Rad Onc Twitter

[thecarbonionangle]

It’s possible to pull that money but almost impossible to get that 9-11 weeks PTO with it

Yeah it is possible. It is also possible to win the lottery. If you look at the MGMA data, most people clearly make less. I know more people at the median than at 600+.

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[TheWallnerus]

Yeah it is possible. It is also possible to win the lottery. If you look at the MGMA data, most people clearly make less. I know more people at the median than at 600+.

$750K salary = 1 in 100
$750K salary and 11 weeks PTO = 1 in a million
Kids going into rad onc now... I'm saying there's a chance

 

[metallica81788]

Yeah it is possible. It is also possible to win the lottery. If you look at the MGMA data, most people clearly make less. I know more people at the median than at 600+.

We all run in different circles and locations but with my closer friends from residency (scattered all over the country albeit no huge cities) if you're at 600 you are at the bottom of the compensation/comparison. Guess we all just got lucky. I am fortunate and unfortunate to know quite a few radoncs with these "unicorn" type jobs at least on the pay front.

 

[deleted1180461]

We all run in different circles and locations but with my closer friends from residency (scattered all over the country albeit no huge cities) if you're at 600 you are at the bottom of the compensation/comparison. Guess we all just got lucky. I am fortunate and unfortunate to know quite a few radoncs with these "unicorn" type jobs at least on the pay front.

Agree. Flyover country and coasts are very different.

 

[thecarbonionangle]

Agree. Flyover country and coasts are very different.

Most graduates will never be interested in fly over. The ones who state they are are currently single mostly. Life changes and you get a partner, they have a career too. You have kids and all of a sudden need help and need to be closer to family or in better schools etc etc. Life comes at you fast.

 

[Reaganite]

I work in a "desirable" area and no question the income opportunities for enterprising dosimetrists and physicists exceeds that of physicians. Many dosimetristd covering multiple sites. Of course, that's totally illegal per RonD if they aren't billing the services from the location they are performing the planning.

 

[deleted1180461]

I work in a "desirable" area and no question the income opportunities for enterprising dosimetrists and physicists exceeds that of physicians. Many dosimetristd covering multiple sites. Of course, that's totally illegal per RonD if they aren't billing the services from the location they are performing the planning.

Doesn't Varian offer remote dosimetry?

Lol at RonD mansplaining to Varian.

 

[evilbooyaa]

Another new chair who only took about a decade to get there. Good for WashU

Hallahan retiring? I wonder if he succeeded in dropping clinical ROs salaries sufficiently during his tenure.

Michalski always the bridemaid, never the bride?

Wonder if Karam can slow down the hemorrhaging of Rad Onc talent out of Wash U. Although I see that they've recently got some good pickups from other facilities...

 

[Reaganite]

Doesn't Varian offer remote dosimetry?

Lol at RonD mansplaining to Varian.

Hmmm a varian qui Tam could be worth billions? RonD can be our expert witness and maybe we can get in on the selfie?

 

[medgator]

Doesn't Varian offer remote dosimetry?

Lol at RonD mansplaining to Varian.

Yes they do. Remote planning widespread and totally legit. Ron D should stick to mansplaining the benefits of heavy ion therapy on X

 

[TheWallnerus]

Yes they do. Remote planning widespread and totally legit. Ron D should stick to mansplaining the benefits of heavy ion therapy on X

Varian now employs more medical physicists than any entity in the world

You want Varian to do your physics for a year at your two linac center? And keep a physicist on site? One million minimum price of entry

Varian/Siemens all in on remote planning (and AI stuff etc)

They also own 16 radiation centers in India treating 70,000 people a year (second largest cancer care provider in that country)

We are living in interesting times (the Chinese curse!)

 

[RickyScott]

Hallahan retiring? I wonder if he succeeded in dropping clinical ROs salaries sufficiently during his tenure.

Michalski always the bridemaid, never the bride?

Wonder if Karam can slow down the hemorrhaging of Rad Onc talent out of Wash U. Although I see that they've recently got some good pickups from other facilities...

did michalski want the chair position? the guy spent his career as Perez's b and invested so much time w/astro, advocating advantages/profits for large medical systems to the detriment of 95% of his colleagues, and this is his reward?

 

[HolySmokes]

But also, there's the possibility - the unspoken possibility - you end up in a situation without a Dosi/Physics arrangement that can produce minimally competent plans for your patients, and it's either do it yourself or be OK with the plan isocenter being set 7cm off the actual isocenter, etc etc etc

I feel personally attacked

 

[thecarbonionangle]

did michalski want the chair position? the guy spent his career as Perez's b and invested so much time w/astro, advocating advantages/profits for large medical systems to the detriment of 95% of his colleagues, and this is his reward?

Bootlickers are not always rewarded. He can keep bringing the diet coke when the button is pressed

 

[Neuronix]

View attachment 386129

Very kind to say so.

Maybe in a few years if someone wants me.

I'm not ready yet. It's not my goal to be chair--seems like a major headache.

My goal is to be a physician-scientist. The only reason I'd do it would be to help others be physician-scientists.

 

[OTN]

did michalski want the chair position? the guy spent his career as Perez's b and invested so much time w/astro, advocating advantages/profits for large medical systems to the detriment of 95% of his colleagues, and this is his reward?

Yes he did, but WashU was always going to go with someone with R01 grants and a translational science background. They always have and always will.

 

[medgator]

Very kind to say so.

Maybe in a few years if someone wants me.

I'm not ready yet. It's not my goal to be chair--seems like a major headache.

My goal is to be a physician-scientist. The only reason I'd do it would be to help others be physician-scientists.

Yep. Chair, POTUS, no thanks

 

[temujim]

I've looked into this.

A lot.

Unfortunately, and similar to the Palliative Care cert, there is no longer a "practical pathway" to sit for the exam based on experience.

Now, I stopped short of contacting the AAMD to see if an exception could be made for physicians because I assume no one has asked before...it does remain on my long-term, "potential to-do list".

However, there doesn't really appear to be any regulations around this, other than perhaps something like APEx. There's no overt prohibition on a RadOnc working as a Dosimetrist - and there are, of course, the tales floating around of a solo RadOnc here and there doing their own Dosimetry for their practice.

The real world is the Wild West.

There are no regulations of who can do dosimetry other than HR. Ultimately no one cares who did the plan, bc the Rad Onc is responsible. But don't begrudge the current slate of dosimetrists making as much bank as possible. The profession won't disappear but the current numbers will no longer be necessary. Writing has been on the wall for 15 years, but starting to see quality auto-planning solutions emerging from the Varians and Raysearch companies of the world. I feel sorry for those who just paid the CMD school fees over the last several years and don't have an RTT to fall back on, or some other profession.

 

[elementaryschooleconomics]

I feel personally attacked

If only people knew what was happening in the Wild West...

(this also is a big component of my opinion on supervision, in that the horrifying atrocities I've seen/experienced under the guise of "Dosimetry" and "Physics" could not be fixed by any form of supervision...only me, learning on the fly how to be my own Dosimetrist...)

 

[Ray D. Ayshun]

If only people knew what was happening in the Wild West...

(this also is a big component of my opinion on supervision, in that the horrifying atrocities I've seen/experienced under the guise of "Dosimetry" and "Physics" could not be fixed by any form of supervision...only me, learning on the fly how to be my own Dosimetrist...)

If you're a rural doc I don't see on site dosimetry as being a good option. Maybe you get very lucky but for the most part it's not very qualified people as opposed to having some badass do things remotely.

 

[deleted1180461]

I did locums once in the middle of nowhere and was given a garbage plan by the dosimetrist without a scorecard. I asked her to work on it and make a scorecard, and the answer was no. Eye opening.

 

[drowsy12]

If you're a rural doc I don't see on site dosimetry as being a good option. Maybe you get very lucky but for the most part it's not very qualified people as opposed to having some badass do things remotely.

I'm not sure why remote dosimetry isn't bigger than it is.

 

[RickyScott]

i have had fleeting thoughts abt doing remote dosimetry. I think I can plan 3x faster and better than most and could probably make a killing on a per plan basis.

 

[deleted1180461]

i have had fleeting thoughts abt doing remote dosimetry. I think I can plan 3x faster and better than most and could probably make a killing on a per plan basis.

How did you learn to do it on your own?

 

[HolySmokes]

How did you learn to do it on your own?

By necessity, mostly.

 

[BobbyHeenan]

i have had fleeting thoughts abt doing remote dosimetry. I think I can plan 3x faster and better than most and could probably make a killing on a per plan basis.

I probably couldn't resist the urge to edit the doc's volumes...

"just take off a little off the top on that CTV, no one will notice..."

"why TF is this doc treating elective nodes on this palliative pancreas plan...let's just tighten up that margin there, he won't notice...."

 

[elementaryschooleconomics]

By necessity, mostly.

Same for me.

I had been shown some basics in residency and was fortunate enough to be using the same TPS (Eclipse). There's some YouTube videos, a PDF here and there (nothing comprehensive sadly), and some friends I could ask.

Re: remote Dosimetry and rural.

Yes. Remote Dosimetry should be the way it goes.

However.

As @MidwestRadOnc pointed out - "no" is definitely an answer you will often encounter to reasonable ideas out here in the Wild West.

In my particular instance: I had a full-time, on-site, human Dosimetrist.

Well. I mean. There was a person with blood and bones who appeared to breathe the air and collected a paycheck for being employed as a Dosimetrist.

Apathy and inertia are often insurmountable forces in the Wild West. Because bad radiation won't kill someone instantly, like bad surgery can, most of our complaints seem dramatic. Who cares if your PTV is only getting 70% coverage because that's the only way they can figure out how to meet your demanding QUANTEC constraints that no one had ever heard of before you started working here?

70% is like, more than 2/3rds. That's good enough. Stop being a perfectionist. The staff hates it.

 

[Tigerstang]

Same for me.

I had been shown some basics in residency and was fortunate enough to be using the same TPS (Eclipse). There's some YouTube videos, a PDF here and there (nothing comprehensive sadly), and some friends I could ask.

Re: remote Dosimetry and rural.

Yes. Remote Dosimetry should be the way it goes.

However.

As @MidwestRadOnc pointed out - "no" is definitely an answer you will often encounter to reasonable ideas out here in the Wild West.

In my particular instance: I had a full-time, on-site, human Dosimetrist.

Well. I mean. There was a person with blood and bones who appeared to breathe the air and collected a paycheck for being employed as a Dosimetrist.

Apathy and inertia are often insurmountable forces in the Wild West. Because bad radiation won't kill someone instantly, like bad surgery can, most of our complaints seem dramatic. Who cares if your PTV is only getting 70% coverage because that's the only way they can figure out how to meet your demanding QUANTEC constraints that no one had ever heard of before you started working here?

70% is like, more than 2/3rds. That's good enough. Stop being a perfectionist. The staff hates it.

One of the many reasons I won't go back to the Midwest.

Say what you will about in Florida, even the "shady" operations here usually put out pretty high quality radiation plans.

 

[RickyScott]

I probably couldn't resist the urge to edit the doc's volumes...

"just take off a little off the top on that CTV, no one will notice..."

"why TF is this doc treating elective nodes on this palliative pancreas plan...let's just tighten up that margin there, he won't notice...."

thats the rub. A lot of docs sometimes provide impossible volumes for the constraints "on the wall" and waste a huge amount of the dosimetrists time with back and forth. would be able to tell them this from the get go and where to compromise the volume. After being in the field for a while, get a sense of what is a "reasonable" ptv and plan looks like in most cases. Ex: have seen boomers ask for 1+ cm expansion on pelvic nodes and then go back and forth with dosimetrists as they cant meet some "wall constraint" where certain volume of small bowel (often adjacent) gets less than 30 Gy.

 

[HolySmokes]

Well. I mean. There was a person with blood and bones who appeared to breathe the air and collected a paycheck for being employed as a Dosimetrist.

Apathy and inertia are often insurmountable forces in the Wild West. Because bad radiation won't kill someone instantly, like bad surgery can, most of our complaints seem dramatic. Who cares if your PTV is only getting 70% coverage because that's the only way they can figure out how to meet your demanding QUANTEC constraints that no one had ever heard of before you started working here?

70% is like, more than 2/3rds. That's good enough. Stop being a perfectionist. The staff hates it.

GET OUT OF MY HEAD

Edit: Minutes after posting this I went to review a plan. I had to send this text to one of my dosimetrists about a 3D plan, "I am concerned that we are not treating the entire PTV."

 

[deleted1180461]

GET OUT OF MY HEAD

Edit: Minutes after posting this I went to review a plan. I had to send this text to one of my dosimetrists about a 3D plan, "I am concerned that we are not treating the entire PTV."

Dosimetrist response: That's just what you're seeing on the computer. Things change day to day so you really have no idea what's getting what and need to be more reasonable. Also, there is no such thing as max point dose. Don't you even dare mention min.

 

[Neuronix]

One of the many reasons I won't go back to the Midwest.

Say what you will about in Florida, even the "shady" operations here usually put out pretty high quality radiation plans.

I loled

 

[NotMattSpraker]

One of the many reasons I won't go back to the Midwest.

Say what you will about in Florida, even the "shady" operations here usually put out pretty high quality radiation plans.

The challenge is making sure they are delivered to the correct part of the body. Heyoooooo!!

 

[elementaryschooleconomics]

GET OUT OF MY HEAD

Edit: Minutes after posting this I went to review a plan. I had to send this text to one of my dosimetrists about a 3D plan, "I am concerned that we are not treating the entire PTV."

The saddest part of all is I know we're not alone.

This is more common than people realize, because most of actual RadOnc is more or less walled off from the residency version of RadOnc.

The SCAROP institutions obviously have a ton of problems, and Lord knows my residency institution is well known across the region for being a garbage fire in terms of Dosimetry.

However, they all have one thing in common: more than one Dosimetrist. And lots of turnover.

Because in a large department, the Dosimetry division can be a "hot mess" through turnover and culture/morale.

But the SCAROP institutions represent, at max, perhaps 25% of the total practicing Radiation Oncologists (approximately 1,200 attendings).

The rest - something north of 4,000 - the rest of us work in places without residents.

No one warns you about the community hospital that's loosely part of "the network" that functions like a republic. And in this community hospital, where you're either a W2 employee or staffing it full time for your group on a PSA, there's only one Dosimetrist. And that one Dosimetrist has been there since the late 1990s.

And yeah, maybe that one Dosimetrist has fallen off in recent years. The senior partner noticed it too. But you know, who hasn't had a rough go of things lately? Don't you know about the family stuff that happened to that one Dosimetrist? Of course, then the pandemic happened, and that was hard for everyone.

You really don't want to be "that" guy, the "young hotshot doctor", coming here and telling people what to do. This QUANTEC thing, yeah, I know you say its been around for like a decade at this point, but that sounds like some Ivory Tower crap. You need to check your attitude because it upsets the staff.

My point being:

You. Yes you, lurking resident. The one who made an SDN account years ago for pre-med but hasn't posted since then.

I know what you're thinking. This isn't real, or if it is, it won't happen to you.

I hope you're right. But if you're not, the one thing I can offer you is the concrete knowledge that you are NOT alone.

Sorry this happened, current and future lurking resident.

I hope it gets better.

 

[deleted1180461]

ESE is exactly correct. The last thing you expect after 10 years of med school and residency is to show up to a small midwestern town to takeover a clinic from a solo retiring doc and encounter a dosimetrist that surfs facebook all day, wears scrubs to work, takes 3 week vacations, tells you how he treats prostates, prefaces every plan presentation with "I worked on this forever, and this is the best I've got... (ie, I'm not doing any more work on it)" and when you bring this up with admin you are told to play nice because "it's really hard to recruit rad onc staff here" Good ol' boys club, and you're not in it.

The staff are allowed to not show up for weeks because of this or that, but if you complain about chart rounds or something, you're a "problem doctor" and scheduled for replacement.

 

[RickyScott]

The saddest part of all is I know we're not alone.

This is more common than people realize, because most of actual RadOnc is more or less walled off from the residency version of RadOnc.

The SCAROP institutions obviously have a ton of problems, and Lord knows my residency institution is well known across the region for being a garbage fire in terms of Dosimetry.

However, they all have one thing in common: more than one Dosimetrist. And lots of turnover.

Because in a large department, the Dosimetry division can be a "hot mess" through turnover and culture/morale.

But the SCAROP institutions represent, at max, perhaps 25% of the total practicing Radiation Oncologists (approximately 1,200 attendings).

The rest - something north of 4,000 - the rest of us work in places without residents.

No one warns you about the community hospital that's loosely part of "the network" that functions like a republic. And in this community hospital, where you're either a W2 employee or staffing it full time for your group on a PSA, there's only one Dosimetrist. And that one Dosimetrist has been there since the late 1990s.

And yeah, maybe that one Dosimetrist has fallen off in recent years. The senior partner noticed it too. But you know, who hasn't had a rough go of things lately? Don't you know about the family stuff that happened to that one Dosimetrist? Of course, then the pandemic happened, and that was hard for everyone.

You really don't want to be "that" guy, the "young hotshot doctor", coming here and telling people what to do. This QUANTEC thing, yeah, I know you say its been around for like a decade at this point, but that sounds like some Ivory Tower crap. You need to check your attitude because it upsets the staff.

My point being:

You. Yes you, lurking resident. The one who made an SDN account years ago for pre-med but hasn't posted since then.

I know what you're thinking. This isn't real, or if it is, it won't happen to you.

I hope you're right. But if you're not, the one thing I can offer you is the concrete knowledge that you are NOT alone.

Sorry this happened, current and future lurking resident.

I hope it gets better.

A lot

ESE is exactly correct. The last thing you expect after 10 years of med school and residency is to show up to a small midwestern town to takeover a clinic from a solo retiring doc and encounter a dosimetrist that surfs facebook all day, wears scrubs to work, takes 3 week vacations, tells you how he treats prostates, prefaces every plan presentation with "I worked on this forever, and this is the best I've got... (ie, I'm not doing any more work on it)" and when you bring this up with admin you are told to play nice because "it's really hard to recruit rad onc staff here" Good ol' boys club, and you're not in it.

The staff are allowed to not show up for weeks because of this or that, but if you complain about chart rounds or something, you're a "problem doctor" and scheduled for replacement.

Staff are absolutely more valued than doctors in this field given the under/over supply. Imagine having any kind of dispute with a young Ron D before his license was revoked. Whose side do you think the cancer admin (nurse with associate degree in business) will take?

 

[NotMattSpraker]

Underserved.

 

[Fpg1245]

View attachment 386180

Underserved.

When I think underserved I think CT. Those poor souls on Greenwich and New Canaan!! They will suffer no longer!

 

[thecarbonionangle]

The injustice of the Yale crowd and surrounding areas lacking protons is finally over. Let us thank the gods!

 

[Tigerstang]

A lot

Staff are absolutely more valued than doctors in this field given the under/over supply. Imagine having any kind of dispute with a young Ron D before his license was revoked. Whose side do you think the cancer admin (nurse with associate degree in business) will take?

License revoked? Say more...

 

[communitydoc13]

I'm not sure why remote dosimetry isn't bigger than it is.

It's pretty big. If you advertise for remote, you will get a lot of reasonable apps.

The barrier is the institution. Some of these still have ridiculous ideas of who needs to be on site (absolutely no need for dosi to be onsite IMO, particularly if adequate physics staffing). This is coming from a doc mostly on-site advocate.

The above tales of the legacy, incompetent, on-site dosimetrist should not be happening. There is a workforce out there for remote service.

Now it is highly variable, and I do encourage for all remote hires an on-site visit, meeting pertinent folks (physics and docs) face to face, maybe even a few days on site for on-boarding and discussion.

Remote dosi should be at your chart rounds, and your chart rounds should be meaningful.

My 2 cents.

 

[deleted1180461]

What the dosis are not going to like as their position transistions to remote/WFH, there will be an oversupply and pay will go down. I don’t think these days of having 3 or more jobs paying historically full time wages will last. I’m sure PE is already on it. The cat’s out of the bag that an average rad onc clinic does not require 40 hours a week of full time dosimetry work. There’s a lot of downtime, enough to work other jobs, even. So admins will start to wonder, we are paying them this much why exactly? And they will find themselves doing 2 remote jobs for what they used to get paid for 1 in person.

 

[NotMattSpraker]

It's pretty big. If you advertise for remote, you will get a lot of reasonable apps.

The barrier is the institution. Some of these still have ridiculous ideas of who needs to be on site (absolutely no need for dosi to be onsite IMO, particularly if adequate physics staffing). This is coming from a doc mostly on-site advocate.

The above tales of the legacy, incompetent, on-site dosimetrist should not be happening. There is a workforce out there for remote service.

Now it is highly variable, and I do encourage for all remote hires an on-site visit, meeting pertinent folks (physics and docs) face to face, maybe even a few days on site for on-boarding and discussion.

Remote dosi should be at your chart rounds, and your chart rounds should be meaningful.

My 2 cents.

Fully agree.

I do think its worth while to have them come a few times a year because meeting people face to face can enhance culture on teams. I've been talking a lot with dosis my institution deals with the existential dread of letting them be remote. They all seem to agree with that.

 

[metallica81788]

When I think underserved I think CT. Those poor souls on Greenwich and New Canaan!! They will suffer no longer!

I probably speak for many of us when I say about a third of my patients drive similar distances for treatment with me (closest to them) as going from New Haven to Boston (or NYC) for protons. And we're not talking CT demographics.

 

[elementaryschooleconomics]

When I think underserved I think CT. Those poor souls on Greenwich and New Canaan!! They will suffer no longer!

Ok but like

Have you entered the Thunderdome wastelands of Waterbury and Bridgeport?

*shudders*

 

[drowsy12]

Ok but like

Have you entered the Thunderdome wastelands of Waterbury and Bridgeport?

*shudders*

Yeah….. Connecticut can get pretty rough.

 

[NotMattSpraker]

I probably speak for many of us when I say about a third of my patients drive similar distances for treatment with me (closest to them) as going from New Haven to Boston (or NYC) for protons. And we're not talking CT demographics.

It is a 1.5 hour drive from Yale to the NY Proton Center. I saw someone yesterday that drove further to see me and I have the closest Linac.

I am embarrassed with how our field approaches "financial toxicity", "the underserved", and "rural" patients. It is super gross.

 

[Mandelin Rain]

Yeah….. Connecticut can get pretty rough.

[Aaron Hernandez has entered the chat]

 

[Ray D. Ayshun]

It is a 1.5 hour drive from Yale to the NY Proton Center. I saw someone yesterday that drove further to see me and I have the closest Linac.

I am embarrassed with how our field approaches "financial toxicity", "the underserved", and "rural" patients. It is super gross.

It's not underserved, it's undeserved.

 

[medgator]

[Aaron Hernandez has entered the chat]

Thought he lived in Mass technically