Rad Onc Twitter

  • Thread starter Thread starter deleted1002574
  • Start date Start date
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
NotMattSpraker said:
LOL, weird turn! I got a lot of DMs from kind people.

At least the internet knows I am a hard worker now!

Funny how some individuals treat “bullying” different on SDN and Twitter, ey? 😘
Click to expand...
Narrator: and thus, hunched over a sticky keyboard and lit only by the warm glow of a 1999 stock Dell monitor, Dr Spraker began the arduous process of authoring an opinion piece for submission to PRO about how the internet had canceled him...
 
winstonfoot5 said:
Update: this went totally off the rails in a way that could only happen on Twitter (X)
Click to expand...
I disagree with Spratt knocking others’ work ethic, but he’s not wrong about practice making perfect. I saw someone post on Twitter once that maybe PhDtwitter shouldn’t be preaching work-life balance for all unconditionally. Maybe if you want to be tenured at Harvard, you really do have to sacrifice balance to achieve it. If that’s not your goal, there are plenty of other jobs that will afford you the balance but not the fame.

With regards to residency training, there’s a point at which volume interferes with learning because you’re just trying to get through the day, but that inflection point is at a high volume, and I think many programs are way too light on cases.
 
grenz said:
I disagree with Spratt knocking others’ work ethic, but he’s not wrong about practice making perfect. I saw someone post on Twitter once that maybe PhDtwitter shouldn’t be preaching work-life balance for all unconditionally. Maybe if you want to be tenured at Harvard, you really do have to sacrifice balance to achieve it. If that’s not your goal, there are plenty of other jobs that will afford you the balance but not the fame.

With regards to residency training, there’s a point at which volume interferes with learning because you’re just trying to get through the day, but that inflection point is at a high volume, and I think many programs are way too light on cases.
Click to expand...

Yeah but some of these places are absolutely crazy. I had a first year at a big program tell me he did 1000 cases. I find it hard to believe.

When I asked how involved they were or how much contouring he did. I was surprised to find he’s counting them only after a sim. No further involvement. Consult and sim?

Maybe he’s technically following the rules but it seems like an artificial inflation of the numbers.
 
grenz said:
I disagree with Spratt knocking others’ work ethic, but he’s not wrong about practice making perfect. I saw someone post on Twitter once that maybe PhDtwitter shouldn’t be preaching work-life balance for all unconditionally. Maybe if you want to be tenured at Harvard, you really do have to sacrifice balance to achieve it. If that’s not your goal, there are plenty of other jobs that will afford you the balance but not the fame.

With regards to residency training, there’s a point at which volume interferes with learning because you’re just trying to get through the day, but that inflection point is at a high volume, and I think many programs are way too light on cases.
Click to expand...
Well, practice doesn't make perfect.

Perfect practice makes perfect.

While too little training is bad, and too much training is bad, this one-to-one apprenticeship model we've got can be problematic even at the perfect volume.

What if your residency institution has high skin volume...but uses an orthovoltage for almost all cases, and you join a practice without ever having seen electrons?

What if your residency institution has high CNS volume...but uses a GammaKnife almost exclusively? So you go out into the world having never done linac-based SRS?

I'm not actually disagreeing with anyone, I guess...mostly lamenting our training structure, as per usual.
 
grenz said:
With regards to residency training, there’s a point at which volume interferes with learning because you’re just trying to get through the day, but that inflection point is at a high volume
Click to expand...
I agree. For clinical work, volume matters and the inflection point is pretty high.

grenz said:
Maybe if you want to be tenured at Harvard, you really do have to sacrifice balance to achieve it.
Click to expand...
This is undoubtedly true. I personally was unwilling to put in the level of personal sacrifice to get anything close to this level of opportunity.

However, there is something amiss with our high achieving, highly productive academic crowd in this field. RW might say, "a stunning lack of imagination".

There is just too much of an emphasis on productivity, drinking 25 muscle milks and chairing 15 committees. At some point, peak meritocracy pushes out the thinkers. (Not that there aren't some great thinkers in radonc. There definitely are. Usually they are the physicists or non-clinical research faculty. Self-effacing types that like candy and beer).
 
Last edited:
communitydoc13 said:
I agree. For clinical work, volume matters and the inflection point is pretty high.


This is undoubtedly true. I personally was unwilling to put in the level of personal sacrifice to get anything close to this level of opportunity.

However, there is something amiss with our high achieving, highly productive academic crowd in this field. RW might say, "a stunning lack of imagination".

There is just too much of an emphasis on productivity, drinking 25 muscle milks and chairing 15 committees. At some point, peak meritocracy pushes out the thinkers. (Not that there aren't some great thinkers in radonc. There definitely are. Usually they are the physicists or non-MD research faculty. Self-effacing types that like candy and beer).
Click to expand...
I feel seen (at least about the candy and beer part - not implying in the least that I merit the compliment of being a great thinker). Forgetting even about personal commitments, there is a point at which the constant stream of demands forces you into only being superficially involved in your obligations. I acknowledge that this point is different for everyone and I certainly prefer > meaningful involvement with fewer projects. Perhaps this Spratt person is such a superstar that he can see 20 consults a day while churning out a dozen high-impact papers a year, providing meaningful service on multiple committees, and, by the way, chairing a department. Not to mention churning out 2000-word screeds for twitter - that has to take some serious time commitment as well. But something has to give eventually, and even the so-called 'superstars' are phoning certain things in. My personal observations during training suggest that that 'something' tends to be clinical care. But I guess if you've delegated this to an entourage of APPs and residents...
 
grenz said:
I disagree with Spratt knocking others’ work ethic, but he’s not wrong about practice making perfect. I saw someone post on Twitter once that maybe PhDtwitter shouldn’t be preaching work-life balance for all unconditionally. Maybe if you want to be tenured at Harvard, you really do have to sacrifice balance to achieve it. If that’s not your goal, there are plenty of other jobs that will afford you the balance but not the fame.

With regards to residency training, there’s a point at which volume interferes with learning because you’re just trying to get through the day, but that inflection point is at a high volume, and I think many programs are way too light on cases.
Click to expand...

Haha, of course I agree with practice makes perfect. This is hard hitting educator advice right here. I'm probably not important enough for someone like Dan to get to know me, but we mostly agree on that.

However, this is exactly why everyone should remember Simone's maxim "Institutions don't love you back". Your family loves you, your friends love you, you're institution never will, even if you can bench press 14 consults in an afternoon. Unless your work will truly save a patient, which is rarely the case in this field, you might think twice leaving your partner to eat dinner alone so you can finish your 14th consult note for the day.

This is what I meant when I said "Im happy now that I left academics".

I am happy that I've found ways to value myself above how much I can sacrifice myself for a large hospital cooperation. Residents would benefit from learning this much earlier than they do. This doesn't make you lazy, it makes you responsible and mature. This is the supposed wellness we all claim to care about.

Hopefully Dan can find that for himself sometime too.
 
elementaryschooleconomics said:
Well, practice doesn't make perfect.

Perfect practice makes perfect.

While too little training is bad, and too much training is bad, this one-to-one apprenticeship model we've got can be problematic even at the perfect volume.

What if your residency institution has high skin volume...but uses an orthovoltage for almost all cases, and you join a practice without ever having seen electrons?

What if your residency institution has high CNS volume...but uses a GammaKnife almost exclusively? So you go out into the world having never done linac-based SRS?

I'm not actually disagreeing with anyone, I guess...mostly lamenting our training structure, as per usual.
Click to expand...

Spot on.

I would 100% rather train with someone thoughtful about the clinic experience as a classroom than someone who thinks of it as a weight room 🤣
 
communitydoc13 said:
I agree. For clinical work, volume matters and the inflection point is pretty high.


This is undoubtedly true. I personally was unwilling to put in the level of personal sacrifice to get anything close to this level of opportunity.

However, there is something amiss with our high achieving, highly productive academic crowd in this field. RW might say, "a stunning lack of imagination".

There is just too much of an emphasis on productivity, drinking 25 muscle milks and chairing 15 committees. At some point, peak meritocracy pushes out the thinkers. (Not that there aren't some great thinkers in radonc. There definitely are. Usually they are the physicists or non-clinical research faculty. Self-effacing types that like candy and beer).
Click to expand...
When it comes to academic medicine productivity, I 100% agree with the quantity over quality culture in academics being a bad thing. But going to my analogy, the tenured biologists at Harvard are publishing multiple Nature/Science papers. High volume of high quality. Generally I’d say the MDs who become full professors at fame-making institutions have done more than just publish a bunch of retrospectives.
 
What is being missed by these people is that there is no physical way to do 14 consults in an afternoon and do 5 head and necks

And to do this often / routinely.

I’m not saying residents should see 5 a week.
15 is fine. Maybe 20 occasionally.
 
RealSimulD said:
What is being missed by these people is that there is no physical way to do 14 consults in an afternoon and do 5 head and necks

And to do this often / routinely.

I’m not saying residents should see 5 a week.
15 is fine. Maybe 20 occasionally.
Click to expand...
If you bill by MDM and have tons of support staff (including a resident), then yes it is possible! It sounds like that’s the week’s #of consults at MSKCC, so the total # might be more reasonable.
 
grenz said:
If you bill by MDM and have tons of support staff (including a resident), then yes it is possible! It sounds like that’s the week’s #of consults at MSKCC, so the total # might be more reasonable.
Click to expand...

Yes. I think the reality is he used an exaggerated number because of the muscle milk or some other unclear reason. People called him on it and this is Rad Onc. When you challenge a chair, you get a hulk smash.

There are a lot of reasonable models. Personally, I like to cap my consults at no more than 6 per day because I dont do them alone. Your team can burn out, even if you are an olympian yourself. Also, sometimes a patient wants a full hour with me personally, not an NP or resident. Most importantly, theres only one group that benefits when a single doctor is seeing 14 patients in an afternoon, the hospital leadership.

Of course, the chair wants you doing that. You need to seek other opinions. That was my point of the tweet that seemed to make him so mad.
 
grenz said:
If you bill by MDM and have tons of support staff (including a resident), then yes it is possible! It sounds like that’s the week’s #of consults at MSKCC, so the total # might be more reasonable.
Click to expand...
It’s simply not reasonable!

Even with help, if a resident is seeing a patient and spending less that 30 minutes on a new head and neck, that’s not good. I have support, too, and I just saw a head neck this AM. With my consult + endoscopy we are at over 30 minutes. I’ve done many of these and have a script and this is not a complex case with possibility of TORS options.

Say reasonable time is 40 minutes (still low for a PGY, IMO). 40 x 14 = 560 minutes. 5 minutes between patients = 65 more
Notes - 14 x 15 min = 210 minutes
Contouring - 1 Hr x 5 = 300 minutes

This is approaching 20 hours. And after noon clinic starts at 1
 
Not to beat a dead horse, but prescient article today in NY Times about Frances Tiafo, a child tennis prodigy who is breaking into the elite tier in the pros. One day, he may regret the obsession and time spent practicing rather than having a personal life, but you can’t deny that the sacrifice is what’s needed to reach the mountain top.

“We all noticed that the moment he came in here at 4 or 5 he just couldn’t get enough tennis,” Ponkka told me recently. “He was always observing, always watching, and all the spare time he had he was hitting against the wall. It wasn’t so much about his natural ability, but his absolutely unbelievable love of the game.”
Salazar recalled, “Other kids that age watched cartoons. Frances only watched the Tennis Channel. If you didn’t want to talk about tennis nonstop, you couldn’t be his friend.”
 
RealSimulD said:
It’s simply not reasonable!

Even with help, if a resident is seeing a patient and spending less that 30 minutes on a new head and neck, that’s not good. I have support, too, and I just saw a head neck this AM. With my consult + endoscopy we are at over 30 minutes. I’ve done many of these and have a script and this is not a complex case with possibility of TORS options.

Say reasonable time is 40 minutes (still low for a PGY, IMO). 40 x 14 = 560 minutes. 5 minutes between patients = 65 more
Notes - 14 x 15 min = 210 minutes
Contouring - 1 Hr x 5 = 300 minutes

This is approaching 20 hours. And after noon clinic starts at 1
Click to expand...
There could be some hyperbole to what Spratt said, but one of my attendings in residency was a relatively recent MSKCC grad, and he said he’d see 20 consults in a Friday with Zelefsky.

If you shadow busy surgeons (usually with poor bedside manner), you’ll see they spend about 10 minutes in the room even if they’re recommending surgery. APP does the rest of the consult. Nancy Lee is probably the same.
 
grenz said:
If you shadow busy surgeons (usually with poor bedside manner), you’ll see they spend about 10 minutes in the room even if they’re recommending surgery. APP does the rest of the consult. Nancy Lee is probably the same.
Click to expand...

100%, it is a possible model. I decided early on I definitely did not want to be part of that kind of practice, but thats just my opinion. Kind of weird though to tout a patient coming to see a "world renowned physician" as Dan did when the physician sees the patient for 10 minutes...

I also agree with your points about tennis, but this is medicine not sports! If you are competing, you're not going to get the glory like athletes do. You're going to get burn out and a slightly richer hospital.
 
grenz said:
If you shadow busy surgeons (usually with poor bedside manner), you’ll see they spend about 10 minutes in the room even if they’re recommending surgery. APP does the rest of the consult. Nancy Lee is probably the same.
Click to expand...

True - but we're supposed to be better than this. It bothers me when CT surgeons poach my SBRT patient and clearly don't explain what the surgical process entails since they only spend 10 minutes with them - I need to get over it honestly or find a better way to retain these patients.

Some days I would love to just walk in say hey you're getting radiation, see you in a few weeks. I do enjoy building good will with patients, staff, and referrings by taking the time. You can become a very important piece of the puzzle doing that over months to years. Some patients will abuse that time, unfortunately.
 
Any effort to normalize seeing double digit consult patients in a half day is a HUGE red flag.

Run, don’t walk away.

The are human beings with real disease, social problems, and emotions that you’re trying your absolute best to help. They are not pigs you’re shooting in the brain before they become bacon.
 
NotMattSpraker said:
100%, it is a possible model. I decided early on I definitely did not want to be part of that kind of practice, but thats just my opinion. Kind of weird though to tout a patient coming to see a "world renowned physician" as Dan did when the physician sees the patient for 10 minutes...

I also agree with your points about tennis, but this is medicine not sports! If you are competing, you're not going to get the glory like athletes do. You're going to get burn out and a slightly richer hospital.
Click to expand...
Totally agree that it’s not the lifestyle I want for myself or my children. I think most of the famous people in our field are not motivated by achieving fame per se, but for the few who are, I’d just ask them “who is the most famous dermatologist?”
 
I don't buy the exceptionalism argument regarding clinical volume one bit.

Think all day about math, cancer biology, physics, value in medicine and produce intellectual product....sure, to be world class in these endeavors requires comparable effort and singularity of focus to being world class in athletics.

Patient volume? Absurd. It's a silly flex (as they all are in our field).

I'm a little person. I just want to be able to enroll in a CME with a panel of three radoncs discussing the recent progress regarding management of a given disease process and be wowed by it. Can somebody give me an example of one of these?

Pick almost any medonc CME and this will happen. The docs aren't even that famous typically, just early-mid career experts participating in an exciting narrative.
 
grenz said:
There could be some hyperbole to what Spratt said, but one of my attendings in residency was a relatively recent MSKCC grad, and he said he’d see 20 consults in a Friday with Zelefsky.

If you shadow busy surgeons (usually with poor bedside manner), you’ll see they spend about 10 minutes in the room even if they’re recommending surgery. APP does the rest of the consult. Nancy Lee is probably the same.
Click to expand...
He didn't back down! Didn't say it was exaggeration.
I had an offline chat with him - he thinks this is good and we don't understand how it works there.
I don't put words into people's mouths. This is what they think is good.
 
grenz said:
Totally agree that it’s not the lifestyle I want for myself or my children. I think most of the famous people in our field are not motivated by achieving fame per se, but for the few who are, I’d just ask them “who is the most famous dermatologist?”
Click to expand...

If you asked 10 people "name the most famous living doctor", how many would say Dr. Oz?

I've always been jealous of those dermatologists that have made a billion dollars selling astringent.
 
BobbyHeenan said:
I put extra condiments on all my sandwiches over the weekend in support.
Click to expand...
spratt-ketchup.jpg
 
grenz said:
There could be some hyperbole to what Spratt said, but one of my attendings in residency was a relatively recent MSKCC grad, and he said he’d see 20 consults in a Friday with Zelefsky.

If you shadow busy surgeons (usually with poor bedside manner), you’ll see they spend about 10 minutes in the room even if they’re recommending surgery. APP does the rest of the consult. Nancy Lee is probably the same.
Click to expand...
Speaking of flex's and Nancy Lee, I remember when she used to say it took her like 3 hours to contour a head/neck case. I'm like... this is nothing to brag about.
 
NotMattSpraker said:
If you asked 10 people "name the most famous living doctor", how many would say Dr. Oz?

I've always been jealous of those dermatologists that have made a billion dollars selling astringent.
Click to expand...
Derm can become Instagram famous. Plastics definitely.

Could you imagine a radonc pulling it off....

I mean, I think if Spratt put together vids with him in clinic in sleeveless scrubs, flexing his triceps while pointing at computer screens or drawing circles, riding a stationary bike during conference and imbibing green smoothies while discussing purpose with pure intent, he might get.....

4K views and 2 comments.

We need to bust out of this collective "failure of imagination".

I'm thinking of XRT as a method for achieving unilateral buttock shrinkage after botched BBL? Bet we could break 5k views.
 
Not getting into the personal/personality stuff.

There is no reason to make RadOnc look cush. It really isn't. The residency can be hard (depending on where you are at) in terms of hours, but there is a lot of reading to do and anatomy to learn and just a brand new language.

I'm not saying that IM is easy, but intern year - other than the hours spent and lots of menial tasks - PGY-1 was far easier than PGY-2. PGY-1 - I just spent the last 4 years on how to do that. PGY-2 - what the fook is brehmstrahlung? And why is the writing in Khan book so small and unreadable?

We are now in a situation where people don't want to join the specialty. If you start saying that there a 14 consult half days and overnight contouring, why would you do RO instead of anesthesia or dx rads or something like that? It just seems so counterproductive from recruitment standpoint.
 
RealSimulD said:
Not getting into the personal/personality stuff.

There is no reason to make RadOnc look cush. It really isn't. The residency can be hard (depending on where you are at) in terms of hours, but there is a lot of reading to do and anatomy to learn and just a brand new language.

I'm not saying that IM is easy, but intern year - other than the hours spent and lots of menial tasks - PGY-1 was far easier than PGY-2. PGY-1 - I just spent the last 4 years on how to do that. PGY-2 - what the fook is brehmstrahlung? And why is the writing in Khan book so small and unreadable?

We are now in a situation where people don't want to join the specialty. If you start saying that there a 14 consult half days and overnight contouring, why would you do RO instead of anesthesia or dx rads or something like that? It just seems so counterproductive from recruitment standpoint.
Click to expand...
It’s what rad oncs do! Ortho actually has fun in not being taken seriously and they seem to still be competitive.
 
RadOncDoc21 said:
It’s what rad oncs do! Ortho actually has fun in not being taken seriously and they seem to still be competitive.
Click to expand...

Sign of the field's "self confidence".

Probably something for leadership to think about when they are taking breaks between bullying community doctors on Twitter and blaming the internet for all their self-imposed problems.
 
RadOncDoc21 said:
It’s what rad oncs do! Ortho actually has fun in not being taken seriously and they seem to still be competitive.
Click to expand...
Richest, smartest boneheads out there! Frequently improving QOL for people. They laugh off any criticism.

Only let reps back to see them if they bring food....or other circumstances.

Ortho are secure in who they are.
 
communitydoc13 said:
Richest, smartest boneheads out there! Frequently improving QOL for people. They laugh off any criticism.

Only let reps back to see them if they bring food....or other circumstances.

Ortho are secure in who they are.
Click to expand...

it doesn't hurt to make a **** ton of money too.

But yeah, I get it.
 
RickyScott said:
So many questions-Will they be able to prescribe chemo like a traditional neuro onc (neurology) who had zero onc training before their one year fellowship?
Click to expand...
LOL. That'd be useful.

So, the answer is no, they won't be able to.
 
Ha!

I’m dress shirt and pants except on Fridays with no consults.

I can’t get myself to wear scrubs to work routinely.
 
You must log in or register to reply here.

Similar threads

uchihastan
Rad Onc vs. Heme/Onc
Replies
18
Views
2K
medgator
M
B
Rad Onc Procedures and RVUs
Replies
35
Views
5K
CurbYourExpectations
CurbYourExpectations
D
Saving Rad Onc
2
Replies
60
Views
6K
RickyScott
R
TheWallnerus
Rad Onc is in a dark place
Replies
13
Views
2K
RickyScott
R
D
Future of rad onc job market
2
Replies
58
Views
9K
BobbyHeenan
B
Top