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Like I said, didn’t think he expanded

And @Dan Spratt - “heck no” about Caribbean grads, as if there is something wrong with them?

If a person is qualified for the job, they are qualified. Let’s not pretend Harvard degree means you’ll be better at this. Ugh.

...

And, gotta give kudos to Dan. Classic misinterpretation and projection, he comes out here and explains that 1) they did not expand 2) why they have 3 spots 3) they did not SOAP.

And the response is a curt "got it, but why didn't you contract, bro?" not an admission of "fake news" or some grace.

I am surprised he comes on for unwarranted abuse. As much as I have differences with the guy, he has done what he says he is going to do.
 
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RealSimulD said:
Like I said, didn’t think he expanded

And @Dan Spratt - “heck no” about Caribbean grads, as if there is something wrong with them?

If a person is qualified for the job, they are qualified. Let’s not pretend Harvard degree means you’ll be better at this. Ugh.

...

And, gotta give kudos to Dan. Classic misinterpretation and projection, he comes out here and explains that 1) they did not expand 2) why they have 3 spots 3) they did not SOAP.

And the response is a curt "got it, but why didn't you contract, bro?" not an admission of "fake news" or some grace.

I am surprised he comes on for unwarranted abuse. As much as I have differences with the guy, he has done what he says he is going to do.
Click to expand...

No pain no gain in spratts mind
 
RealSimulD said:
I am surprised he comes on for unwarranted abuse.
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Spot on regarding the kudos. Also, I agree, the Caribbean thing is bogus. A few Caribbean grads who scrambled in during my era are doing better than me and a few from the era just before are on pretty notable faculty. The job ain't hard and MCATs and undergrad grades probably correlate close to zero with radonc acumen.

I don't know Spratt, but he is saying all the right things about his program and this is free advertising. Non-RVU based, non-meaningless paper productivity based reward system with an emphasis on culture and real innovation? Everybody wants this. He might have even gotten some of the wording from SDN.
 
medgator said:
Got it. What is to stop you from holding one of those spots out of the match year given clear workforce concerns until the results of the ASTRO workforce study are available? 7 is an odd number anyways for a smaller program. Just do 2-2-1-1 as your 7th spot was only recently approved in 2019 was it not?

Anderson and your big brother in Cleveland have done just that and actually and reduced a spot they are offered in the match
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My assessment when I spoke at SCAROP meeting is >50% of resident slots are in northeast yet there are near identical number of practicing radoncs in the Midwest. However, published data shows very few residents from northeast in large programs take jobs in Midwest (<5%).

So our residency program serves a valuable purpose to provide quality training in all modalities for people who mostly stay in Midwest. Additionally programs with 4-6 residents I feel do not provide optimal training environment as residents learn a lot from their peers and 7-10 for a big program allows a good split of duties. From a pure training environment bubble I would expand, but have chosen not to given national job concerns.

It’s easy to say to residency programs that have stayed smaller to shrink when if you cut the northeast programs by just 10-20% you would reduce massive number of slots. There is a surplus of open jobs last year in Midwest unlike most of the country. Also, Midwest was one of the only regionals in SCAROP data to show salaries went up and most of the west and northeast went down given supply and demand imbalances.

Despite this I don’t want to contribute to the problem and also want us to lead by example to not expand just because we easily can justify being 12+ spots. We treat about 4000 patients per yr, whereas many programs that treat fewer have 12+ residents.

I am sure not everyone will agree, but I believe we have created an incredible residency program very different than most with leadership training, support of numerous career tracks, and bringing experts all over the world to train them. I don’t think dropping one spot in a smaller residency program in the Midwest is the problem. I realize every chair will make some analogous rationalization.

Best
Dan
 
communitydoc13 said:
The job ain't hard and MCATs and undergrad grades probably correlate close to zero with radonc acumen
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Click to expand...


the "brightest folks" go into derm and plastics... why?

the answer all why questions is the same: It has been, and always will be, about the money.

Derm and plastics are absolutely stupidly easy compared to radonc knowledge volume...
 
communitydoc13 said:
Spot on regarding the kudos. Also, I agree, the Caribbean thing is bogus. A few Caribbean grads who scrambled in during my era are doing better than me and a few from the era just before are on pretty notable faculty. The job ain't hard and MCATs and undergrad grades probably correlate close to zero with radonc acumen.

I don't know Spratt, but he is saying all the right things about his program and this is free advertising. Non-RVU based, non-meaningless paper productivity based reward system with an emphasis on culture and real innovation? Everybody wants this. He might have even gotten some of the wording from SDN.
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Completely agree. My apologies for how that came across. Was not trying to knock Caribbean or any other med schools. Was more so reacting to what I thought was implied about SOAP and expansion.

I went to a bottom tier undergrad and got rejected to many med schools, and am thankful I wasn’t fully judged for that

I saw their point of concern that if we were SOAPing people always AND were expanding that does deserve scrutiny.

What I care about is peoples drive, compassion, EQ, and who is open to learn. The people make championship teams and residents are part of the team. Where the people trained or what country they are from does not define who will be champions. Hence why there are amazing radoncs all over the country in big and no name places and there are subpar radoncs at big and no name places.

Thanks for calling that out.
 
My wife went into derm and she tells many she wishes sometimes she went into radonc given how rewarding our field is.

They are facing massive workforce issues in Mohs with very saturated job market, and salaries in big cities like NYC are comically low (her close friends who work 4 days a week in Manhattan make <$300k). Don’t want to post my wife’s history of salaries in NYC, Michigan, and in Cleveland but radoncs do much better.

Many people graduating from Mohs fellowships are being forced in urban areas to do only part time Mohs and mostly genera derm.
 
Dan Spratt said:
facing massive workforce issues in Mohs with very saturated job market
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We are going to reap, at a national level, the consequences of a perverse market based healthcare system and cartel like med school behavior.

Central planning has a big downside, but the mismatch we are going to experience between providers and actual demographics is going to be shocking. I suspect that NYC has more than enough docs across the board.

That med students compete for consideration to the most lucrative and sometimes least impactful (in terms of public health outcomes) specialties is just perverse (and how it has always been).

We need general surgeons, PCPs, OB-GYNs and medical oncologists. We need these folks in areas far from top 20 metros. We need doctors who are committed to making their life in and serving a community and not docs who will move with the market to greener pastures many times over in their careers (Not a shot at anybody who has done this. I just believe that the biggest issue regarding viability of community hospitals, which I believe in turn provide the highest value to the communities they serve (as opposed to large systems) will be the availability of staff).

Of course, we need hospitals that value their docs.

I say double the med school spots. Actually fail some people. Don't increase the number of radoncs.

Physician workforce in the United States of America: forecasting nationwide shortages - PMC

Physicians play a critical role in healthcare delivery. With an aging US population, population growth, and a greater insured population following the Affordable Care Act (ACA), healthcare demand is growing at an unprecedented pace. This study is to ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
 
Dan Spratt said:
My assessment when I spoke at SCAROP meeting is >50% of resident slots are in northeast yet there are near identical number of practicing radoncs in the Midwest. However, published data shows very few residents from northeast in large programs take jobs in Midwest (<5%).

So our residency program serves a valuable purpose to provide quality training in all modalities for people who mostly stay in Midwest. Additionally programs with 4-6 residents I feel do not provide optimal training environment as residents learn a lot from their peers and 7-10 for a big program allows a good split of duties. From a pure training environment bubble I would expand, but have chosen not to given national job concerns.

It’s easy to say to residency programs that have stayed smaller to shrink when if you cut the northeast programs by just 10-20% you would reduce massive number of slots. There is a surplus of open jobs last year in Midwest unlike most of the country. Also, Midwest was one of the only regionals in SCAROP data to show salaries went up and most of the west and northeast went down given supply and demand imbalances.

Despite this I don’t want to contribute to the problem and also want us to lead by example to not expand just because we easily can justify being 12+ spots. We treat about 4000 patients per yr, whereas many programs that treat fewer have 12+ residents.

I am sure not everyone will agree, but I believe we have created an incredible residency program very different than most with leadership training, support of numerous career tracks, and bringing experts all over the world to train them. I don’t think dropping one spot in a smaller residency program in the Midwest is the problem. I realize every chair will make some analogous rationalization.

Best
Dan
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So what do the chairs and PDs of the Northeast programs say to that? Everything you are saying is true but it's all just talk unless SCAROP and ASTRO change course on this issue.
 
Dan Spratt said:
My assessment when I spoke at SCAROP meeting is >50% of resident slots are in northeast yet there are near identical number of practicing radoncs in the Midwest. However, published data shows very few residents from northeast in large programs take jobs in Midwest (<5%).

So our residency program serves a valuable purpose to provide quality training in all modalities for people who mostly stay in Midwest. Additionally programs with 4-6 residents I feel do not provide optimal training environment as residents learn a lot from their peers and 7-10 for a big program allows a good split of duties. From a pure training environment bubble I would expand, but have chosen not to given national job concerns.

It’s easy to say to residency programs that have stayed smaller to shrink when if you cut the northeast programs by just 10-20% you would reduce massive number of slots. There is a surplus of open jobs last year in Midwest unlike most of the country. Also, Midwest was one of the only regionals in SCAROP data to show salaries went up and most of the west and northeast went down given supply and demand imbalances.

Despite this I don’t want to contribute to the problem and also want us to lead by example to not expand just because we easily can justify being 12+ spots. We treat about 4000 patients per yr, whereas many programs that treat fewer have 12+ residents.

I am sure not everyone will agree, but I believe we have created an incredible residency program very different than most with leadership training, support of numerous career tracks, and bringing experts all over the world to train them. I don’t think dropping one spot in a smaller residency program in the Midwest is the problem. I realize every chair will make some analogous rationalization.

Best
Dan
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What has made this an incredible residency program in 1 (1.5 years?)? It had - in the past - been known as one of the poorer programs in terms of education.

In 1-1.5 year I am curious to know this. If it can be done with such speed, this model should be copied. There are amazing PDs/Chairs that have had decades to improve.
 
RealSimulD said:
What has made this an incredible residency program in 1 (1.5 years?)? It had - in the past - been known as one of the poorer programs in terms of education.

In 1-1.5 year I am curious to know this. If it can be done with such speed, this model should be copied. There are amazing PDs/Chairs that have had decades to improve.
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Changing the residency program was the easiest thing to do as it doesn’t cost millions to do. It was all about culture change from the top down. Totally new didactic structure, hired inpatient APP to take over much of day call duties, expanded grand rounds and visiting professors to over 15 a year for the residents, created a new journal club that any practice changing radonc trial the PI of the trial joins, new leadership book club led by Dr. Zaorsky, hired 3 PhD biostatisticians to work with residents and created new practical biostats course, hired the right leaders and faculty who care about the residency program, and I set the expectations of culture that doesn’t tolerate the classical academic models of Professors who can’t even use the EMR or where the program makes exceptions for this person or that. We are all in it together. The ACGME survey results this year were the best they had been in at least a decade and were beating national averages in almost every category.

Not surprising when we have new head of physics, nursing, RTTs, research, education, program coordinator, department administrator, and 15 new physicians hand picked to fit with the new culture.

Really not hard to do when you have an amazing team with a shared vision. Turning the department as a whole around is for more complex and massive strategy needed. That would take days to go through how we had our best year in history in 2022 despite it being one of the worst years across the country.
 
Dan Spratt said:
Heck no man. My first year here we were fortune to match one of our most favorite rotators and she is amazing. Hoping for another great match this year. I can’t comment on the past but I see your concern that you thought our program expanded (incorrect) and were solely going through SOAP (incorrect). That would be a problem if true. We have not expanded, but have revamped our program as making it an amazing place to train and raising our game will be the way to ensure we match.

Feel free just to email me if you have questions about our program.
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This is what I have:

Case Western currently at 7/7 filled positions. Did not match in 2019 for 2 and 2020 for 1 position. The residency compliment expanded by 1 position from 2019 to 2021 from 6 to 7. Obviously, this all predates the current leadership's tenure.
 
Dan Spratt said:
Changing the residency program was the easiest thing to do as it doesn’t cost millions to do. It was all about culture change from the top down. Totally new didactic structure, hired inpatient APP to take over much of day call duties, expanded grand rounds and visiting professors to over 15 a year for the residents, created a new journal club that any practice changing radonc trial the PI of the trial joins, new leadership book club led by Dr. Zaorsky, hired 3 PhD biostatisticians to work with residents and created new practical biostats course, hired the right leaders and faculty who care about the residency program, and I set the expectations of culture that doesn’t tolerate the classical academic models of Professors who can’t even use the EMR or where the program makes exceptions for this person or that. We are all in it together. The ACGME survey results this year were the best they had been in at least a decade and were beating national averages in almost every category.

Not surprising when we have new head of physics, nursing, RTTs, research, education, program coordinator, department administrator, and 15 new physicians hand picked to fit with the new culture.

Really not hard to do when you have an amazing team with a shared vision. Turning the department as a whole around is for more complex and massive strategy needed. That would take days to go through how we had our best year in history in 2022 despite it being one of the worst years across the country.
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I like this!

The APP move is brilliant. Henry Ford (just using them as example, b/c I spoke to them recently) does the same. Very, very good for residents.

Biostats - if it is actually good teaching, this will be great for them.

Curious as to how to deal the "Professors" - I feel nationally, this is the norm rather than exception. I know award winning ASTRO gold medalists that cannot contour, and as you say, make constant exceptions for these folks. I wonder how they continue to exist and get paid extraordinary salaries. My pea community brain no comprendo.

Nice work. I think these are great strategies.

I just got a message the other day about residents having to be present on the Friday after Thanksgiving even if no work to do, with the rationale being "precedence". Precedence is never the correct answer.
 
Dan Spratt said:
Completely agree. My apologies for how that came across. Was not trying to knock Caribbean or any other med schools. Was more so reacting to what I thought was implied about SOAP and expansion.

I went to a bottom tier undergrad and got rejected to many med schools, and am thankful I wasn’t fully judged for that

I saw their point of concern that if we were SOAPing people always AND were expanding that does deserve scrutiny.

What I care about is peoples drive, compassion, EQ, and who is open to learn. The people make championship teams and residents are part of the team. Where the people trained or what country they are from does not define who will be champions. Hence why there are amazing radoncs all over the country in big and no name places and there are subpar radoncs at big and no name places.

Thanks for calling that out.
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Good to hear Case is not expanding. You may want to look into re-structing your programs, so like a 2-2-2-1 or something if you want to maintain 7 total. Although you may catch flak for taking 2 on a year you 'normally' would've taken 1. I wouldn't really expect you to contract given the massive expansion of attendings you have brought on.

Can we both (all?) agree that using the SOAP to match Rad Onc residents in the current era is not good though? Regardless of where the applicant comes from (Caribbean vs elsewhere)? If there isn't someone who actually WANTS to go into rad onc and applies into ENT, and then soaps into Rad Onc, is that really who we (as a field) want?
 
RealSimulD said:
Curious as to how to deal the "Professors" - I feel nationally, this is the norm rather than exception. I know award winning ASTRO gold medalists that cannot contour, and as you say, make constant exceptions for these folks. I wonder how they continue to exist and get paid extraordinary salaries. My pea community brain no comprendo.
Click to expand...

These sound like excellent candidates for fellowship or clinical instructorship. You could cut their salary instantly!

evilbooyaa said:
Good to hear Case is not expanding. You may want to look into re-structing your programs, so like a 2-2-2-1 or something if you want to maintain 7 total. Although you may catch flak for taking 2 on a year you 'normally' would've taken 1. I wouldn't really expect you to contract given the massive expansion of attendings you have brought on.

Can we both (all?) agree that using the SOAP to match Rad Onc residents in the current era is not good though? Regardless of where the applicant comes from (Caribbean vs elsewhere)? If there isn't someone who actually WANTS to go into rad onc and applies into ENT, and then soaps into Rad Onc, is that really who we (as a field) want?
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I think there are so many individuals in our field doing great things locally for residents. This is a national problem. The cleaning without SOAP and calls to contract were awesome 3 or 4 years ago, but it has done very little to address the issue. Everyone agrees programs are heterogeneous and everyone agrees the "good ones" shouldn't close. When the president of ASTRO is happy to SOAP residents over and over and no one speaks up, it's all just talk.

At this point, at least in my opinion, a variety of machines and high clinical volume is not enough to be able to say "this isn't my fault, I'm one of the good ones". It is a national problem that needs a collective response.
 
NotMattSpraker said:
So what do the chairs and PDs of the Northeast programs say to that? Everything you are saying is true but it's all just talk unless SCAROP and ASTRO change course on this issue.
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One ACGME requirement should be only 1 residency program per city... and to prevent cheating, defined as the metropolitan statistical area.
 
communitydoc13 said:
We need these folks in areas far from top 20 metros
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Well, most folks who make decent coin don't want to live in bupkisville. Their entire lives were in major metro areas (suburbs, college, med school, residency) and now they need to live in rural nowhere?

Learn how to fly... [geographic freedom achievement: unlocked] [higher pay: unlocked][Freedom to work anywhere and live where you want: user award]
 
temujim said:
One ACGME requirement should be only 1 residency program per city... and to prevent cheating, defined as the metropolitan statistical area.
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Having a children's hospital/peds onc program and enough brachy case requirements would solve that problem.

In the case of Cleveland, Cleveland clinic would actually be the one affected as they send out for peds
 
medgator said:
Having a children's hospital/peds onc program and enough brachy case requirements would solve that problem.

In the case of Cleveland, Cleveland clinic would actually be the one affected as they send out for peds
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So your suggestion is that CCF should shut down bc peds is elsewhere, even though 98% of us won’t treat a kid with cancer in our career?
 
RealSimulD said:
So your suggestion is that CCF should shut down bc peds is elsewhere, even though 98% of us won’t treat a kid with cancer in our career?
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It has been discussed as a way to cull spots and programs. Probably not the best way, i agree. What about a program that doesn't meet enough brachy cases?
 
sirspamalot said:
Well, most folks who make decent coin don't want to live in bupkisville. Their entire lives were in major metro areas (suburbs, college, med school, residency) and now they need to live in rural nowhere?

Learn how to fly... [geographic freedom achievement: unlocked] [higher pay: unlocked][Freedom to work anywhere and live where you want: user award]
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Yeah, well an army of flying docs is probably not the best solution. Dunning Kruger piloting aside: no continuity, no emphasis on long term follow-up, nearly impossible to be as accountable long term and potential selection for more dangerous docs period.

Hazardous Attitudes: Physician Decision Making in Radiation Oncology

The Federal Aviation Administration quantifies hazardous attitudes (HAs) among pilots using a scale. HAs have been linked to aviation risk. We assessed the influence of HAs and other factors in treatment decision making in radiation oncology (RO).
www.advancesradonc.org

I do believe that to some degree, continuity is correlated with quality.
 
It really is amazing how many of us were trained by people who did not know how to contour in TPS, did not care or use the EMR, and it was just widely seen as normal and acceptable and exceptions were always made for these people. Some of them were not even that “old”, you’d be surprised!
 
sirspamalot said:
Well, most folks who make decent coin don't want to live in bupkisville. Their entire lives were in major metro areas (suburbs, college, med school, residency) and now they need to live in rural nowhere?

Learn how to fly... [geographic freedom achievement: unlocked] [higher pay: unlocked][Freedom to work anywhere and live where you want: user award]
Click to expand...

Interviewed for a job where the retiring doctor told stories of how the physicist owned multiple clinics in the region and was also a pilot. They would fly to 3-4 clinics in a day sometimes to meet whatever requirements existed.

$$$$$$$$$$$$$$ etc
 
metallica81788 said:
Interviewed for a job where the retiring doctor told stories of how the physicist owned multiple clinics in the region and was also a pilot. They would fly to 3-4 clinics in a day sometimes to meet whatever requirements existed.

$$$$$$$$$$$$$$ etc
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Freestanding centers and groups are really something to behold.

I strongly prefer to work in a hospital solo setting. Less friction and ****ery.. but ya gotta remember the golden rule about Administration no matter how nice they seem..
 
I strongly agree that solo hospital based is the way to go IF you can find admin that will truly let you run the show. If admin views you as an employee just like physics and dosimetry, and expects you to be a "team player" and make MD-level decisions as a group, then hard pass. Unfortunately this is most of them. If I could find a hospital whose admin went to the staff and said, whatever the doctor says goes, he's the doctor, you do what he says, got it? I would sign on tomorrow even if it were in Kearney. Instead, it's oh lets have 15 meetings about how you hurt dosimetry's feelings and don't want to fill out prescriptions the way physics tells you to. In freestanding, while you have to deal with with greedy and crazy peers, the "everybody is an employee on the same level" issues with staff and admin go away.

Regarding physician pilots, this is a fantasy. GA aircraft by and large suck, even the nice ones, and unless you can get your own citation with a co-pilot, you're going to be flying solo out in an old Mooney or maybe a Cirrus if you're ballar, and do this enough, you WILL encounter a bad weather situation and/or an equipment malfunction that will bring you down and you better hope it happens over rural Kansas in the middle of the day with clear skies and no wind, and not in Eagle county colorado with a light snow that suddenly turned into a blizzard. This is a quick way to make yourself dead, and if you don't believe me a quick google search will turn up over a thousand doctor pilots who thought that wouldn't be them. I have TWO friends who lost parents in GA accidents.
 
ALso, why even bother flying and burning $200/hr in fuel and operations costs on your plane.

I see NO reason why I can't base myself in Puerto Rico, Facetime consults and OTVs, have an NP on site to cover in person needs, and contour and plan with a fiber connection. And I get to pay 4% federal income tax for living in Puerto Rico. Screw 1099 tax dodges LOL!
 
Holy wrongballs lets break this down.

First yes, get a Cirrus. If you're flying its the safest, most economical teleport machine at the 200mph range. 200/hr is a fantasy, try 300 with current fuel rates (5.8/g). 2000 hours and more than 15 years flying safely all across america.. uh, no. You can die in a car wreck tomorrow too. Be conservative and live. It will take you 4 years to become a proficient IFR pilot if you fly regularly, plan accordingly, start now.

Pick a job that understands you might have to defer nor not make it to work.. and a family that understands you might not come home this weekend due to weather. Getthereitis kills, don't do it. Go early, Go Later, or don't go at all. Figure it out. That is the lyfe, part of the deal.

Second, flying a light single, even with semi FIKI (depending on version), onboard XM weather, strikefinder (lighting), and ADSBin weather tools (and skywatch and adsb traffic) is still not something to do without serious training, and good ADM. It will take you 4 years to become a proficient IFR pilot if you fly regularly.. time to get started. Bonus: when you retire, no flying commercial except long distances or overseas.. unlock thousands of airports and experiences you can't dream of flying commercial.

95% of accidents are due to a) poor decision making that is obvious b) failure to maintain the aircraft and supervise its service. Its no joke, and it takes years to become a careful, thorough pilot. At least the Cirrus offers a parachute option (avoid light twins).

ps. deductions you say? why soitenly..
 
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Moonbeams said:
I strongly agree that solo hospital based is the way to go IF you can find admin that will truly let you run the show. If admin views you as an employee just like physics and dosimetry, and expects you to be a "team player" and make MD-level decisions as a group, then hard pass. Unfortunately this is most of them. If I could find a hospital whose admin went to the staff and said, whatever the doctor says goes, he's the doctor, you do what he says, got it? I would sign on tomorrow even if it were in Kearney. Instead, it's oh lets have 15 meetings about how you hurt dosimetry's feelings and don't want to fill out prescriptions the way physics tells you to. In freestanding, while you have to deal with with greedy and crazy peers, the "everybody is an employee on the same level" issues with staff and admin go away.

Regarding physician pilots, this is a fantasy. GA aircraft by and large suck, even the nice ones, and unless you can get your own citation with a co-pilot, you're going to be flying solo out in an old Mooney or maybe a Cirrus if you're ballar, and do this enough, you WILL encounter a bad weather situation and/or an equipment malfunction that will bring you down and you better hope it happens over rural Kansas in the middle of the day with clear skies and no wind, and not in Eagle county colorado with a light snow that suddenly turned into a blizzard. This is a quick way to make yourself dead, and if you don't believe me a quick google search will turn up over a thousand doctor pilots who thought that wouldn't be them. I have TWO friends who lost parents in GA accidents.
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I can list off the top of my at least 3 doctor pilots who put themselves in life threatening situation. Let’s just say 1 bought themselves a flaming casket to the ground along with a good chunk of their immediate family.

Idk what it is with doctor pilots but the combination of free time and arrogance and inexperience seems to be pretty deadly
 
In terms of mortality risk, which is worse: becoming a pilot as a doctor, or buying a motorcycle? I would guess that flying a plane is safer… but too lazy to check
 
Buying a motorcycle isn't the dangerous part.. its the riding lol.
Becoming a pilot is not easy, and it has a low injury/death rate.

The graveyard spike in mortality for pilots begins after a couple hundred hours.. you know, when someone thinks "See, I know it all" and/or becomes more aggressive in their flying or decision making..
 
Lamount said:
In terms of mortality risk, which is worse: becoming a pilot as a doctor, or buying a motorcycle? I would guess that flying a plane is safer… but too lazy to check
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Not a pilot (never will be, I hate flying but do it fairly frequently). Somewhat obsessed with air safety since adolescence when I witnessed a crash.

The numbers are always so hard to compare (per hour, per mile, per trip, etc) but I believe that general aviation is considered roughly 50x as dangerous as commercial flight, which is very safe. Almost certainly more dangerous than driving for most people who both drive and participate in general aviation IMO.

But, consider the diversity of both of these practices. General aviation I believe includes stuff like private business or high end travel (private jets) and sky diving operations (much greater ability to control variables when you are just flying around your drop zone and pretty safe) and other.

So what is the risk of general aviation for a radiation oncologist four years into flight training and creating a schedule where they are flying across the US in all seasons?

I don't know but I'm not participating. Kudos to @sirspamalot for making a fairly unique career model work.
 
Agreed, this is an unusual lifestyle. I only work generally within ~3.5 hrs ~500 miles of my home (flight time). My overall travel time (to and from both airports) is roughly 4.5 hours.

Not being "stuck" allows freedom to negotiate terms favorable to you, and of course the pay.. is very good. The schedule is also very good, but the back and forth isn't always fun.. and sometimes is stressful.

Job nirvana: 2x pay, modest workload, doable in 3.5 days a week, nice group of experienced folks who respect the leadership of the physician, nobody hassling you about your work (admins), and grateful patients.
 
Palex80 said:


Comments are interesting
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Yeah, I just don't care and it's not interesting. 5-->2, more intrafraction management, always more risk, although this may not be demonstrated in a clinical trial, marginally more convenient. Likely (almost certainly) more long term fibrosis.

Some of the comments are ridiculous and some are spot on.

Why are the margins different? They want a positive trial.

Not justifying RP cause it's only 2 visits? I hope I'm misinterpreting the comment, but this is bad thinking.

I'm a radonc, but for men in their 50s and below, I believe RP is often still preferable. Why? Cause of the salvage options. RP at 55, salvage RT at 69-70, no ADT for a lifetime. This benefit significantly diminished in men at a more advanced age at the time of diagnosis.

For men averse to surgery, even 44 fxns coming in daily and chatting with a good team while spending the rest of the day doing whatever is more convenient than surgery.
 
Palex80 said:


Comments are interesting
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17CCBF0A-9782-4B79-8499-B909A33FD333.jpeg
 
The “you could tx 2.5 x the patients this way” is a tell. In the US, this could very well read, “even less reason to refer for treatment back to the community”.

I think very few of us (if any?) are the bottleneck to treatment regarding prostate or any other cancer. We are much more likely to experience anxiety from our patients regarding starting soon, after their work up took 3-6 months due to bottlenecks in PCP, OR time, imaging or other specialist availability.

I am unaware of any radonc clinic where 5 (or 40) fraction prostate treatments are pushing other patients down the road in terms of treatment time.

I suspect that if we were treating so many prostates with XRT that this became a meaningful resource drain, we would be treating too many prostates period.

Gotta love MRI fusion biopsies in 78 year olds!
 
5fx vs 2fx 🤣
Talk about diminishing returns

I'm not even sure if that's any better than the DEI "research", I guess marginally because it actually involves oncology and radiation

What's good catchy acronym for "How to poach more patients from community to the big centers"
 
metallica81788 said:
5fx vs 2fx 🤣
Talk about diminishing returns

I'm not even sure if that's any better than the DEI "research", I guess marginally because it actually involves oncology and radiation

What's good catchy acronym for "How to poach more patients from community to the big centers"
Click to expand...
You get nearly no benefit as you have to count the hassle of spacer and fiducial. I’d bet most people rather just do 5 and not go through an extra needle poke through the rectum. Some prb do the spacer and fiducial on different days so even less benefit of convenience.
 
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