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She apologizes that it was not her intention?
So, she actually meant it? 🤣🤣🤣
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Please, discuss…

duck and cover documentary GIF by Kino Lorber
 
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Scope creep/midlevels seems somewhat irrelevant to radiation oncology.

Please don't tell me you're teaching your APRN to see consults, contour, and evaluate plans. It's bad enough that some of us are teaching prospective students & surplus residents.

I'm happy to lead care teams consisting of AI language models and autoplanning neural networks.
 
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yesmaster said:
Scope creep/midlevels seems somewhat irrelevant to radiation oncology.

Please don't tell me you're teaching your APRN to see consults, contour, and evaluate plans. It's bad enough that some of us are teaching prospective students & surplus residents.

I'm happy to lead care teams consisting of AI language models and autoplanning neural networks.
Click to expand...
I have never worked with an NP or even seen an NP in “rad onc action.” But I see so many NPs on rad onc staff websites!
 
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yesmaster said:
Scope creep/midlevels seems somewhat irrelevant to radiation oncology.

Please don't tell me you're teaching your APRN to see consults, contour, and evaluate plans. It's bad enough that some of us are teaching prospective students & surplus residents.

I'm happy to lead care teams consisting of AI language models and autoplanning neural networks.
Click to expand...
CMS claims records indicate mid-levels are definitely not irrelevant to Radiation Oncology...
 
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Gfunk6 said:
View attachment 368589



Well, if the machine does all the work and humans are solely there for blame then I'd say we do have some things to worry about. o_O
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This loss of control… letting the “machine do all the work” and inverse optimize (“No more cord blocks for head and neck RT???”)… was super scary for old timers.
 
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I still have no idea how/why VMAT actually* works. I mean, yeah, its insane to think a rotating gantry with moving leaves is doing its thing. Like magnetic forces, its witchcraft. Its just a magic box and the Physics Wizard tells me "go forth my child" and we do.

That is all.
 
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sirspamalot said:
I still have no idea how/why VMAT actually* works. I mean, yeah, its insane to think a rotating gantry with moving leaves is doing its thing. Like magnetic forces, its witchcraft. Its just a magic box and the Physics Wizard tells me "go forth my child" and we do.

That is all.
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At least you’re being truly honest.
 
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taserlaser said:
Not this again lol. German comparative cohort published for LDRT and Covid

Treatment of COVID-19 pneumonia with low-dose radiotherapy plus standard of care versus standard of care alone in frail patients​

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It's not German! It's
matador torero GIF by jsot


TheWallnerus said:
Damn that’s actually a hell of a positive study.
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No, it's not. Allow me to dissect it.


1. The primary endpoint was not met.

2. Bear in mind this great imbalance in the baseline characteristics.

1680717076850.png



Now, what is a CURB-65 score?

CURB-65 - Wikipedia

en.wikipedia.org en.wikipedia.org
CURB-65, also known as the CURB criteria, is a clinical prediction rule that has been validated for predicting mortality in community-acquired pneumonia and infection of any site.

The risk of death at 30 days increases as the score increases:

0—0.7%
1—3.2%
2—13.0%
3—17.0%
4—41.5%
5—57.0%

The really bad COVID cases were more than twice as common in the Control cohort than in the LD-RT cohort.
Why?
Because they chose to match the control group based only on age, gender, comorbidities, and SAFI values.
 
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Palex80 said:
It's not German! It's
matador torero GIF by jsot



No, it's not. Allow me to dissect it.


1. The primary endpoint was not met.

2. Bear in mind this great imbalance in the baseline characteristics.

View attachment 368927


Now, what is a CURB-65 score?

CURB-65 - Wikipedia

en.wikipedia.org en.wikipedia.org
CURB-65, also known as the CURB criteria, is a clinical prediction rule that has been validated for predicting mortality in community-acquired pneumonia and infection of any site.

The risk of death at 30 days increases as the score increases:

0—0.7%
1—3.2%
2—13.0%
3—17.0%
4—41.5%
5—57.0%

The really bad COVID cases were more than twice as common in the Control cohort than in the LD-RT cohort.
Why?
Because they chose to match the control group based only on age, gender, comorbidities, and SAFI values.
Click to expand...
I stand corrected - sorry Spaniards. Thanks for the commentary
 
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How many wRVUs for 0 fractions for breast cancer? 🤣
 
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So curious: what was the last competitive year of radonc graduates? I’m considering only hiring graduates that came out before that year. Hospitals can low-ball a new grad and get the cheapest person, but as a PP I want the best possible candidate.
 
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thesauce said:
So curious: what was the last competitive year of radonc graduates? I’m considering only hiring graduates that came out before that year. Hospitals can low-ball a new grad and get the cheapest person, but as a PP I want the best possible candidate.
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I'm guessing the first year (2019) they had 30+ unfilled pretty much marks the transition.

The Residency Training Landscape - ASTRO Blog- American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

A look at the overall training and oversight system that trains medical students to provide specialized care as a licensed physician.
www.astro.org www.astro.org
 
thesauce said:
So curious: what was the last competitive year of radonc graduates? I’m considering only hiring graduates that came out before that year. Hospitals can low-ball a new grad and get the cheapest person, but as a PP I want the best possible candidate.
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That seems a bit arbitrary. If pre residency credentials are important to you, you will have their CV. You can tell if they’re someone who was well qualified/would have matched in peak years.
 
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Not sure if you guys do outreach to PCPs regarding PSA screening but new data just dropped, 21 year Dutch cohort of ERSPC.

pubmed.ncbi.nlm.nih.gov

A Detailed Evaluation of the Effect of Prostate-specific Antigen-based Screening on Morbidity and Mortality of Prostate Cancer: 21-year Follow-up Results of the Rotterdam Section of the European Randomised Study of Screening for Prostate Cancer - Pub

Prostate-specific antigen-based prostate cancer screening reduces metastasis and mortality. Longer follow-up shows fewer invitations and diagnoses needed to prevent one death, a positive note towards the issue of overdiagnosis.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

To prevent one prostate cancer death you need to invite to screen 246 and diagnose 14. To prevent one case of Mets it is 121 and 7. This compares favorably to colonoscopy, mammograms etc.

No benefit seen in those starting enrolled after age 70 (note not the same as continuing screening after age 70). I actually think this understated the benefit, as the median age at enrollment was over 61. If you enroll all 50-55 year olds as they become eligible this will likely magnify the benefit. Plus the usual caveats of PSA contamination in control arm and noncompliance with biopsy. A big chunk of the prostate cancer deaths in the screening arm are those who only attended one screening event or who were recommended biopsy but didn’t receive.
 
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Palex80 said:


How many wRVUs for 0 fractions for breast cancer? 🤣
Click to expand...

You get a few for the consult.

And then, of course since we are the real oncologists, we continue seeing the unirradiated breast cancer patients the rest of their lives. Good RVUs for that. We weigh in on hormone therapy side effects and black cohosh and switching medications and that sort of stuff (we do not Rx, but write excellent notes about what should be Rx’d). Med oncs defer to our opinions on these things in the USA.
 
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TheWallnerus said:
You get a few for the consult.

And then, of course since we are the real oncologists, we continue seeing the unirradiated breast cancer patients the rest of their lives. Good RVUs for that. We weigh in on hormone therapy side effects and black cohosh and switching medications and that sort of stuff (we do not Rx, but write excellent notes about what should be Rx’d). Med oncs defer to our opinions on these things in the USA.
Click to expand...
You forgot the "/s" at the bottom of your paragraph
 
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The problem with the MGMA and SCAROP data is that they often scale production to 1.0 FTE. But, it's not always clear which data is scaled and which isn't.

The SCAROP data I have from a few years ago shows ~11,000 wRVUs scaled to 1.0 FTE but closer to 8,000 actually produced among clinical faculty greater than 0.7 FTE.

@Dan Spratt Any comment on the above? Do you have the full datasets and if so would you mind sharing?
 
thesauce said:
So curious: what was the last competitive year of radonc graduates? I’m considering only hiring graduates that came out before that year. Hospitals can low-ball a new grad and get the cheapest person, but as a PP I want the best possible candidate.
Click to expand...

Last competitive year was those who matched in 2018 and thus will be graduating this year (2023). I think 2024 graduates would be fine, but I'd be wary of 2025 and onward graduates.
 
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metview said:
Last competitive year was those who matched in 2018 and thus will be graduating this year (2023). I think 2024 graduates would be fine, but I'd be wary of 2025 and onward graduates.
Click to expand...
Hate to paint with broad strokes but definitely have to question the folks who consciously decided to match into this specialty this decade
 
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metview said:
Last competitive year was those who matched in 2018 and thus will be graduating this year (2023). I think 2024 graduates would be fine, but I'd be wary of 2025 and onward graduates.
Click to expand...

If the 2018 cohort had any sense there should be less of them. I know a few that jumped ship to do something else
 
I guess if you are going to Harvard/MDACC/MSK and planning on an academic career (MD/PhD even) it makes sense. Otherwise, it makes no cents.
 
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Nothing specific against any applicant of course, but:

2024 Class: Graduates were competitive
2025 Class: God help us
 
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thesauce said:
So curious: what was the last competitive year of radonc graduates? I’m considering only hiring graduates that came out before that year. Hospitals can low-ball a new grad and get the cheapest person, but as a PP I want the best possible candidate.
Click to expand...
Hospitals and dept chairs are not just lowballing new grads, but also their mature and mid-career faculty.

One mid-career doctor I know told me that his Chairman advised him to start looking for a new place, because his salary cost the same as 2 new grads. It's just simple math to the business people.

Nobody's work is truly irreplaceable. Even Steve Jobs once got fired from Apple.
 
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IonsAreOurFuture said:
Hospitals and dept chairs are not just lowballing new grads, but also their mature and mid-career faculty.

One mid-career doctor I know told me that his Chairman advised him to start looking for a new place, because his salary cost the same as 2 new grads. It's just simple math to the business people.

Nobody's work is truly irreplaceable. Even Steve Jobs once got fired from Apple.
Click to expand...

Maybe that’s why many of these mid and late career academics have left for industry. I can name at least 5 I’ve worked with in the past and there are probably more out there. Many of them don’t even work with anything radiation related when they leave.

So not only are you turning out grads like crazy, you are scaring away any remaining talent further pushing down any possibility of innovation the field (but let’s be honest probably not much going on anyway) and admin is actively Pershing a penny wise pound foolish approach to HC.

After the initial novelty has worn off, I’m sure the new grads are will be thrilled to learn that the decision to hire them was primary to replace an “expensive” older doctor. Hurray Meritocracy!
 
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Fpg1245 said:
Maybe that’s why many of these mid and late career academics have left for industry. I can name at least 5 I’ve worked with in the past and there are probably more out there. Many of them don’t even work with anything radiation related when they leave.
Click to expand...

This is perhaps the most frightening part of the oversupply issue. They’re replacing high-quality faculty (and community docs) with low-quality new grads. Our field doesn’t have a f—- chance.
 
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