Rad Onc Twitter

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medgator said:
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Man, I know it's hard to follow (I really dislike the weird Twitter format), but the DEI RadOnc "Journal Club" today has been ABSOLUTE FIRE. It's breathtaking to see all of this said out loud, non-anonymously, by actual URMs.

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Just...glorious to see people being openly honest about this.
 
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I need to see the roster - senior faculty or junior faculty?

Because there has literally never been any event, scenario, or situation for the last 20 years where residents HAVEN'T lost to senior faculty. Even if they somehow did objectively "win" something, someone with gray hair and tenure plays the "professionalism" card and residents actually lose.

(facetious...somewhat...and junior faculty don't count in this joke)
 
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No one is saying any of the work done as a RadOnc is bad, just that there is over training.

"Fringe Anonymous Fan Base" can be the name of our SDN punk rock band
 
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If you remember that this exercise was about him, not the field, then it’s easy to understand.

I’m not surprised at any of this. But, I said that from the start.
 
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RealSimulD said:
If you remember that this exercise was about him, not the field, then it’s easy to understand.

I’m not surprised at any of this. But, I said that from the start.
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What!!? Someone who has to remind people of all of his accomplishments, publications and status! He also knows how to use his time efficiently!
 
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The fringe group that has been right about all their prognostications.

1. Shah (and cheerleading from SDN): you can’t fix a maldistribution issue with more residents. Going to tank the market.

2. “Canary in coal mine” med students may very well not pick rad onc, but programs will just SOAP. This is a dumb path forward.

3. All of the Ben Smith prognostics about cases/work force do not take into account hypofrac or use of mid levels. You’ll use this data to expand but once corrected you will not use it to contract.


The story of SDN is not the ****posting or name calling or memes or anonymity…it’s that the “fringe theories” in here have been historically dead on accurate predictions and analysis of what is and will be coming to pass.
 
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Whoa, whoa, whoa.

The prognostications could have been dumb luck, but the **** posting and memes are… art.
 
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elementaryschooleconomics said:
Man, I know it's hard to follow (I really dislike the weird Twitter format), but the DEI RadOnc "Journal Club" today has been ABSOLUTE FIRE. It's breathtaking to see all of this said out loud, non-anonymously, by actual URMs.

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Just...glorious to see people being openly honest about this.
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Absolutely, DEI in radiation oncology, as it stands right now, just feels like it is more for show, parading minorities and women around, just to check a box for optics.

It just reminds me of this:
 
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medgator said:
Some in rad Onc have been nefarious enough to repurpose it to hit 2 birds with one stone however, rads isn't hurting to match folks as their job market is far more robust
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This^. All of this talk about DEI without addressing their future job prospects and working conditions.

Let us be clear, we are not anti-DEI. We want a future where everyone can thrive, with a diverse and inclusive workforce, for our patients.

Minorities are not a prop, neither are women, but ASTRO and rad onc leadership certainly acts like they are.
 
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medgator said:
Some in rad Onc have been nefarious enough to repurpose it to hit 2 birds with one stone however, rads isn't hurting to match folks as their job market is far more robust
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Yes everything is worse with you guys. In Radiology, it has been a huge distraction which prevents from much needed investments in fixing the other fires.

My academic place has lost 20 rads and hired like 5 since July 2021. The work still needs to get done but the money is being spent on DEI and not on, yknow, paying more to get people or giving more vacation.

It’s leading to burnout and triggering a toxic spiral amongst the remaining people. I expect it to get worse before it gets better.

Oversupply is bad, don’t get me wrong. But administrator obstinacy remains even in face of a tremendous workforce shortage.
 
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SubserviantToABR said:
This^. All of this talk about DEI without addressing their future job prospects and working conditions.

Let us be clear, we are not anti-DEI. We want a future where everyone can thrive, with a diverse and inclusive workforce, for our patients.

Minorities are not a prop, neither are women, but ASTRO and rad onc leadership certainly acts like they are.
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Without DEI, what other topics will academic RO publish on to get out of their 5 year instructor position at Harvard/Stanford/MDACC?
 
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Would be interesting to hear more about that urorads era from those more experienced, most of us in the post 2015 grad classes didn’t grow up with this
 
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RickyScott said:
load of bs.
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He's full of ****. How do you think multi specialty centers where everyone got a piece of the technical was able to be created? Yep, the in office ancillary exemption (ioae). @jondunn

Hasn't Sameer keole always been in academics? How would he have any credibility on this?

The main thing i remember hearing about in training and when i got out were the academic centers complaining about urorads because they were losing their prostate cases to the place across town. Many of the urorads or med onc/gu combo practices were in partnership with the RO either pro only or some % of global billing. Certainly a lot better than what the places like Cleveland clinic, UPMC etc have done over the years to PPs when they buy practices and hospitals and end up either forcing the PPs out or taking over and cutting their salaries
 
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medgator said:
He's full of ****. How do you think multi specialty centers where everyone got a piece of the technical was able to be created? Yep, the in office ancillary exemption (ioae). @jondunn

Hasn't Sameer keole always been in academics? How would he have any credibility on this?

The main thing i remember hearing about in training and when i got out were the academic centers complaining about urorads because they were losing their prostate cases to the place across town. Many of the urorads or med onc/gu combo practices were in partnership with the RO either pro only or some % of global billing. Certainly a lot better than what the places like Cleveland clinic, UPMC etc have done over the years to PPs when they buy practices and hospitals and end up either forcing the PPs out or taking over and cutting their salaries
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Not even worth arguing. From this mornings New York Times “On state television, they’re told that Europe is rotten and that its people are on the bread line. Nowhere is better than Russia.”
 
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Sameer was in private practice for many years. He was a partner of a group in OKC.

He’s somewhat old school, but I would not dismiss him completely. He knows a lot about how prices are set/RVU calculation, the RUC, etc.
 
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RealSimulD said:
Sameer was in private practice for many years. He was a partner of a group in OKC.

He’s somewhat old school, but I would not dismiss him completely. He knows a lot about how prices are set/RVU calculation, the RUC, etc.
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He is a good guy. I remember him from when he was at Uf and gave osler lectures, but he is way off here.
 
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RickyScott said:
He is a good guy. I remember him from when he was at Uf and gave osler lectures, but he is way off here.
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I agree

It’s perception

His friends and colleagues were on the losing end and many practices folded. Yet, here we are a decade letter and UroRad still exists.
 
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I came out of residency toward the end of the urorad heyday, but what I remember at the time was that the rad oncs they employed made a **** ton of money but practiced with minimal autonomy (vis a vis fractionation, etc...). They were actively outcompeting academic institutions for prostate patients, and several residencies had difficulty even fielding a GU service.

It was these two things (jealousy over salary and getting butt kicked by competition) that lead ASTRO (read: academic radiation oncology) to target them under the auspice of "over-utilization of IMRT" because of the minimal autonomy piece. Not to protect private practice, or other such nonsense. That's ultimate revisionist history there. They were jealous and mad and wasted a decade of lobbying capital for nothing.
 
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Realistically, it was a missed opportunity to make radiation THEE standard treatment for prostate cancer. Which would've improved life for all rad oncs, and likely patients.
 
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jondunn said:
Would be interesting to hear more about that urorads era from those more experienced, most of us in the post 2015 grad classes didn’t grow up with this
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In the ~2007-2013 era this was one of the hottest topics in academics.

I would meet GU rad oncs who were lamenting the fall off in their prostate work because a local shoppe had set up a UroRads in town. Academic rad onc had Putin-against-Ukraine levels of hate toward urologists buying linacs and if you were a rad onc working with them you were un collaborateur.

ASTRO criticizes urologist self-referral for IMRT

For the second time in a month, urologists are being criticized for self-referred ancillary services?this time by radiologists for providing intensity-modulated radiotherapy (IMRT) treatment for prostate cancer patients in urologists' own radiation therapy centers.
www.urologytimes.com www.urologytimes.com

ASTRO responds to study on growth of IMRT for prostate cancer

ASTRO responds to study on growth of IMRT for prostate cancer
www.urotoday.com www.urotoday.com


www.eurekalert.org

ASTRO applauds new GAO report on physician self-referral abuse

ASTRO Chairman Michael L. Steinberg, M.D., FASTRO, called attention to the Government Accountability Office's striking report released today, "Medicare: Higher Use of Costly Prostate Cancer Treatment by Providers Who Self-Refer Warrants Scrutiny," that details clear mistreatment of patients who...
www.eurekalert.org
 
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TheWallnerus said:
In the ~2007-2013 era this was one of the hottest topics in academics.

I would meet GU rad oncs who were lamenting the fall off in their prostate work because a local shoppe had set up a UroRads in town. Academic rad onc had Putin-against-Ukraine levels of hate toward urologists buying linacs and if you were a rad onc working with them you were un collaborateur.

ASTRO criticizes urologist self-referral for IMRT

For the second time in a month, urologists are being criticized for self-referred ancillary services?this time by radiologists for providing intensity-modulated radiotherapy (IMRT) treatment for prostate cancer patients in urologists' own radiation therapy centers.
www.urologytimes.com www.urologytimes.com

ASTRO responds to study on growth of IMRT for prostate cancer

ASTRO responds to study on growth of IMRT for prostate cancer
www.urotoday.com www.urotoday.com


www.eurekalert.org

ASTRO applauds new GAO report on physician self-referral abuse

ASTRO Chairman Michael L. Steinberg, M.D., FASTRO, called attention to the Government Accountability Office's striking report released today, "Medicare: Higher Use of Costly Prostate Cancer Treatment by Providers Who Self-Refer Warrants Scrutiny," that details clear mistreatment of patients who...
www.eurekalert.org
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Also article in nejm. Nevertheless, the impact on the job market was orders of magnitude less than today. That was peak radonc for a good reason. I would get very good unsolicited job offers every 6 months.
 
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ASTRO/academic rad onc's persistent attack on "utilization of radiation*" is confounding and openly hostile to the entirety of the specialty.

*non-MR-guided, photon based radiation (i.e. the high value radiation)
 
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RickyScott said:
Also article in nejm. Nevertheless, the impact on the job market was orders of magnitude less than today. That was peak radonc for a good reason.
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Yes ASTRO held a big press conference about it

www.eurekalert.org

NEJM study exposes overuse of radiation therapy when urologists profit from self-referral

A comprehensive review of Medicare claims for more than 45,000 patients from 2005 through 2010 found that nearly all of the 146 percent increase in intensity- modulated radiation therapy for prostate cancer among urologists with an ownership interest in the treatment was due to self-referral...
www.eurekalert.org
 
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TheWallnerus said:
Yes ASTRO held a big press conference about it

www.eurekalert.org

NEJM study exposes overuse of radiation therapy when urologists profit from self-referral

A comprehensive review of Medicare claims for more than 45,000 patients from 2005 through 2010 found that nearly all of the 146 percent increase in intensity- modulated radiation therapy for prostate cancer among urologists with an ownership interest in the treatment was due to self-referral...
www.eurekalert.org
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"Oncology patients being treated with radiation. Radiation oncology society, aghast!"
 
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1)Uro rads was/is often abt more pts receiving xrt vs prostatectomy than diverting pts from academic centers, so Astro position really just one of jealousy.
When academic systems dominate a market, rvu incentive among their urologists push the pts towards surgery.
2) lot of hate directed at imrt (and presumed profit motive behind it) then by astro, yet they they are dead silent on price gouging, which as we all know is a much bigger issue. 45 fractions of imrt at community center can easily be much less than 28 fractions at upenn/mdacc of 3d, but somehow the community center is unethical. Ben smith is the poster boy for this.
 
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RickyScott said:
1)Uro rads was/is often abt more pts receiving xrt vs prostatectomy than diverting pts from academic centers, so Astro position really just one of jealousy.
When academic systems dominate a market, rvu incentive among their urologists push the pts towards surgery.
2) lot of hate directed at imrt (and presumed profit motive behind it) then by astro, yet they they are dead silent on price gouging, which as we all know is a much bigger issue. 45 fractions of imrt at community center can easily be much less than 28 fractions at upenn/mdacc of 3d, but somehow the community center is unethical. Ben smith is the poster boy for this.
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Ben smith would steal your half eaten bagel if you left it around along with your patient!
 
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When I interviewed for residency at Louis Potter's program he spent the entirety of the allotted time going on a rant about the evils urorads. I don't think I was even able to get more then a few words in. So bizarre.
 
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RickyScott said:
1)Uro rads was/is often abt more pts receiving xrt vs prostatectomy than diverting pts from academic centers, so Astro position really just one of jealousy.
When academic systems dominate a market, rvu incentive among their urologists push the pts towards surgery.
2) lot of hate directed at imrt (and presumed profit motive behind it) then by astro, yet they they are dead silent on price gouging, which as we all know is a much bigger issue. 45 fractions of imrt at community center can easily be much less than 28 fractions at upenn/mdacc of 3d, but somehow the community center is unethical. Ben smith is the poster boy for this.
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AsTRo take on urorads naked jealousy tarted up with some moral superiority
 
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fiji128 said:
When I interviewed for residency at Louis Potter's program he spent the entirety of the allotted time going on a rant about the evils urorads. I don't think I was even able to get more then a few words in. So bizarre.
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Yet he ended up okay. You too can have the same success!
 
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RealSimulD said:
Sameer was in private practice for many years. He was a partner of a group in OKC.

He’s somewhat old school, but I would not dismiss him completely. He knows a lot about how prices are set/RVU calculation, the RUC, etc.
Click to expand...
A few years... Most of his time was at Mayo and uf iirc. The big picture answer is that the IOAE is the only way private practice rad oncs have been able to survive. Being a single specialty RO group has pretty much gone the way of being a dinosaur, only want to ensure referrals is to get everyone skin in the game
 
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medgator said:
A few years... Most of his time was at Mayo and uf iirc. The big picture answer is that the IOAE is the only way private practice rad oncs have been able to survive. Being a single specialty RO group has pretty much gone the way of being a dinosaur, only want to ensure referrals is to get everyone skin in the game
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I just don't find it to be helpful to say he's never worked in PP when in fact he was an owner, and changing goalposts to say "oh well it was a few years". Either he worked as an owner and has experience or he doesn't. It's pretty binary.

I don't agree with him on this either - there are winners and losers. They happened to lose that battle.

Over-utilization was not a prostate center thing. It was an everyone thing. Especially academic centers.
 
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TheWallnerus said:
Yes ASTRO held a big press conference about it

www.eurekalert.org

NEJM study exposes overuse of radiation therapy when urologists profit from self-referral

A comprehensive review of Medicare claims for more than 45,000 patients from 2005 through 2010 found that nearly all of the 146 percent increase in intensity- modulated radiation therapy for prostate cancer among urologists with an ownership interest in the treatment was due to self-referral...
www.eurekalert.org
Click to expand...
Think someone could get "Academic Medicine's Use of Proton Therapy for Prostate Cancer" accepted into NEJM? Would likely make urorads look bush league in terms of expenditures on a per patient basis.
 
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Wildcat321 said:
Think someone could get "Academic Medicine's Use of Proton Therapy for Prostate Cancer" accepted into NEJM? Would likely make urorads look bush league in terms of expenditures on a per patient basis.
Click to expand...

I'm a huge fan of proton therapy but am getting tired of the increasing rate of patients coming here and asking about protons for literally everything. A patient (who needed emergent whole brain) asked if I could do proton the other week and ultimately the family decided to drive 8+ hours to a proton center without an appointment. Saw another patient on Friday who had been setup for post-operative 5 fraction proton for pancreas but wanted to get treatment locally and thankfully felt more comfortable with a conventional treatment course anyway. Just more and more WTF every day I could go on...

The crap proton messaging is harming patients and leading them to make bad decisions. Even if they don't ultimately end up getting proton treatment for something unnecessary, the second opinions and googling wastes time/delays care and emotionally manipulates vulnerable people.
 
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Moonbeams said:
I'm a huge fan of proton therapy but am getting tired of the increasing rate of patients coming here and asking about protons for literally everything. A patient (who needed emergent whole brain) asked if I could do proton the other week and ultimately the family decided to drive 8+ hours to a proton center without an appointment. Saw another patient on Friday who had been setup for post-operative 5 fraction proton for pancreas but wanted to get treatment locally and thankfully felt more comfortable with a conventional treatment course anyway. Just more and more WTF every day I could go on...

The crap proton messaging is harming patients and leading them to make bad decisions. Even if they don't ultimately end up getting proton treatment for something unnecessary, the second opinions and googling wastes time/delays care and emotionally manipulates vulnerable people.
Click to expand...
Once again MDACC leads the way

www.southall7.com

MD Anderson — Southall 7 Creative

MD Anderson Cancer Center
www.southall7.com www.southall7.com
 
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