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An
Astro ceo, who have I never hear of earns 650?
 

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In 2020 total comp was $750k

In 2020 total comp was $750k
Who is this non-md? Has anyone heard of them. Quite a salary to work against our interests.
 
ASTRO might say that is the going rate for a CEO, and they would likely be right. A chair might say 300s starting is “going rate” for a RO, and they might be right! CEO makes over twice as much as many people, but CEOs also didn’t double their numbers. It is simple market economics. Field did it to itself. Just be happy you have A job, “leaders” say.
 
We all bitch about it but we're better off than what is happening the ABIM. The ABR knows not to push any further.

I'm quite sure the ABR could be easily staffed by willing volunteers only with expenses covered and one plush trip as a reward per year. After all, all the actual WORK that goes into r3tarded things like OLA is done by.. people who like to work for free.
 
Damn, 650 to oversee a period of massive Medicare cuts such that we are below 2000 levels of reimbursement when adjusted for inflation AND while helping the old guard cash out on the back of new grads by allowing unchecked residency expansion and mass SOAPing of candidates who had no interest in the field while radiation use is diminishing?

Sign me up. A lot more than I make for helping cancer patients. I want to be a compassion farmer too.
 
You'll have to climb the ladder through a lot of groveling, free labor (volunteering), brownnosing (networking and talking to your in-group) and delayed gratification.

Kamala Harris Dont Come GIF by GIPHY News


Once you finally climax (Get paid) you are NOT leaving that mountain and will find any excuse to keep on grifting. And climaxing...


Star Wars Disney Plus GIF by Disney+
 
ASTRO might say that is the going rate for a CEO, and they would likely be right. A chair might say 300s starting is “going rate” for a RO, and they might be right! CEO makes over twice as much as many people, but CEOs also didn’t double their numbers. It is simple market economics. Field did it to itself. Just be happy you have A job, “leaders” say.

It does seem to be the going rate. Sometimes the CEO is an MD though.

And one can always ask, am I getting what I am paying for?

As a member, the answer was no for me, so I dropped my membership.

I wonder if the board thinks they are getting their money’s worth with their CEO?
 
We all bitch about it but we're better off than what is happening the ABIM. The ABR knows not to push any further.

I'm quite sure the ABR could be easily staffed by willing volunteers only with expenses covered and one plush trip as a reward per year. After all, all the actual WORK that goes into r3tarded things like OLA is done by.. people who like to work for free.
The ABIM is just greedy, they aren’t actively working to harm the salaries and employment prospects of their members. This is where Astro really distinguishes itself.
It does seem to be the going rate. Sometimes the CEO is an MD though.

And one can always ask, am I getting what I am paying for?

As a member, the answer was no for me, so I dropped my membership.

I wonder if the board thinks they are getting their money’s worth with their CEO?
the board is certainly getting their moneys worth and more. Residency expansion/cheap labors and protons are the priorities?
 
the board is certainly getting their moneys worth and more. Residency expansion/cheap labors and protons are the priorities?

Just personal opinion, but the board and other prominent non-board members are a lot less cohesive than people might think.

Anyway, anyone can look at their published strategic plan to objectively judge the success of executives and the board. While it is not any one board members fault, I think they collectively do a very bad job on more than half of their stated goals.

 
Just personal opinion, but the board and other prominent non-board members are a lot less cohesive than people might think.

Anyway, anyone can look at their published strategic plan to objectively judge the success of executives and the board. While it is not any one board members fault, I think they collectively do a very bad job on more than half of their stated goals.

"You miss 100% of the shots you don't take." - ASTRO

"Stop, ASTRO! Don't shoot!" - me
 
I quit ASTRO. I encourage everyone to quit ASTRO. As in 100.0% of pp radoncs should stop supporting ASTRO until they stop destroying our field.

ACRO - meh, I don't care for some of the personalities, but at least they pay homage to pp. The fearless leader got a (successful) lawsuit against him for discrimination (university paid) and started a company treating people with "red light" therapy for a bunch of different health issues.. but hey, its all good.
 
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I quit ASTRO. I encourage everyone to quit ASTRO. As in 100.0% of pp radoncs should stop supporting ASTRO until they stop destroying our field.

ACRO - meh, I don't care for some of the personalities, but at least they pay homage to pp. The fearless leader got a (successful) lawsuit against him for discrimination (university paid) and started a company treating people with "red light" therapy for a bunch of different health issues.. but hey, its all good.
LOL almost true; they never worked for a university, the lawsuit(s) did not make it to trial, laser center did not get up and running. But I am not arguing with your impression
 
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Precisely. ITV also an issue.
If we're getting that technical, there was also an old paper, surgical no less, informing ctv decisions by evaluating distance microscopic disease can exist from the primary. I think something like 95% of it in adenos is within 8mm of the primary and within 6 mm in squames (which is not to say I got this big). In any case I do use a ctv, but never do whole lobe rt...
 
I'm still not sure what that screenshot is pointing out. Bad plan? If he's suggesting the volumes are to big, he should at least give us a pic on lung window.
I’m not sure either. Is that his example of a good plan or a bad plan? Doesn’t seem like enough detail to know. The margins don’t look that big if you figure in windowing and 4D
 
I’m not sure either. Is that his example of a good plan or a bad plan? Doesn’t seem like enough detail to know. The margins don’t look that big if you figure in windowing and 4D
It's absurd to think it's bad In my estimation. It's not like we get creative. We contour gross disease, account for respiratory motion, make standard expansions and go from there. No offense to Dr stiles, but la-nsclc is one of the more straightforward things we do. Perhaps I should post a pic of a whole right upper lobe sitting on a specimen table and explaining what a travesty it is that theres only a 1 cm adeno in there somewhere.
 
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It’s what we do as rad oncs. We btch and complain, fraction/volume/modality shame and wonder why we are at the bottom. All we do is compete with each other to distinguish ourselves to either feed our low levels of self-esteem or to somehow gain an edge against another rad onc to survive.
 
It’s what we do as rad oncs. We btch and complain, fraction/volume/modality shame and wonder why we are at the bottom. All we do is compete with each other to distinguish ourselves to either feed our low levels of self-esteem or to somehow gain an edge against another rad onc to survive.

the matrix fringe GIF
 
My interpretation is that he thinks it is an overly complex plan for which a thoracic rad onc is needed and that others 'should not try this at home' embedded with a slight a$$ kissing of the radiation oncologists he works with by specifying that they should not be left out of the conversation about expert care at a tertiary referral center. Typical day on the bird app
 
Perfect example of community practice/"inferior outcomes"/how to think outside the box that they don't teach you in residency is happening today in my world....

I have a p16+ but heavy smoker head/neck guy that doesn't want standard of care treatment. He doesn't want his teeth messed with (refuses pre treatment dental eval) . He's willing to sacrifice efficacy for a chance at better quality of life. He absolutely refuses 70 Gy with weekly Cis. He probably needs a tube but he's refusing it.

I never ran into this at the academic center (partially bcause some of the attendings, not all but some, would just refuse to treat him).

So now do I try to bargain and cut him back to 60 Gy total dose? Consider some neoadj chemo treatment to see if he has a great response then cut dose back (a la the ECOG trial)? Eliminate any elective nodal treatment? Just offer palliative radiation alone to kick the can down the road?

Out in community practice, especially in my area, I swear there is a lot of bargaining patients do. Never saw this in residency.

I have seen cures with treatments that would fail me on boards. But I try to meet people in the middle and some treatment is often better than none. It's a fine line in letting a patient dictate their care to you and trying to get some treatment in to help them and potentially cure them.
 
Perfect example of community practice/"inferior outcomes"/how to think outside the box that they don't teach you in residency is happening today in my world....

I have a p16+ but heavy smoker head/neck guy that doesn't want standard of care treatment. He doesn't want his teeth messed with (refuses pre treatment dental eval) . He's willing to sacrifice efficacy for a chance at better quality of life. He absolutely refuses 70 Gy with weekly Cis. He probably needs a tube but he's refusing it.

I never ran into this at the academic center (partially bcause some of the attendings, not all but some, would just refuse to treat him).

So now do I try to bargain and cut him back to 60 Gy total dose? Consider some neoadj chemo treatment to see if he has a great response then cut dose back (a la the ECOG trial)? Eliminate any elective nodal treatment? Just offer palliative radiation alone to kick the can down the road?

Out in community practice, especially in my area, I swear there is a lot of bargaining patients do. Never saw this in residency.

I have seen cures with treatments that would fail me on boards. But I try to meet people in the middle and some treatment is often better than none. It's a fine line in letting a patient dictate their care to you and trying to get some treatment in to help them and potentially cure them.
At some level/point, i let them go elsewhere if they want to practice medicine/dictate their care (perfect local NCI-designated pps exempt center referral honestly)
 
At some level/point, i let them go elsewhere if they want to practice medicine/dictate their care (perfect local NCI-designated pps exempt center referral honestly)

Yes.

We all have our lines we're unwilling to cross. I don't hold judgement on those that would refuse to alter standard of care. I do think that being rigid though can at times end up in worse outcomes for all involved. But we all know standard of care is that way for a reason most of the time, so deviating can have MAJOR pitfalls.

Just try to do your best with what you're comfortable with.
 
Bargained a skin cancer into 35/5 which ive never done and otherwise he said no treatment. He lived 70 miles away. QOD. Raging skin reaction/desquamation. Scared me.

He is happy a few months out.
 
Perfect example of community practice/"inferior outcomes"/how to think outside the box that they don't teach you in residency is happening today in my world....

I have a p16+ but heavy smoker head/neck guy that doesn't want standard of care treatment. He doesn't want his teeth messed with (refuses pre treatment dental eval) . He's willing to sacrifice efficacy for a chance at better quality of life. He absolutely refuses 70 Gy with weekly Cis. He probably needs a tube but he's refusing it.

I never ran into this at the academic center (partially bcause some of the attendings, not all but some, would just refuse to treat him).

So now do I try to bargain and cut him back to 60 Gy total dose? Consider some neoadj chemo treatment to see if he has a great response then cut dose back (a la the ECOG trial)? Eliminate any elective nodal treatment? Just offer palliative radiation alone to kick the can down the road?

Out in community practice, especially in my area, I swear there is a lot of bargaining patients do. Never saw this in residency.

I have seen cures with treatments that would fail me on boards. But I try to meet people in the middle and some treatment is often better than none. It's a fine line in letting a patient dictate their care to you and trying to get some treatment in to help them and potentially cure them.

Often enough patients want to ignore my advice. Well ok let's think outside of the box. View it as a natural experiment. Sometimes (more often that I would have thought) works out for them.

For your HN guy might think about 54 in 18. If he refuses even that, SBRT, 44-50 in 5. Every other day or twice a week.
 
Often enough patients want to ignore my advice. Well ok let's think outside of the box. View it as a natural experiment. Sometimes (more often that I would have thought) works out for them.

For your HN guy might think about 54 in 18. If he refuses even that, SBRT, 44-50 in 5. Every other day or twice a week.
A few folks I know with do multiple courses of quad shot q2 weeks
 
Perfect example of community practice/"inferior outcomes"/how to think outside the box that they don't teach you in residency is happening today in my world....

I have a p16+ but heavy smoker head/neck guy that doesn't want standard of care treatment. He doesn't want his teeth messed with (refuses pre treatment dental eval) . He's willing to sacrifice efficacy for a chance at better quality of life. He absolutely refuses 70 Gy with weekly Cis. He probably needs a tube but he's refusing it.

I never ran into this at the academic center (partially bcause some of the attendings, not all but some, would just refuse to treat him).

So now do I try to bargain and cut him back to 60 Gy total dose? Consider some neoadj chemo treatment to see if he has a great response then cut dose back (a la the ECOG trial)? Eliminate any elective nodal treatment? Just offer palliative radiation alone to kick the can down the road?

Out in community practice, especially in my area, I swear there is a lot of bargaining patients do. Never saw this in residency.

I have seen cures with treatments that would fail me on boards. But I try to meet people in the middle and some treatment is often better than none. It's a fine line in letting a patient dictate their care to you and trying to get some treatment in to help them and potentially cure them.
Just had an 80 year old lady that I only treated gross disease.
 
Out in community practice, especially in my area, I swear there is a lot of bargaining patients do. Never saw this in residency.

I have seen cures with treatments that would fail me on boards. But I try to meet people in the middle and some treatment is often better than none. It's a fine line in letting a patient dictate their care to you and trying to get some treatment in to help them and potentially cure them.
This is my favorite part of what I like to call...Redneck RadOnc.

There's what we're taught in the hivemind of the crucible. But the <100 institutions where we all start our training, and the "ASTRO Zeitgeist" in the Red Journal...that's not what's really happening for most of us.

However, it goes in both directions, "good" and "bad" (though I don't believe what we do can be easily labeled in those terms).

At least once a year, and it just happened again this last week, someone will Tweet about doing a "same-day CTSIM with accelerated planning and treatment delivery" like it's a miracle. There are several publications regaling us with tales of such feats.

Except...I've done that many times. The first time, the staff at my small clinic were confused why I was under the impression it wasn't possible. They had no idea that it wasn't routine elsewhere. No one thought it was worth talking about.

Now, the time I did same-day hand calcs for electrons...nah. Never again. Once. One time.

Redneck RadOnc. Sometimes you teach an old man about why you should use soap, sometimes you turn a stellar VMAT plan around in a day. Who knows.
 
This is my favorite part of what I like to call...Redneck RadOnc.

There's what we're taught in the hivemind of the crucible. But the <100 institutions where we all start our training, and the "ASTRO Zeitgeist" in the Red Journal...that's not what's really happening for most of us.

However, it goes in both directions, "good" and "bad" (though I don't believe what we do can be easily labeled in those terms).

At least once a year, and it just happened again this last week, someone will Tweet about doing a "same-day CTSIM with accelerated planning and treatment delivery" like it's a miracle. There are several publications regaling us with tales of such feats.

Except...I've done that many times. The first time, the staff at my small clinic were confused why I was under the impression it wasn't possible. They had no idea that it wasn't routine elsewhere. No one thought it was worth talking about.

Now, the time I did same-day hand calcs for electrons...nah. Never again. Once. One time.

Redneck RadOnc. Sometimes you teach an old man about why you should use soap, sometimes you turn a stellar VMAT plan around in a day. Who knows.
Ok how this? Icu pt on vent. Imported the diagnostic scan into eclipse and drew the field and then brought pt down and used a cone beam/kv to center on carina and give 8 gy off cord without a sim in under 2 hrs total
 
Ok how this? Icu pt on vent. Imported the diagnostic scan into eclipse and drew the field and then brought pt down and used a cone beam/kv to center on carina and give 8 gy off cord without a sim in under 2 hrs total
Does it matter…did emergent RT help? Fortunately, I’m 100% outpatient based so I don’t have to make these decisions.
 
Does it matter…did emergent RT help?
Meme Reaction GIF by Robert E Blackmon

Used to feel great, doing commando heroic inpt RT on ICU patients.

Now that I'm in a freestanding, can't treat anyone with more than a nasal cannula and honestly i think that's probably for the better based on what I've seen with those really sick pts getting RT, end of life
 
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Meme Reaction GIF by Robert E Blackmon

Used to feel great, doing commando heroic inpt RT on ICU patients, now freestanding, can't treat more than someone with a nasal cannula and honestly i think that's probably for the better based on what I've seen with those really sick pts getting RT, end of life

Treated too many inpatients that died within days to weeks of RT that were so called “emergencies”. Failure to consult the correct specialists
 
Treated too many inpatients that died within days to weeks of RT that were so called “emergencies”. Failure to consult the correct specialists
If anything, I can see the inpatient team blaming radiation for “rapid decompensation following radiation”- radiation pneumonitis is a popular phrase inappropriately used a lot.
 
Redneck RadOnc uses same-day "sim-plan-treat" because the farmers live an hour away and I'm still the closest linac.

Redneck RadOnc DOES NOT believe in the concept of "emergency radiation".

In fact...Redneck RadOnc might have just responded to an email from MedOnc expressing a similar sentiment, before authoring this post...
 
Redneck RadOnc uses same-day "sim-plan-treat" because the farmers live an hour away and I'm still the closest linac.

Redneck RadOnc DOES NOT believe in the concept of "emergency radiation".

In fact...Redneck RadOnc might have just responded to an email from MedOnc expressing a similar sentiment, before authoring this post...
We have a contract to treat with local hospital. Can't remember the last time we had to use it.

It's a lose-lose for everyone esp on straight Medicare patients
 
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