better compared to wisdom and experience. But I’ll admit sometimes it does.

One things for sure. Our field is going to change. But Radiation is not dead. It’s just feeling a bit hormone resistant. And Protons are definitely not going to help with that!

Great post! My only criticism of the rad oncs who came before me is that they did not do enough to protect our field especially during the “golden era” of radiation oncology (2000-2015).

 

[PhotonBomb]

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

Without doxxing myself, I am extremely familiar

 

[RadOncDoc21]

Without doxxing myself, I am extremely familiar

See... I told ya’ll he’s cool!

 

[PhotonBomb]

See... I told ya’ll he’s cool!

too kind!

 

[medgator]

Without doxxing myself, I am extremely familiar

So then you know the administrators have zero say over employment and don't even employ the doctors.

 

[OTN]

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

You are 100% wrong and completely incorrect. TOPA is a physician-led and owned organization, full-stop. MDs after they are partner are not employed. Administrators do whatever the MDs want and have no say whatsoever in clinical treatment decisions made by the physicians. I'm not sure how or why you're so confident when you are so very wrong.

As far as patients being able to get better/more cost-effective treatment at an academic center because of administration pressure on TOPA MDs, that's not true at all. Active surveillance is of course an option for prostate cancer, and an administrator would never, ever even have a chance to say to an MD what to do or how to treat a patient.

If some of you are going to come after a particular private practice, you had better have your facts in order before you start talking $hit.

 

[scarbrtj]

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

Lest we forget: these young residents are being highly encouraged from their chairs/PDs to lean positively and forcefully into the social media (have some tweeties on the Tweeter, make friends on everyone's FaceBooks, do whatever it is they do on the InstaGram, etc.) nowadays.

See... I told ya’ll he’s cool!

 

[medgator]

Lest we forget: these young residents are being highly encouraged from their chairs/PDs to lean positively and forcefully into the social media (have some tweeties on the Tweeter, make friends on everyone's FaceBooks, do whatever it is they do on the InstaGram, etc.) nowadays.

RadOnc chairman kool-aid is strong stuff

 

[thecarbonionangle]

You are 100% wrong and completely incorrect. TOPA is a physician-led and owned organization, full-stop. MDs after they are partner are not employed. Administrators do whatever the MDs want and have no say whatsoever in clinical treatment decisions made by the physicians. I'm not sure how or why you're so confident when you are so very wrong.

As far as patients being able to get better/more cost-effective treatment at an academic center because of administration pressure on TOPA MDs, that's not true at all. Active surveillance is of course an option for prostate cancer, and an administrator would never, ever even have a chance to say to an MD what to do or how to treat a patient.

If some of you are going to come after a particular private practice, you had better have your facts in order before you start talking $hit.

So you’re basically paraphrasing Omar from “The Wire”. “If you’re gonna come for the king, you BEST NOT miss” ?

 

[OTN]

Would've been a much more succinct way to put it.

 

[evilbooyaa]

Lol wowza coming at a specific private practice 3000 miles away from where the initial issue was.
@PhotonBomb your status is listed as a medical student. If you are truly an attending I encourage you to change your status as such.

 

[PhotonBomb]

OTN - never did I say that TOPA did not allow active surveillance. You are also as aware as I am that every TOPA practice is slightly different. I never said that we didn’t own the practice either.

 

[Mandelin Rain]

If you were wondering, it's a perfect example of what is called a Strawman Argument.


Poster 1: Academic hospitals are using satellites to refer patients for protons so they can charge even more exorbitant prices for the same care.

Poster 2: But, Texas Oncology....

[Much arguing about Texas Oncology, original thought and point forgotten without debate]

That is how it works my friends!

 

[medgator]

OTN - never did I say that TOPA did not allow active surveillance. You are also as aware as I am that every TOPA practice is slightly different. I never said that we didn’t own the practice either.

At least you're coming clean now.... Also no mention of the practice administration either... Hmmmm

 

[PhotonBomb]

At least you're coming clean now.... Also no mention of the practice administration either... Hmmmm

I stand by what I said. TOPA takes great care of patients. But to pretend that there isn’t ‘guidance’ from practice managers and admins on how to do things is just not correct. Not sure why OTN got triggered.

 

[RickyScott]

I am skeptical that anyone at MSKCC would advise against active surveillance in order to bring up numbers. I couldn’t see zelefsky doing that.

Nevertheless, utilization is a distraction from rates which are the real source of financial toxicity. The real issue here is the prices they charge insurance companies are likely 3-5 x higher what 21c charges in a nyc suburb or texas oncology charges for that matter.

 

[RadDoc11]

I am skeptical that anyone at MSKCC would advise against active surveillance in order to bring up numbers. I couldn’t see zelefsky doing that.

Nevertheless, utilization is a distraction from rates which are the real source of financial toxicity. The real issue here is the prices they charge insurance companies are likely 3-5 x higher what 21c charges in a nyc suburb or texas oncology charges for that matter.

Like I said, I know firsthand that that is exactly what happened in addition to dissuading patients from being treated closer to home.

This issue is very real to those patients who spent 9 weeks traveling for radiation that they either didn’t need or could have gotten much closer to home.

 

[medgator]

Far more wonderful, and probably actually will be useful:



Marty isn't shilling for a new residency program

 

[RickyScott]

Like I said, I know firsthand that that is exactly what happened in addition to dissuading patients from being treated closer to home.

This issue is very real to those patients who spent 9 weeks traveling for radiation that they either didn’t need or could have gotten much closer to home.

What a degeneration.

 

[PhotonBomb]

 

[RadOncDoc21]

I had to repeat a MRI because the “university” affiliated hospital would not send me any imaging studies. Same (wouldn’t send treatment plan info) with the community docs down the street. We can all go tit for tat.

 

[PhotonBomb]

I don’t think this was about academics vs PP.

 

[medgator]

I had to repeat a MRI because the “university” affiliated hospital would not send me any imaging studies. Same (wouldn’t send treatment plan info) with the community docs down the street. We can all go tit for tat.

Sad from both sides. Can't say I've ever experienced that

 

[Reaganite]

Give us some context. I've had Academic Med oncs in my area literally send a patient to their radoncs a week after patient has finished treatment with me. Damn straight they're gonna jump through hoops to get those records.

 

[RadOncDoc21]

I don’t think this was about academics vs PP.

Just assumed it was, either that or about the job market so I took a guess.

 

[PhotonBomb]

Give us some context. I've had Academic Med oncs in my area literally send a patient to their radoncs a week after patient has finished treatment with me. Damn straight they're gonna jump through hoops to get those records.

Weird flex but okay

 

[domestique]

Give us some context. I've had Academic Med oncs in my area literally send a patient to their radoncs a week after patient has finished treatment with me. Damn straight they're gonna jump through hoops to get those records.

My favorite hoop to jump through is reporting behavior like this to the state medical board. DICOM-RT files seem to arrive very quickly thereafter.

 

[PhotonBomb]

Give us some context. I've had Academic Med oncs in my area literally send a patient to their radoncs a week after patient has finished treatment with me. Damn straight they're gonna jump through hoops to get those records.

This is embarrassing and not something you should post in public

 

[medgator]

This is embarrassing and not something you should post in public

So it's fine for academic specialists to scoop up patients and redirect them for care internally within their system?

Fwiw, I avoid sending patients out to certain tertiary care centers for that exact reason (when referrals are needed for tme/lar, Whipple, esophagectomy etc).

 

[Reaganite]

This is embarrassing and not something you should post in public

Lol, dude, you have no clue. I'm not suggesting I'm going to do anything to the detriment of the patient. But if I get a call from my competitor down the street asking for records I'm going to investigate why patient wasnt sent back to me. Was there a change in preferred provider status in network?Did someone intentionally redirect the patient? If so, I expect an explanation because maybe THAT provider needs to be reported to someone..say the local insurance company. Of course, if the request is legit (patient moved out of the area), then it's no big deal. But don't kid yourself--academic centers try to pull this bs all the time and you cant just sit back and let them get away with it.

 

[medgator]

--academic centers try to pull this bs all the time and you cant just sit back and let them get away with it.

The NCI designated center near us is notorious for that, while some of the larger private tertiary centers have physicians that are more cognizant and don't refer patients sent to them to everyone else in their system....

 

[PhotonBomb]

Lol, dude, you have no clue. I'm not suggesting I'm going to do anything to the detriment of the patient. But if I get a call from my competitor down the street asking for records I'm going to investigate why patient wasnt sent back to me. Was there a change in preferred provider status in network?Did someone intentionally redirect the patient? If so, I expect an explanation because maybe THAT provider needs to be reported to someone..say the local insurance company. Of course, if the request is legit (patient moved out of the area), then it's no big deal. But don't kid yourself--academic centers try to pull this bs all the time and you cant just sit back and let them get away with it.

Investigate those details all you want. Send the records first. You have no idea what’s going on the other side. Perhaps patient is admitted, etc. Jesus, Jump through hoops. Again, this is a joke. You’re putting your business sense above all. Not good.

 

[taserlaser]

Where I trained there was a private pathologist that ran a lump and bumps clinic, did patient consults, FNAs, read his own slides, etc. Good access for patients and a lot of h&n SCCs came in that way. But didn’t report or was able to do p16 immunostains, and wouldn‘t share slides to those who could. So patients had to go for repeat biopsy, and await for a final diagnosis all over again. Definitely an instance of detriment to fragmented care, and when people don’t play. ball like that it’s incredibly not patient focused care, and frustrating for them and the MD.

 

[scarbrtj]

My favorite hoop to jump through is reporting behavior like this to the state medical board. DICOM-RT files seem to arrive very quickly thereafter.

Yes. Also... It’s one thing to behave like an ass and another to behave like an ass in the eyes of a lawyer. Have the patient get a lawyer to write a nastygram. They might make a little extra money in the process too.

 

[Mandelin Rain]

Sometimes we all forget our place, which is at the service of our patients.

 

[medgator]

Sometimes we all forget our place, which is at the service of our patients.

Fwiw, I wouldn't refuse a request for records regardless of situation, ultimately the patient is in the driver's seat for where it goes, as long as we have a valid signed release of information on file

 

[deleted774703]

Fwiw, I wouldn't refuse a request for records regardless of situation, ultimately the patient is in the driver's seat for where it goes, as long as we have a valid signed release of information on file

It’s most unfortunate this is a PP doc who is doing this

as usual academic twitter and offline will seize on this and say all PP docs are shady etc blah blah

This is just one bad apple!

devils advocate: idk this doctors personal situation ie sick etc

 

[Reaganite]

It’s most unfortunate this is a PP doc who is doing this

as usual academic twitter and offline will seize on this and say all PP docs are shady etc blah blah

This is just one bad apple!

devils advocate: idk this doctors personal situation ie sick etc

I think you're missing the point here. When I talk about jumping through hoops, I'm not saying you delay records in an emergency situation or do anything to compromise the care of a patient. You really think I'm suggesting you withhold records without knowing the full story? I mean, give me a break. I'm saying if I get a call asking for records, I get on the phone and ask why. It's quality assurance from a patient care and business perspective. This is, after all, a patient I treated, and I wanna know what's going on. Maybe patient had a complication from my treatment that I should know about. Maybe patient is in the ER 5 minutes down the street from me and it would be better for me to personally see the patient immediately since I know the nuances of the case. If secretary on other line tells me patient is scheduled for an outpatient consult a week from now, then guess what? Before I send those records, I'm going to spend 5 minutes calling the patient to find out what happened and offer them an opportunity to see me that day. If patient says they want to go elsewhere, of course I'm going to send the records. If patient tells me medical oncologist who is employed by same organization as rad onc told her only that rad onc can offer the treatment she needs (not an infrequent occurrence), then yeah, I'm going to call the med onc out on that. The devil's advocate here is that in my area, the private docs know to send back to the treating doc. The only time I'm seeing requests for records is when some shady employed med onc tries to redirect the patient to their guy. So call it jumping through hoops or whatever else you want to call it, but it's my preference to find out what happened.

 

[deleted774703]

I think you're missing the point here. When I talk about jumping through hoops, I'm not saying you delay records in an emergency situation or do anything to compromise the care of a patient. You really think I'm suggesting you withhold records without knowing the full story? I mean, give me a break. I'm saying if I get a call asking for records, I get on the phone and ask why. It's quality assurance from a patient care and business perspective. This is, after all, a patient I treated, and I wanna know what's going on. Maybe patient had a complication from my treatment that I should know about. Maybe patient is in the ER 5 minutes down the street from me and it would be better for me to personally see the patient immediately since I know the nuances of the case. If secretary on other line tells me patient is scheduled for an outpatient consult a week from now, then guess what? Before I send those records, I'm going to spend 5 minutes calling the patient to find out what happened and offer them an opportunity to see me that day. If patient says they want to go elsewhere, of course I'm going to send the records. If patient tells me medical oncologist who is employed by same organization as rad onc told her only that rad onc can offer the treatment she needs (not an infrequent occurrence), then yeah, I'm going to call the med onc out on that. The devil's advocate here is that in my area, the private docs know to send back to the treating doc. The only time I'm seeing requests for records is when some shady employed med onc tries to redirect the patient to their guy. So call it jumping through hoops or whatever else you want to call it, but it's my preference to find out what happened.

First of all, this was not directed at you. Not sure how you made it that way

my response is in RE to the Twitter post by Dr. Evans discussing how she is having A hard time receiving RT dosimetry records despite the patient signing off

it doesn’t matter if you want to spend 5 min, 10 min, 60 min, etc, you should still send the records once the patient has signed off.

Nothing wrong with speaking to other rad Onc who wants records to find out what happened to patient. Alternatively can also just call the patient and make sure things are okay

Finally my post is meant to be read as “if a single PP RO does anything academic RO doesn’t like, then all PP seem to become maligned”

 

[medgator]

Finally my post is meant to be read as “if a single PP RO does anything academic RO doesn’t like, then all PP seem to become maligned”

Vs academic ROs trashing perfectly competent PP physicians with zero evidence. That seems to get a free pass

 

[deleted774703]

Vs academic ROs trashing perfectly competent PP physicians with zero evidence. That seems to get a free pass

exactly. That’s what I’m saying as well in above posts

it’s such a power imbalance with all of power in academics hands

it’s unfortunate that they control the narrative and more often than not it’s used to say PP are inferior

 

[RadOncDoc21]

exactly. That’s what I’m saying as well in above posts

it’s such a power imbalance with all of power in academics hands

it’s unfortunate that they control the narrative and more often than not it’s used to say PP are inferior

Photonbomb is going to come in and say how this is all “fake news,” etc. KHE is going to blame Obama.

 

[Reaganite]

First of all, this was not directed at you. Not sure how you made it that way

my response is in RE to the Twitter post by Dr. Evans discussing how she is having A hard time receiving RT dosimetry records despite the patient signing off

it doesn’t matter if you want to spend 5 min, 10 min, 60 min, etc, you should still send the records once the patient has signed off.

Nothing wrong with speaking to other rad Onc who wants records to find out what happened to patient. Alternatively can also just call the patient and make sure things are okay

Finally my post is meant to be read as “if a single PP RO does anything academic RO doesn’t like, then all PP seem to become maligned”

Oh yeah I was just being lazy. Pulled up the last quote which happened to be yours. Sorry!

 

[Mandelin Rain]

My first take on the initial tweet was maybe it's a potential medicolegal scenario that the other doc doesn't want discovered. Missed an obvious node. Overdosed something. Treated the wrong spot/side. etc...

EDIT: Not to say that makes it right. Quite the opposite. Just trying to think through the motivation. If you don't want your patient to leave you, throwing petty road blocks in their way as they try to seek another opinion isn't the best way to ingratiate yourself.

 

[Reaganite]

My first take on the initial tweet was maybe it's a potential medicolegal scenario that the other doc doesn't want discovered. Missed an obvious node. Overdosed something. Treated the wrong spot/side. etc...

EDIT: Not to say that makes it right. Quite the opposite. Just trying to think through the motivation. If you don't want your patient to leave you, throwing petty road blocks in their way as they try to seek another opinion isn't the best way to ingratiate yourself.

My own emotions aside since this happens to me frequently, these are often uncomfortable situations. I always try to send back to the original rad onc unless insurance dictates otherwise. If I have to treat and initial requests for records are ignored (happens all the time), I go to the office in person. I have had cases where it was simply a matter of the doc being out of town and having a policy of no records being sent unless he's personally contacted as someone mentioned previously. If patient signed off, doc should send, but it's still nice to have a little context in these cases.

 

[PhotonBomb]

Photonbomb is going to come in and say how this is all “fake news,” etc. KHE is going to blame Obama.

Academics controls a lot of the narrative while in training, no doubt.

PP still the vast numbers and there are more of us involved with ASTRO than some may think. I encourage everyone in PP to join an ASTRO committee. It’s easy to get involved

 

[deleted774703]

Interesting discussion.

 

[evilbooyaa]

Ralph protecting his UChicago lack of good brachy experience?

I'm glad that everything that has been said on SDN for the past 2 years is now being said in the twittersphere, even if it is by senior residents.

 

[PhotonBomb]

Ralph protecting his UChicago lack of good brachy experience?

I'm glad that everything that has been said on SDN for the past 2 years is now being said in the twittersphere, even if it is by senior residents.

UChicago does tons of GYN brachy and they do LDR prostate I believe last I heard. Don’t think that’s an issue.

for me I don't have a strong opinion on brachy numbers specifically I think all numbers need to go up to raise the barrier of entry for new programs though