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radoncle said:
Please tell me these examples are hyperbolic and not factual.. I unfortunately am aware of drunk chairman.. wishfully hoping the other examples may not true, possibly??
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Hyperbole?

I thought he was very discreet with that post. Vague enough that it could be anyone.

I only know of one chair, er, what do the kids say? Bumping xanny bars?

But the other examples are pretty standard. I don't mean that to imply it's rampant - it's not, most people are generally not terrible humans. But I have my own versions of those examples, and I know they're not @RealSimulD's examples.

It is what it is.
 
elementaryschooleconomics said:
Hyperbole?

I thought he was very discreet with that post. Vague enough that it could be anyone.

I only know of one chair, er, what do the kids say? Bumping xanny bars?

But the other examples are pretty standard. I don't mean that to imply it's rampant - it's not, most people are generally not terrible humans. But I have my own versions of those examples, and I know they're not @RealSimulD's examples.

It is what it is.
Click to expand...
Waiting for the "tell me your worst moment at your brutal residency/staff" thread.

I'm sure you all have fun ones.. Enjoy:

My last words to a former ASTRO President (about 15 years prior to election) were "You can go F yourself."
 
GapCalc said:
This is pretty ridiculous… Dr. Simone is nice person, and very humble the (admittedly few) times I’ve spoken with him.

Maybe instead of forming a circular firing squad we could, you know, talk about solutions?

Protons are an issue but they are not the issue of the day… 42-ish centers are not shifting the tide against practicing rad oncs in the community nearly as much as anti-competitive hiring practices (SCAROP salary data), residency expansion, endless SOAPing, etc…
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Cannot speak to Simone. Have never met him. I agree that disparaging people we do not know is poor form. It is a shame that so many of us have experienced "pathologies of power" among our leaders at some point.

Protons are exaggerated in my mind because of the proposed carve outs in ROCR and their disproportionate impact on my region, where there are roughly 4 centers within 3 hours of me and they have functioned largely as a HALO device and undoubtedly contribute to residency program's assessment of what residency numbers are appropriate. Three of these centers are associated with large academic organizations that have been major players in regional consolidation.

I would argue that 42 centers is not trivial and 90 centers will definitely not be trivial. The commitment of academic radonc to high cost/low value care and the proposals of our professional organization to support these initiatives is actually a threat to many of our livelihoods within years and definitely within 1-2 decades.

Protons also represent an avenue for hype, large capital investment and the disproportionate significance of radonc departments within their larger institutions. This is not a positive. It prevents leadership from acknowledging that we are becoming less significant clinically....because we are spending more time and money per patient.
 
I have heard nice things about Simone personally, but I have not met him. I'm not averse to people taking big swings. He is, in my view, fully transparent in his biases and support of protons. That's all they have and that's all they want to use. What are they supposed to do? He doesn't profess to any ideals of equity or reducing financial toxicity. He and they are fully transparent and playing by the rules, as far as I can tell.

That being said, protons as an "industry" and ASTRO's full-throated support of them, while foisting cuts on us - meh. There's a difference between a placed called NY Protons vs Johns Hopkins who is spamming us under the guise of academia. There's a difference between their docs promoting what they do online vs Maryland's / MDACC misinformation.
 
Baddie GIF by Giphy QA


Yes, those owners/radoncs who hype non-academic proton centers proudly are just slightly above pond scum because they aren't hiding behind what they are doing. I guess.

But they still damage the radiation oncology world that we all live in. And for that, I give zero respect. Anyone who has a problem with my attitude can also ask how many I have to give:

michael cohen GIF
 
mehrlicht said:
oh yay buttsecks jokes. that will definitely result in you all being taken more seriously...
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no laughing matter.
pubmed.ncbi.nlm.nih.gov

Radiation safety of receptive anal intercourse with prostate cancer patients treated with low-dose-rate brachytherapy - PubMed

During the immediate weeks after prostate seed implant, the estimated intrarectal dose rates are higher in (103)Pd compared to (125)I. As (103)Pd decays faster than (125)I, 2 months after the implant, radiation exposure from (103)Pd becomes lower than (125)I. Receptive anal intercourse time...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
 
RickyScott said:
no laughing matter.
pubmed.ncbi.nlm.nih.gov

Radiation safety of receptive anal intercourse with prostate cancer patients treated with low-dose-rate brachytherapy - PubMed

During the immediate weeks after prostate seed implant, the estimated intrarectal dose rates are higher in (103)Pd compared to (125)I. As (103)Pd decays faster than (125)I, 2 months after the implant, radiation exposure from (103)Pd becomes lower than (125)I. Receptive anal intercourse time...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
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Did you see the artwork in this article? Not even in the same league of quality as Dr. Dickstein's.

S4aD6QX.png


What a thread!
 
mehrlicht said:
oh yay buttsecks jokes. that will definitely result in you all being taken more seriously...
Click to expand...
I've personally written ~3000 posts, many of which I approach with the exact same effort I gave my PhD dissertation on DNA damage and repair, including citations and figures.

I'm not alone.

Yet still, @Neuronix made that poll yesterday.

I strongly approve of the buttsecks jokes - not only do they exemplify free speech, they at least EARN the childish reputation some establishment folks want to slander SDN with.
 
RickyScott said:
no laughing matter.
pubmed.ncbi.nlm.nih.gov

Radiation safety of receptive anal intercourse with prostate cancer patients treated with low-dose-rate brachytherapy - PubMed

During the immediate weeks after prostate seed implant, the estimated intrarectal dose rates are higher in (103)Pd compared to (125)I. As (103)Pd decays faster than (125)I, 2 months after the implant, radiation exposure from (103)Pd becomes lower than (125)I. Receptive anal intercourse time...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
Click to expand...
This was a thing back in the day. Homosexual men specifically sought out seeds, prioritizing preservation of potency. Dunno if it is still the case.
 
Radonc90 said:
Well, this is going to be interesting...

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Florida is the state that DEFINITELY needed less guard rails protecting the quality of health care within their state.

When RFK Jr is in Tampa prescribing folks hydroxychloroquine penile suppositories to make their dong bigger, this will look like a much worse idea.
 
Mandelin Rain said:
Florida is the state that DEFINITELY needed less guard rails protecting the quality of health care within their state.

When RFK Jr is in Tampa prescribing folks hydroxychloroquine penile suppositories to make their dong bigger, this will look like a much worse idea.
Click to expand...

I have seen zero (0) data suggesting the ABIM does anything other than line their own pockets. This is a win for physicians in Florida, and hopefully it expands rapidly across the country.
 
Mandelin Rain said:
Florida is the state that DEFINITELY needed less guard rails protecting the quality of health care within their state.

When RFK Jr is in Tampa prescribing folks hydroxychloroquine penile suppositories to make their dong bigger, this will look like a much worse idea.
Click to expand...

This is a core issue with MOC in my opinion. People want it to be something it is not. We have so much in the way of credentialism these days and the bad actors continue to slip through. MOC will never be what people want, a paternalistic mechanism to protect uneducated patients from snake oil salesmen. Policies that harm the vast majority to try to hinder a few bad apples are a pet peeve 🤣

Despite it being a current event topic, I have not seen a single "pro-MOC" argument beyond "it could be worse". The reality is that we have constant attacks on our credibility and we essentially pay protection to boards for the privilege of using the skills that we paid 6 figures to learn.

The momentum for board certification and MOC is that it is lucrative for these non-profit organizations. There is nothing else.

We would benefit from an honest assessment of this problem and a scientific evaluation of solutions. Just like the boards encourage us to do with clinical/medical problems.
 
NotMattSpraker said:
The momentum for board certification and MOC is that it is lucrative for these non-profit organizations. There is nothing else.
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This is the way.

But we joined into a medical career because we OPTED OUT of greed for greed's sake. We wanted to do something honorable. At least, thats the gist of it, while making a comfortable interesting living.

MOC represents the worst grift, an abuse of its own. We do it because we have no other choice.

Westby's lawsuit failed. Therefore this is only one remaining solution:


#NBPASorGTFO

Until we advocate for a law saying hospitals MUST RECOGNIZE NBPAS then fear will keep hospital based specialists like us in check.
 
NotMattSpraker said:
This is a core issue with MOC in my opinion. People want it to be something it is not. We have so much in the way of credentialism these days and the bad actors continue to slip through. MOC will never be what people want, a paternalistic mechanism to protect uneducated patients from snake oil salesmen. Policies that harm the vast majority to try to hinder a few bad apples are a pet peeve 🤣

Despite it being a current event topic, I have not seen a single "pro-MOC" argument beyond "it could be worse". The reality is that we have constant attacks on our credibility and we essentially pay protection to boards for the privilege of using the skills that we paid 6 figures to learn.

The momentum for board certification and MOC is that it is lucrative for these non-profit organizations. There is nothing else.

We would benefit from an honest assessment of this problem and a scientific evaluation of solutions. Just like the boards encourage us to do with clinical/medical problems.
Click to expand...
Yeah, I was more just making a joke about the state of health care in Florida (a state RICH with snake oil salesmen) and who Florida's Governor seems to think would be a good choice to head the CDC.

florida GIF


I think there is some modest value in initial certification. But yes, MOC is just a box checking, administrative cash grab.
 
NotMattSpraker said:
The momentum for board certification and MOC is that it is lucrative for these non-profit organizations. There is nothing else.
Click to expand...
I don't know here.

Credentialism is what makes us docs. It is tied deeply to cultural expectations, gvt and private payor payment and is what separates us from homeopathic practitioners....and APPs.

To the left (of which I'm roughly a part), the fundamental narrative is that healthcare is a right and as such market forces should have a very limited role. Credentialism is critical, and payment should be for labor regarding a well regulated and evidence based service. The terminal pay structure for a national health care service may be all docs 250-350k, APPs 150-225k and nursing 85-175k (made up numbers that pass my personal understanding of reasonableness). From the left, the AMA represents a self serving group that opposed medicare and wants to limit physician supply to prop up salaries.

To the right, the AAMC and AMA represent cartels. Artificially suppressing supply of docs through standards and credentialism. This credentialism skews market forces and raises prices while not allowing markets to sort out winners. Remember, Milton Friedman was not a fan of board certification.

Credentialism is all that we have. If you get rid of it, prepare to swim with the sharks. For everyone who believes in value based care and evidence, you will be out of the field.
 
sirspamalot said:
This is the way.

But we joined into a medical career because we OPTED OUT of greed for greed's sake. We wanted to do something honorable. At least, thats the gist of it, while making a comfortable interesting living.

MOC represents the worst grift, an abuse of its own. We do it because we have no other choice.

Westby's lawsuit failed. Therefore this is only one remaining solution:


#NBPASorGTFO

Until we advocate for a law saying hospitals MUST RECOGNIZE NBPAS then fear will keep hospital based specialists like us in check.
Click to expand...

Haha I was just talking to someone, I am looking in to NBPAS. If it seems compelling, I plan to discuss this with my current hospital as an option.

This area is ripe for competition. If we can't make it go away entirely, at least we can have some choice. After all, a monopoly is unAmerican, right?

My one biggest question right now is that if you leave the ABR but need to go back for a future job change, can you re-join without a penalty?
 
communitydoc13 said:
I don't know here.

Credentialism is what makes us docs. It is tied deeply to cultural expectations, gvt and private payor payment and is what separates us from homeopathic practitioners....and APPs.
Click to expand...
Definitely true.

I wouldn't seek to question it.

What I do seek to question: the entities bestowing the credentials. Are THEY doing a good job? Are THEY minimally competent to credential others?

Who watches the watchers and whatnot.
 
NotMattSpraker said:
Well, we are only separated from APPs until organizations decide profits are more important than that separation.
Click to expand...
This would be the consequence of a terminal right leaning trajectory in medicine (all care by private equity type organizations). Although I would say our underlying culture of credentialism still provides value in terms of marketing. So not clear it goes to zero to me.

In the opposite scenario, credentialism is critical, unless you want your salary to be the same as an APP. The hard truth is that most of us (I do) feel that we are worth more than this.

NotMattSpraker said:
The question is what do these boards add over all those things?
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What do you typically think of the type of docs out in the community who let their board certification lapse?
 
Perhaps this is a naive question… but why not have the government handle credentialing? At least then, those credentialing bodies would be answerable to someone.
 
sirspamalot said:
This is the way.

But we joined into a medical career because we OPTED OUT of greed for greed's sake. We wanted to do something honorable. At least, thats the gist of it, while making a comfortable interesting living.

MOC represents the worst grift, an abuse of its own. We do it because we have no other choice.

Westby's lawsuit failed. Therefore this is only one remaining solution:


#NBPASorGTFO

Until we advocate for a law saying hospitals MUST RECOGNIZE NBPAS then fear will keep hospital based specialists like us in check.
Click to expand...
Wait wait wait.

"We opted out of greed."

But your entire schtick is pay me an inordinate amount of money to not do much work...

Now, I'm thinking this is all an act, you make $600k, work 35 hours with a 15 min commute in a cool city like Austin and spend all your free time with your loved ones and friends and are actually chummy with administrators and staff.

#WillTheRealSpamPleaseStandUp?
 
communitydoc13 said:
What do you typically think of the type of docs out in the community who let their board certification lapse?
Click to expand...

It's interesting you bring up this point. I have recently moved from academics to the community for the first time in my career. I've been super, super impressed with the physicians overall. They are way better than my academic colleagues told me they were.

Once I started working, I realized some academic colleagues were not as good at oncology as one would think given how they walk around talking about the greatness of academic, reference center medicine.

I have one oncologist I work with currently that does some real weird stuff, not in line with standards (not RO). They are boarded.

So, I've learned to judge doctors based on how they act at work, ie peer review. Labels and credentials don't seem to help very much.

Now, if you ask patients what they think of doctors, the answers are wild! We make jokes about it... "would you rather see the junior doctor or the chair?"

This is like so many other things. We have this idea of what medicine could be or should be, a beacon of integrity. Without important checks and balances, it will be 1850 again and snake oil salesmen will run amok.

What we actually have are physicians doing the best we can for our patients despite working in a system that is loaded with COI and false narratives.
 
I am confident spam is 750ing all day long as there are so many little centers out there who keep the lights on with locums. I know about 5 rad oncs like this off the top of my head and he could be any of them.

The only thing that raises my eyebrows is the whole fly-in fly-out thing.

Besides the cost of doing that, these stories are in the news every week... ‘Renowned’ California surgeon, 72, IDed as victim of fiery Santa Fe plane crash

This pilot made the most basic of an error after an engine failure on a twin after takeoff (clearly panic-induced). Which is what happens when you don't treat flying like a full-time job and are in the simulator training for emergencies every other week like the pros do.
 
I’m doing something similar but not as high of a rate.

I’m just saying, own the greed. We know that’s how America grows and thrives!
 
NotMattSpraker said:
What we actually have are physicians doing the best we can for our patients despite working in a system that is loaded with COI and false narratives.
Click to expand...
I agree 100%....in general.

Some crazy, marginal medical existences out there in the community however. Like docs who lose their hospital privileges but run their own surgical center, horrific plastics practices or very marginal community pathology practices with good relationships with local docs (probably fine for most cases but when it's cancer, it's never adequate).

Most community docs are very good IMO. In radonc, the path to reputation in academic medicine has essentially nothing to do with clinical skills (a few exceptions). In surgery, I think this is a bit different.
 
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