Rad Onc Twitter

[medgator]

I have a fellowship I'd like to pitch to you....

Would happy to have inpatient coverage...errrr, provide inpatient "teaching experience" on symptomatic/palliative onc patients

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[RadOncDoc21]

Maybe I'm a dismissive dingus but the concept that palliative RT is some sort of art that requires its own discipline just doesn't resonate with me.

But I also get bored by breast radiation so maybe it's just me.

Breast is the worst! Do you treat whole breast or regional nodal? If so do you do standard or hypofx?

Contour a breast, maybe some lymph nodes and boom you’re done! Of course we will all debate on these topics but it really is the same thing day in and day out.

 

[scarbrtj]

Breast is the worst! Do you treat whole breast or regional nodal? If so do you do standard or hypofx?

Contour a breast, maybe some lymph nodes and boom you’re done! Of course we will all debate on these topics but it really is the same thing day in and day out.

best... worst... distaff... idk
Prediction:
“Same thing day in and day out” will be “same thing day in” in a few years...

Stereotactic image-guided neoadjuvant ablative single-dose radiation, then lumpectomy, for early breast cancer: the SIGNAL prospective single-arm trial of single-dose radiation therapy

Adjuvant whole-breast irradiation after breast-conserving surgery, typically delivered over several weeks, is the traditional standard of care for low-risk breast cancer. More recently, hypofractionated, partial-breast irradiation has increasingly become ...

www.ncbi.nlm.nih.gov

 

[RadOncMegatron]

best... worst... distaff... idk
Prediction:
“Same thing day in and day out” will be “same thing day in” in a few years...

Stereotactic image-guided neoadjuvant ablative single-dose radiation, then lumpectomy, for early breast cancer: the SIGNAL prospective single-arm trial of single-dose radiation therapy

Adjuvant whole-breast irradiation after breast-conserving surgery, typically delivered over several weeks, is the traditional standard of care for low-risk breast cancer. More recently, hypofractionated, partial-breast irradiation has increasingly become ...

www.ncbi.nlm.nih.gov

Shoot me now. Can I do whatever I want as long as I put “phase 1/2” in front of it?

Phase 1/2 trial of working at home vs going to work. Primary endpoint salary with a 1.25 non-inf margin compared to historical controls; secondary endpoint respect from surgical colleagues.

 

[FrostyHammer]

Eh, I kinda read that as Ralph and Siker basically being like "who cares that US grads aren't applying for rad onc anymore?"... which ties into the whole "Rad Onc should be more diverse than just US MDs, so the increase of DOs, FMGs, and IMGs is a good thing for the field!!11"

These folks who love the "increased diversity of applicants" (meaning groups that historically would not have had the academic credentials to match) in Rad Onc will love to work with all the folks who would not have had a chance in Rad Onc as recently as 5 years ago.... all the DOs, IMGs, and Ophtho/derm/ortho rejects. SOAP numbers will look better for the field next year as word will get out that all you need to match rad onc is a pulse and no obvious gigantic red flags.

That's what folks in academics are hanging their hat on. The same folks who would throw a US MD without double digit publications or a 240 in the trash as recently as 5-10 years ago will be bending the knee and interviewing every applicant, including the DO/IMG with no publications and average step scores.

And then, to the academic folks, all will be back to normal, and thus no (painful) changes will need to be made for the health of the specialty.

And somewhere, Paul Wallner will laugh a great hearty laugh similar to Emperor Palpatine, having summarily predicted the downfall of the quality of the average Radiation Oncology resident. Perhaps it's not just a prediction, and Paul Wallner is Chancellor Palpatine orchestrating the Clone Wars as a means to an end - the extermination of the Jedi. What that is analogous to in the current situation is.... unknown. But maybe it will be just as much of a shocker as Order 66 was when we (eventually) got around to watching Episode 3.

Wallner: "I AM THE ABR" (said to the tone of "I am the Senate")

 

[FrostyHammer]

VALOR can potentially change the game for us in perception as long as SBRT is equivalent (doesn't need to be better)

Won't change a thing, I'm telling you now. As long as others control the diagnostic processes and push their agenda, RT will always be in the backseat. Happens for prostate all the time, will happen for early stage lung SBRT too.

 

[medgator]

Won't change a thing, I'm telling you now. As long as others control the diagnostic processes and push their agenda, RT will always be in the backseat. Happens for prostate all the time, will happen for early stage lung SBRT too.

Lung probably easier than prostate... Pcps and Pulmonary often involved before they see a Thoracic Surgeon, esp Pulmonary. I sometimes get SBRT referrals straight from them when the pfts are terrible

 

[FrostyHammer]

Lung probably easier than prostate... Pcps and Pulmonary often involved before they see a Thoracic Surgeon, esp Pulmonary. I sometimes get SBRT referrals straight from them when the pfts are terrible

And nearly all pulmonary docs know absolutely nothing to do with these pts than to reflexively refer them to a surgeon. SMH.

 

[RadOncDoc21]

And nearly all pulmonary docs know absolutely nothing to do with these pts than to reflexively refer them to a surgeon. SMH.

Or to a med onc. My current system is set up where all cancers go to a med onc initially. I’ve been trying to “educate” the docs without much success.

 

[thecarbonionangle]

Won't change a thing, I'm telling you now. As long as others control the diagnostic processes and push their agenda, RT will always be in the backseat. Happens for prostate all the time, will happen for early stage lung SBRT too.

Sounds to me like you believe RO are catfish?

 

[thecarbonionangle]

Wallner: "I AM THE ABR" (said to the tone of "I am the Senate")

Wallner is like Mitch Mconell, aka the turtle aka the gream reaper? Interesting theory!

 

[deleted774703]

Won't change a thing, I'm telling you now. As long as others control the diagnostic processes and push their agenda, RT will always be in the backseat. Happens for prostate all the time, will happen for early stage lung SBRT too.

It really varies based on your practice structure.

In private with entrenched systems, maybe not

But academics or pseudoacademics, where all pts are discussed then possibly yes.

 

[medgator]

And nearly all pulmonary docs know absolutely nothing to do with these pts than to reflexively refer them to a surgeon. SMH.

It really varies based on your practice structure.

In private with entrenched systems, maybe not

But academics or pseudoacademics, where all pts are discussed then possibly yes.

This. Much harder in an entrenched/employed/academic system, but out in the real world, it doesn't hurt to network with Pulmonary and let them know where to send those COPDers with clinically early stage disease with poor dlco/fev1's.... Definitely can get referrals that way

 

[deleted774703]

Hypocrisy of Fumiko chino continues

MSKCC among those that charge $$$ for parking

While I agree with sentiment, should fix your own house first

 

[RadOncDoc21]

Hypocrisy of Fumiko chino continues

MSKCC among those that charge $$$ for parking

While I agree with sentiment, should fix your own house first

Some high quality research being done these days.

 

[Mandelin Rain]

“The highest standard of” research.

 

[medgator]

Hypocrisy of Fumiko chino continues

MSKCC among those that charge $$$ for parking

While I agree with sentiment, should fix your own house first

A lot of centers pay for that parking. I guess mskcc doesn't?

 

[RickyScott]

Hypocrisy of Fumiko chino continues

MSKCC among those that charge $$$ for parking

While I agree with sentiment, should fix your own house first

In reality, they take mostly premium insurances that are out of reach of someone who has difficulty affording parking (which is probably 40$+ a visit).

 

[medgator]

In reality, they take mostly premium insurances that are out of reach of someone who has difficulty affording parking (which is probably 40$+ a visit).

Yup, plenty of out of town "destination" patients going to Sloane and Anderson I'd imagine

 

[StIGMA]

I was charged something like $60 for parking when I interviewed at MSKCC (1 day). No vouchers. I was not impressed with that.

 

[RadOncMegatron]

Hypocrisy of Fumiko chino continues

MSKCC among those that charge $$$ for parking

While I agree with sentiment, should fix your own house first

She is doing good work, but one day (if not already) will realize she is at the wrong institution to do this type of research ie top 2 name brand NYC expensive $$$ cancer center.

Most of the things she rightfully fights against are happening right under her nose, from the CMO scandal , NYC proton center, CMS exemption, and MSKCC parking prices (as @StIGMA noted it's not free). All these things should be pointed out, but it's hard to take her seriously if she doesn't really make changes at MSKCC first.

 

[Neuronix]

it's hard to take her seriously if she doesn't really make changes at MSKCC first.

The faculty at an institution have no ability to change the parking prices. Maybe by bringing public attention to it like this, it might help. I doubt it though.

 

[deleted774703]

The faculty at an institution have no ability to change the parking prices. Maybe by bringing public attention to it like this, it might help. I doubt it though.

You may be right @RadOncMegatron @Neuronix but without making changes this type of work is pure careerism

I wouldn’t mind but she’s consistently spouting her moral superiority to the rest of us

 

[deleted605854]

I don't know her personally but maybe she feels that by publishing such research she can change things down the line? Or maybe by having MSKCC on her CV she can use it as a springboard to go ahead and change things in the future by landing a position that helps her to do so?


Am I being naive ? Has my naivete hurt me in the past? Yes. Do I still continue to be naive and optimistic? I guess I'm just that kind of guy.

 

[w00tz]

First step is identifying the problem? I knew parking could be an issue, but didn't know it could be up to $1400.

I don't know Fumiko personally, but the vibe I get from her is that she genuinely cares about her patients and financial toxicity. Perhaps I am blinded by the Twitter virtue-signalling? The irony is definitely glaring - an advocate of financial health for patients while working at M$KCC. I guess one could argue that if she can minimize financial burden of her patients within the MSKCC system, she is probably saving each patient more absolute dollars. (Could also argue that if she really cared, she would be sending standard XRT cases to high quality community practices). Perhaps working at MSKCC, she is in an environment with high financial toxicity that can be studied? Lol.

I just don't think I want to give her a hard time over this. Some people see hypocrisy. I see her sticking out her neck and calling out her employer for crazy parking fees.

 

[deleted774703]

First step is identifying the problem? I knew parking could be an issue, but didn't know it could be up to $1400.

I don't know Fumiko personally, but the vibe I get from her is that she genuinely cares about her patients and financial toxicity. Perhaps I am blinded by the Twitter virtue-signalling? The irony is definitely glaring - an advocate of financial health for patients while working at M$KCC. I guess one could argue that if she can minimize financial burden of her patients within the MSKCC system, she is probably saving each patient more absolute dollars. (Could also argue that if she really cared, she would be sending standard XRT cases to high quality community practices). Perhaps working at MSKCC, she is in an environment with high financial toxicity that can be studied? Lol.

I just don't think I want to give her a hard time over this. Some people see hypocrisy. I see her sticking out her neck and calling out her employer for crazy parking fees.

Perhaps I’m being cynical

But then again I still remember when she let slip about unnecessary EKG at MSKCC for breast cancer patients and then suddenly POOF it was gone

I also don’t see a list of actual names that are charging too high. Just saying overall 1/3. Perhaps to avoid angering anyone?

Also curious no response to this question below...

 

[RickyScott]

Perhaps I’m being cynical

But then again I still remember when there was mention of unnecessary EKG at MSKCC for breast cancer patients and then suddenly POOF it was gone

I also don’t see a list of actual names that are charging too high. Just saying overall 1/3. Perhaps to avoid angering anyone?

Also curious no response to this question below...

In this space, some of the best work is from probably Marty Makary, a surgonc at Hopkins. He is not afraid to criticize Hopkins and others who price gouge and sue patients:
Amazon product

 

[frijoles]

The faculty at an institution have no ability to change the parking prices. Maybe by bringing public attention to it like this, it might help. I doubt it though.

This is not true. A rad onc dept I was at previously got free parking for rad onc patients, it was negotiated by the dept chair. Worked out some kind of deal with the president.

 

[scarbrtj]

Say what you will about Fumiko but I'm not getting on that next level respect until she makes a tweet like "Did you know that some people with #cancer may be paying up to $1400 in PARKING?"....
and then tags it with a nice #radoncrocks.

 

[w00tz]

Say what you will about Fumiko but I'm not getting on that next level respect until she makes a tweet like "Did you know that some people with #cancer may be paying up to $1400 in PARKING?"....
and then tags it with a nice #radoncrocks.

needs to @therealdonaldtrump to earn my respect.

 

[thecarbonionangle]

needs to @therealdonaldtrump to earn my respect.

yeah i mean “what do you have to lose”?!

 

[elementaryschooleconomics]

First step is identifying the problem? I knew parking could be an issue, but didn't know it could be up to $1400.

I don't know Fumiko personally, but the vibe I get from her is that she genuinely cares about her patients and financial toxicity. Perhaps I am blinded by the Twitter virtue-signalling? The irony is definitely glaring - an advocate of financial health for patients while working at M$KCC. I guess one could argue that if she can minimize financial burden of her patients within the MSKCC system, she is probably saving each patient more absolute dollars. (Could also argue that if she really cared, she would be sending standard XRT cases to high quality community practices). Perhaps working at MSKCC, she is in an environment with high financial toxicity that can be studied? Lol.

I just don't think I want to give her a hard time over this. Some people see hypocrisy. I see her sticking out her neck and calling out her employer for crazy parking fees.

Yeah I also agree that she seems genuine.

She's brand-new junior faculty pushing concepts which shouldn't be controversial but have a high controversial potential because MURICA under her own name on Twitter. Meanwhile, I just nod my head when my Chair says there's no such thing as resident oversupply. She's got skin in the game and it'll take a long time for her to incur change.

Now, if, in 15 years, it still seems like virtue signaling - that's something else.

 

[elementaryschooleconomics]

 

[beamseyeview]

Yeah I also agree that she seems genuine.

She's brand-new junior faculty pushing concepts which shouldn't be controversial but have a high controversial potential because MURICA under her own name on Twitter. Meanwhile, I just nod my head when my Chair says there's no such thing as resident oversupply. She's got skin in the game and it'll take a long time for her to incur change.

Now, if, in 15 years, it still seems like virtue signaling - that's something else.

I also don't know her personally, but Fumiko is 100% genuine. I don't think that she would be upset that the article below is shared (particularly because it was reported by a major news organization), but her motivations for this type of work are very personal. It's not careerism. Sometimes the voices of the well-intentioned get mixed up in the shuffle of #radoncrocks, but we absolutely shouldn't go after someone like this.

Widowed Early, A Cancer Doctor Writes About The Harm Of Medical Debt

A decade after the death of her husband, Fumiko Chino is studying the strain that uncovered medical costs put on cancer patients, even those who have insurance.

www.npr.org

 

[Krukenberg]

I also don't know her personally, but Fumiko is 100% genuine. I don't think that she would be upset that the article below is shared (particularly because it was reported by a major news organization), but her motivations for this type of work are very personal. It's not careerism. Sometimes the voices of the well-intentioned get mixed up in the shuffle of #radoncrocks, but we absolutely shouldn't go after someone like this.

Widowed Early, A Cancer Doctor Writes About The Harm Of Medical Debt

A decade after the death of her husband, Fumiko Chino is studying the strain that uncovered medical costs put on cancer patients, even those who have insurance.

www.npr.org

here here. Her research is rooted in personal tragedy. It may seem hypocritical she’s talking about cost of care while working at mskcc, but as an academician you want to be at the place that will set you up for success, and mskcc gives her a prominent platform. I also don’t doubt Simon Powell gave her an outstanding package. It would be spiting her face to go work for Geisinger or some other low cost system where she’ll have less impact.

 

[OTN]

I strongly agree that she is doing her research for the right reasons, that's plainly obvious. She's a tremendous advocate for patients.

However, from an economists's standpoint (remember, it is 'the dismal science') the issue is that by focusing on costs but not cleaning your own house first (or at least working in that direction), all you are essentially doing is asking your competitors to reduce their revenue. This is truly an area where "lead by example" becomes critical. I sincerely hope MSKCC gives her the power to affect real change so they may do so.

 

[RadOncMegatron]

I strongly agree that she is doing her research for the right reasons, that's plainly obvious. She's a tremendous advocate for patients.

However, from an economists's standpoint (remember, it is 'the dismal science') the issue is that by focusing on costs but not cleaning your own house first (or at least working in that direction), all you are essentially doing is asking your competitors to reduce their revenue. This is truly an area where "lead by example" becomes critical. I sincerely hope MSKCC gives her the power to affect real change so they may do so.

Very good work being done and it is at the right place IF she does impact change at MSKCC. If she can make changes there at one of the most elite institutions it may trickle down. One thing about her is that she is in the right place, at the right time, with the right motivations, and it would be a huge opportunity lost if she doesn't aim her focus hard on MSKCC. With her spotlight, even if she gets fired, she could bring more attention to these issues.

Long story short, we have a rad onc that has the ability and personal drive to do it and we are all waiting to see if she does. Best of luck to you Dr. Chino if you are reading this forum. You have my support.

 

[thecarbonionangle]

Im sure shes a great gal and a role model. Her success is all of our success. We should cheer her on and support her.

 

[deleted774703]

Hahaha I hope you guys are all right!

The research is impressive IMO and glad it’s being done

I just don’t want to hear anything how non MSKCC places should be changing (hasn’t been said yet to my knowledge)

As much as I hope she’s able to change the policies at MSKCC, I don’t think she should martyr herself when it comes down to it

 

[evilbooyaa]

I was not aware of her personal tragedy in this regard. Certainly understand her motivations a bit better.

I think there's a place for both, and while, as a junior attending, maybe she can't call out MSKCC by name, she can at least bring to light these issues (which her own institution is guilt of), in the hopes that all facilities will change, not JUST non-MSKCC.

 

[thecarbonionangle]

People have unreasonable expectations on her. People expect her to bash her own institution. How many of you would do this and remain employed? Didn’t think so, folks!

we must support people who are trying to do good within the system. Even if it is modest, better is still good.

 

[medgator]

UW is a known bad program with tons of scut. pay attention folks!

Recent resident experience would seem to confirm that on Twitter:

 

[thecarbonionangle]

Recent resident experience would seem to confirm that on Twitter:

i find that i have to repeat myself a lot on here. I warned about breadlines. i warned this was a bad no good place. I ask People to reconsider, perhaps people know something about something? I mean what do i know. Know nothing here. Am i even a rad onc?

 

[scarbrtj]

"Being the only URM physician in my department has been lonely. I joined Twitter to network."

Lonely being in a niche field in medicine, bit lonely for rad onc in the American College of Radiology and American Board of Radiology, lonely in rad onc funding for our outsize MD/PhD cohort, loneliness on the job search trail... heck we have big-name, white, male rad oncs who write editorials in Red Journal that can essentially be summarized as "I'm kind of lonely." So there should be in-depth caveat emptor sessions for URM females planning to enter rad onc. Psychologically it's gonna be tough, seriously, no joke.

 

[medgator]

i find that i have to repeat myself a lot on here. I warned about breadlines. i warned this was a bad no good place. I ask People to reconsider, perhaps people know something about something? I mean what do i know. Know nothing here. Am i even a rad onc?

Geez

 

[RadOncMegatron]

Not defending what has happened, but I hope she talked with her colleague / friend / co-resident first before roasting him in public on Twitter. Go ahead and report him to your PD in private. We are a small field I think this could’ve been down more discretely. Real consequences to be had. Don’t mind her other anecdotes where no single person can be pinpointed. Now if this guy kept going and said I don’t care well that’s a different story. I hope the revenge was worth it. The DIE (diversity, inclusion, & equity) crew will come for you guns blazing and you better pray they have mercy.

 

[thecarbonionangle]

Looks like TIMESUP in rad onc folks. Post names. The pitchforks are coming.

country club secret handshake good old boy rad onc crew know what is coming.

 

[thecarbonionangle]

TIMESUP on ABR!

 

[RadOncMegatron]

Looks like TIMESUP in rad onc folks. Post names. The pitchforks are coming.

country club secret handshake good old boy rad onc crew know what is coming.

What did I just say?!?!

 

[thecarbonionangle]

What did I just say?!?!

dont worry magatron, they won’t come for you as you’ve never said anything bad.