Rad Onc Twitter

[Radonc90]

- Not true, multimillionaire guy has no case in court.

- ASTRO Silence = Complicity with the man from City of Angels. If you read his essay (still available at ROHub), it is insulting to many attendings. Some people may not know the whole history why he wrote that particular essay. All they see is his essay. ROHub is "one-way street."

- Not a single female ASTRO members, junior or senior or chair, writes a rebuttal to the man from City of Angels on ROHub. This is truly a tragedy of the field. What happens to all #WomenWhoCurie or #RadoncRocks people? They were very vocal about women issues on Twitter...

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[deleted774703]

- Not true, multimillionaire guy has no case in court.

- ASTRO Silence = Complicity with the man from City of Angels. If you read his essay (still available at ROHub), it is insulting to many attendings. Some people may not know the whole history why he wrote that particular essay. All they see is his essay. ROHub is "one-way street."

- Not a single female ASTRO members, junior or senior or chair, writes a rebuttal to the man from City of Angels on ROHub. This is truly a tragedy of the field. What happens to all #WomenWhoCurie or #RadoncRocks people? They were very vocal about women issues on Twitter...

Exactly right

 

[thecarbonionangle]

- Not true, multimillionaire guy has no case in court.

- ASTRO Silence = Complicity with the man from City of Angels. If you read his essay (still available at ROHub), it is insulting to many attendings. Some people may not know the whole history why he wrote that particular essay. All they see is his essay. ROHub is "one-way street."

- Not a single female ASTRO members, junior or senior or chair, writes a rebuttal to the man from City of Angels on ROHub. This is truly a tragedy of the field. What happens to all #WomenWhoCurie or #RadoncRocks people? They were very vocal about women issues on Twitter...

there’s a quote in the white coat investor chapter about asset protection which goes something like “no matter how frivolous the lawsuit you still have to pay someone to defend you”. The person suing with heavy pockets can literally bankrupt you by keeping you in court, making you pay fees, beating you into submission. This is a technique Trump frequently used according to Michael Cohen. When Wallner threatens similar action he is taking cues from the mob.

 

[GapCalc]

ROHub is trash. No meaningful conversations. Zero replies to Mike because no one wants to catch his wrath. ASTRO wants ROHub to take the place of TheMedNet and SDN but they just can’t make it happen. Heavy-handed moderation won’t help.

It’s telling that they deleted Simul’s post but left up some mildly inflammatory replies to a thread for an ethnicity-specific RO Interest group...

 

[Radonc90]

Re ROHub forum etiquette...

I used to have a Honda Odyssey family van (already sold the van) with sliding door problem.
I went to the Honda forum for help and you will see that these are mostly dads and moms and I have to say that 99.9% of the posts are very
civil. Once in a while we see a good/bad joke, but people treat each other with respects even when they disagree with each other.
Although they do NOT have the same education like we do, these van owners behave much better than some people in ROHub (incl some radonc chairs)!

This is the Honda Odyssey forum FYI:

2005 - 2010 Odyssey

3rd Generation Odyssey topics

www.odyclub.com

This tells you something, sadly more education ---> worse behavior.

ROHub should ONLY delete really bad stuff (like blatantly racist, sexist posts). Leave the rest alone. We are all board-certified radonc, we know how to read the medical literature, we know how to read forum debate. Let the members decide for themselves what they think about a post. A debate makes things better, whether it is medical or political.

Editing/deleting a controversial post is the single most stupid thing to do. Only China does censor its citizens.
Leave the controversial post alone, let others judge it.
By editing/deleting post, people (most ASTRO members are well-educated board-certified radoncs) feel offended and they leave the forum.

Look at Red Journal or any med journal, people debate over medical topics all the time (things like baby aspirin for heart disease, DCIS: to treat or not to treat etc. etc.).

Now, you go to ROHub, all you see is how good ASTRO is, great leadership (they beat their own drums), everything is nice and dandy...
They cannot even take a little heat from their own members...That is NOT leadership.
Leadership is taking the heat and make appropriate changes to improve the specialty.

 

[Radonc90]

@GapCal,

Mike does not have much power like people think.
He is no academician.
Most leaders in the field do not have respect for him.
Trust me.

PS: BTW, the man gave a lecture on "Emotional Leadership" at ASTRO 2019 in Chicago.
A tone-deaf man giving an "Emotional Leadership" lecture? What a joke...

 

[deleted774703]

@GapCal,

Mike does not have much power like people think.
He is no academician.
Most leaders in the field do not have respect for him.
Trust me.

PS: BTW, the man gave a lecture on "Emotional Leadership" at ASTRO 2019 in Chicago.
A tone-deaf man giving an "Emotional Leadership" lecture? What a joke...

I may be in the minority, but I have been upset with ARRO choices on the ARRO day. They keep choosing friends of friends etc "famous names" rather than good ppl to teach us things

Steinberg biggest joke of an example. Same with the residency panel (exception being Lee)

 

[medgator]

 

[elementaryschooleconomics]

"How dare people be concerned if their massive investment of time and money will result in a viable career at the end"

 

[fiji128]

That's great, next year when there are about 74 US med school grads applying to rad onc in the match it can all just be blamed on covid and the subsequent lack of exposure to the specialty. None the less, I'm sure ortho, derm, plastic, optho will somehow not be effected quite as much though.

 

[thecarbonionangle]

ROHub is trash. No meaningful conversations. Zero replies to Mike because no one wants to catch his wrath. ASTRO wants ROHub to take the place of TheMedNet and SDN but they just can’t make it happen. Heavy-handed moderation won’t help.

It’s telling that they deleted Simul’s post but left up some mildly inflammatory replies to a thread for an ethnicity-specific RO Interest group...

havent checked rohub in a while but my impression was that it was a trash place. Sounds about right

 

[deleted774703]

Ridiculous. They hide under the guise of loving students

MDACC has so many IMG students or grads do fellowship there

Those IMGs apply to RO residency. I’ve personally seen their LOR. MDACC attendings always say they are superstar & your would be lucky to have them

Guess where they almost never get an interview or match? MDACC!

Hypocrites

 

[RickyScott]

Ridiculous. They hide under the guise of loving students

MDACC has so many IMG students or grads do fellowship there

Those IMGs apply to RO residency. I’ve personally seen their LOR. MDACC attendings always say they are superstar & your would be lucky to have them

Guess where they almost never get an interview or match? MDACC!

Hypocrites

"They hide under the guise of loving students " very true

 

[thecarbonionangle]

Ridiculous. They hide under the guise of loving students

MDACC has so many IMG students or grads do fellowship there

Those IMGs apply to RO residency. I’ve personally seen their LOR. MDACC attendings always say they are superstar & your would be lucky to have them

Guess where they almost never get an interview or match? MDACC!

Hypocrites

they have never hired one of their “wonderful” FMG fellows that i know.

 

[elementaryschooleconomics]

they have never hired one of their “wonderful” FMG fellows that i know.

Not yet...

 

[thecarbonionangle]

Not yet...

i know of three fellows they hired: Choi, Pugh, Chun. anybody else?

i guess we’ll keep waiting for that FMG hire!

 

[deleted774703]

i know of three fellows they hired: Choi, Pugh, Chun. anybody else?

i guess we’ll keep waiting for that FMG hire!

Nice finds! I don't even mind that they don't hire IMG. That is their prerogative. Just don't gaslight the rest of us

 

[thecarbonionangle]

Nice finds! I don't even mind that they don't hire IMG. That is their prerogative. Just don't gaslight the rest of us

a few years ago a friend of mine was considering a fellowship so we did the research on what could be found. They hired someone who did an IMRT fellowship back in day, someone who did GU stayed on and then went back to Colorado, and i think the other one did general and stayed on at a satellite.

Btw Dr Pugh is hands down the tallest man in rad onc i have ever seen and former college basketball player. He is also a very nice person, have met him a few times at conferences.

 

[elementaryschooleconomics]

From ROHub:

I feel like this is probably the attitude a lot of the naysayers take. The problem is, this data can never really truly exist, and the closest we could get would require actual economists, not residents doing database analysis.

The math is simply: 127% increase in resident positions from 2001 to 2019 (SOURCE).

Therefore, to avoid an oversupply at least one of the following must take place:

1) A significant increase in the need for radiation therapy (either through more cancer patients, more fractions, more indications, etc)
2) A significant increase in the reimbursement for our services (similar to IMRT in the 2000s)
3) A significant increase in the number of practicing RadOncs retiring

I don't think any of the above have taken place, or will take place. I would argue the opposite has happened for points 1 and 2, and we don't have data for point 3.

This is just...basic math. Elementary school level math.

 

[scarbrtj]

From ROHub:

View attachment 311973

I feel like this is probably the attitude a lot of the naysayers take. The problem is, this data can never really truly exist, and the closest we could get would require actual economists, not residents doing database analysis.

The math is simply: 127% increase in resident positions from 2001 to 2019 (SOURCE).

Therefore, to avoid an oversupply at least one of the following must take place:

1) A significant increase in the need for radiation therapy (either through more cancer patients, more fractions, more indications, etc)
2) A significant increase in the reimbursement for our services (similar to IMRT in the 2000s)
3) A significant increase in the number of practicing RadOncs retiring

I don't think any of the above have taken place, or will take place. I would argue the opposite has happened for points 1 and 2, and we don't have data for point 3.

This is just...basic math. Elementary school level math.

Why is ~600K rad onc new patients a year divided by 5000+ rad oncs (and growing), for ~120 new patients a year (and shrinking), not objective data I wonder. Along with the objective data of falling rad onc utilization and fractionation... a true, beautiful double whammy. Plus APM pressures.

(These are hard, fast, true, easily findable numbers and data btw, everyone.)

 

[deleted941485]

From ROHub:

View attachment 311973

I feel like this is probably the attitude a lot of the naysayers take. The problem is, this data can never really truly exist, and the closest we could get would require actual economists, not residents doing database analysis.

The math is simply: 127% increase in resident positions from 2001 to 2019 (SOURCE).

Therefore, to avoid an oversupply at least one of the following must take place:

1) A significant increase in the need for radiation therapy (either through more cancer patients, more fractions, more indications, etc)
2) A significant increase in the reimbursement for our services (similar to IMRT in the 2000s)
3) A significant increase in the number of practicing RadOncs retiring

I don't think any of the above have taken place, or will take place. I would argue the opposite has happened for points 1 and 2, and we don't have data for point 3.

This is just...basic math. Elementary school level math.

Randall doesn’t believe this for the simple reason that he just cannot seem to find too many willing BC ROs or graduating residents that want to stay in KY treat patients 5day/wk with the expectation you will publish and possibly run the program all while making less than hospital employed counter parts in other health systems in even in same state.

For him and probably a lot of chairs, it’s all local. If they can’t get what they want for what they are offering then that equates to a shortage in their mind.

 

[thecarbonionangle]

Randall doesn’t believe this for the simple reason that he just cannot seem to find too many willing BC ROs or graduating residents that want to stay in KY treat patients 5day/wk with the expectation you will publish and possibly run the program all while making less than hospital employed counter parts in other health systems in even in same state.

For him and probably a lot of chairs, it’s all local. If they can’t get what they want for what they are offering then that equates to a shortage in their mind.

Yup. in this past year, many were saying, Randall was in the market for cheap labour offering a fully clinical job with below average pay with expectations to publish and run the program eventually. He’s a nice guy but he totally stands to benefit from oversupply. It is no surprise that he posts, “where is the data?”

interestingly by the time we have “data” the breadlines will wrap around the block.

 

[deleted941485]

Yup. in this past year, many were saying, Randall was in the market for cheap labour offering a fully clinical job with below average pay with expectations to publish and run the program eventually. He’s a nice guy but he totally stands to benefit from oversupply. It is no surprise that he posts, “where is the data?”

interestingly by the time we have “data” the breadlines will wrap around the block.

Even then the breadlines won’t be long enough for them

It’s clear that chairs either selfishly or by pressure from admin cannot be trusted to maintain the integrity of this specialty and every effort should be made to eliminate the expansionary opinions voices from the ranks.

Some may think it is wrong to control speech but I would submit that that expansionists control the narrative and have done their best to suppress the inconvenient view points in the field.

They need to be called out and shouted down at every turn not just on forums But in real life. Don’t collaborate with them, call them out in meetings for their nonsense, make them feel uncomfortable, when they see you at a conference they should be made to sweat.

We also need to be able to point to new leaders which unfortunately we are short on right now.

 

[elementaryschooleconomics]

Randall doesn’t believe this for the simple reason that he just cannot seem to find too many willing BC ROs or graduating residents that want to stay in KY treat patients 5day/wk with the expectation you will publish and possibly run the program all while making less than hospital employed counter parts in other health systems in even in same state.

For him and probably a lot of chairs, it’s all local. If they can’t get what they want for what they are offering then that equates to a shortage in their mind.

I agree with "it's all local" in the other direction too. At my institution (recognized name, good geography) I've been told we get at least 20-30 job applications every year and have forever. I don't think they'll notice if it cranks up to 40-50 (well, maybe 50).

There seems to be an inability to take a global understanding of our field by the leadership...wait, what's that quote about understanding something if your paycheck depends on you not understanding it...

 

[medgator]

From ROHub:

View attachment 311973

I feel like this is probably the attitude a lot of the naysayers take. The problem is, this data can never really truly exist, and the closest we could get would require actual economists, not residents doing database analysis.

The math is simply: 127% increase in resident positions from 2001 to 2019 (SOURCE).

Therefore, to avoid an oversupply at least one of the following must take place:

1) A significant increase in the need for radiation therapy (either through more cancer patients, more fractions, more indications, etc)
2) A significant increase in the reimbursement for our services (similar to IMRT in the 2000s)
3) A significant increase in the number of practicing RadOncs retiring

I don't think any of the above have taken place, or will take place. I would argue the opposite has happened for points 1 and 2, and we don't have data for point 3.

This is just...basic math. Elementary school level math.

Boomers gonna boom

 

[BobbyHeenan]

What "data" are they looking for? Do they literally want unemployment applications or W2 pdf's to show people are having trouble finding good jobs?

How much more objective data do you need than what scarbrtj is posting? Those aren't subjective feelings, it's the cold hard data that we graduate WAAYY more residents than we did in the past, we treat with fewer fractions, and there are certainly not expanding indications for radiation. Combine that with the more subjective survey data (residents worried about job market, etc)...and there you go. If you WANT to see the problem, it's crystal clear.

The O.G. oracle on this Chirag Shah sees a problem. Simul sees a problem. We all see a problem. The residents see a problem.

The ONLY people that don't see a problem, are the people that benefit the most from not seeing a problem. They've caused this, and they don't want to fix it.

It's No Skin in the Game and asymmetry in decision making at its worst.

 

[Chartreuse Wombat]

I agree with "it's all local" in the other direction too. At my institution (recognized name, good geography) I've been told we get at least 20-30 job applications every year and have forever. I don't think they'll notice if it cranks up to 40-50 (well, maybe 50).

There seems to be an inability to take a global understanding of our field by the leadership...wait, what's that quote about understanding something if your paycheck depends on you not understanding it...

For those that like references

“It is difficult to get a man to understand something, when his salary depends on his not understanding it.”

― Upton Sinclair, I, Candidate for Governor: And How I Got Licked

 

[elementaryschooleconomics]

Is he serious with this? We have more Radiation Oncologists in America than at any point in history right now, and we have literally 1,000 more in the pipeline.

Even if we "undertrain" for the next decade, I think we'll SOMEHOW manage the increase from...what? 120 patients/RadOnc/year to...150? Come on.

 

[StIGMA]

Some of the thinking seems to be, more radiation oncologists = larger professional group = stronger specialty = more radiation oncology advocates and researchers... while ignoring the unpleasantness of it all on the individual.

 

[deleted774703]

View attachment 311981

Is he serious with this? We have more Radiation Oncologists in America than at any point in history right now, and we have literally 1,000 more in the pipeline.

Even if we "undertrain" for the next decade, I think we'll SOMEHOW manage the increase from...what? 120 patients/RadOnc/year to...150? Come on.

Kentucky Chair is an idiot.

We have increased residents over time

During that same time, RT use for lymphoma has declined significantly

Guess what? Increased numbers didn't save us from being losing volume....

That's just one disease site. Can do the same for multiples.

COI: I have no interest in taking the crap Markey Clinic job from UK that has been posted for >1 year now

 

[medgator]

Some of the thinking seems to be, more radiation oncologists = larger professional group = stronger specialty = more radiation oncology advocates and researchers... while ignoring the unpleasantness of it all on the individual.

Sounds like a path to disaster (pun intended)

 

[Chartreuse Wombat]

Kentucky Chair is an idiot.

We have increased residents over time

During that same time, RT use for lymphoma has declined significantly

Guess what? Increased numbers didn't save us from being losing volume....

That's just one disease site. Can do the same for multiples.

COI: I have no interest in taking the crap Markey Clinic job from UK that has been posted for >1 year now

https://www.taxpayersunitedofamerica.org/wp-content/uploads/Kentucky-Top-100-Est.-Pensions-for-University-Employees.pdf

Top 10 in the state of Kentucky...let them eat cake

 

[RickyScott]

Some of the thinking seems to be, more radiation oncologists = larger professional group = stronger specialty = more radiation oncology advocates and researchers... while ignoring the unpleasantness of it all on the individual.

Have also seen magical thinking and bizarre suggestion that somehow more docs will allow us to bend laws of nature and physics so that we can expand indications for xrt. Perhaps we can treat Kidney disease with radiation?

 

[deleted774703]

https://www.taxpayersunitedofamerica.org/wp-content/uploads/Kentucky-Top-100-Est.-Pensions-for-University-Employees.pdf

Top 10 in the state of Kentucky...let them eat cake

Damn good for him. >500K per year in low cost of living state and >8 million pension coming

Guy is loaded

I still don’t want that job and think he’s absolutely wrong about residents but good for him

 

[deleted941485]

Damn good for him. >500K per year in low cost of living state and >8 million pension coming

Guy is loaded

I still don’t want that job and think he’s absolutely wrong about residents but good for him

Tell him to work harder see more patients problem solved.

 

[deleted941485]

Have also seen magical thinking and bizarre suggestion that somehow more docs will allow us to bend laws of nature and physics so that we can expand indications for xrt. Perhaps we can treat Kidney disease with radiation?

It worked out really well for pathology, and IM...right??

 

[scarbrtj]

Some of the thinking seems to be, more radiation oncologists = larger professional group = stronger specialty = more radiation oncology advocates and researchers... while ignoring the unpleasantness of it all on the individual.

Sadly according to the rad onc head of ABR applicant quality is declining so the new blood might sink us instead of save us. Again, according to Wallner.

 

[scarbrtj]

Pretty optimistic given my ASCO experience. And not so fantastic for job seekers where ASTRO serves as a nice job fishing net.

 

[taserlaser]

Quality of research is going to go down I think. Don’t get me wrong - the brilliant minds that are already in our specialty are going nowhere. But it is going to be harder to recruit numbers for trials on a per RO basis to answer important questions, I think, which will limit the power of single institution studies.

 

[beamseyeview]

Damn good for him. >500K per year in low cost of living state and >8 million pension coming

Guy is loaded

I still don’t want that job and think he’s absolutely wrong about residents but good for him

Pretty unfortunate that the second most highly paid rad onc at UK makes $299k though

 

[fiji128]

https://www.taxpayersunitedofamerica.org/wp-content/uploads/Kentucky-Top-100-Est.-Pensions-for-University-Employees.pdf

Top 10 in the state of Kentucky...let them eat cake

https://www.kentucky.com/news/databases/article235380877.html

You can see that Randall's current yearly is listed at $650,000 on top of that ridiculous pension number. I know people who have inquired about the jobs recently posted for the University of Kentucky and their various satellite operations and the pay about $240,000ish for new/recent grads. What US grad would sign up for Rad Onc knowing what awaits them is some job 60 miles outside of Lexington, KY, for probably less then what the local internist makes who at least has infinitely more work flexibility. How much of Randall's compensation is tied to getting the lowest cost grad he can find for staffing? Seems like some one claiming he wants to see "data" should disclose that.

The mentality that every position everywhere needs to be filled for whatever salary and whatever practice situation is super dangerous for the long term health of the specialty. I've actually heard similar sentiment from old rad onc "leaders" at ASTRO a few years back, that what they are really worried about is some center somewhere is unstaffed and patients go without RT. Why not just increase the resident number to 250? Maybe then starting pay could go down to $175,000/year and every position 4 hours from an airport would have 10 applicants and fill immediately. Of course the specialty at that point would probably be 85% non matched fmg picked up in the SOAP.

 

[GapCalc]

We should applaud Dr. Randall for pulling back the curtain for potential future trainees. He is proving to every med student who might consider rad onc that current leadership (he is a chair, after all) just doesn't care about the future of the specialty. As others have mentioned, he directly benefits from cheaper labor, which is what happens when you have more job seekers than jobs.

A >100% increase in residents in 20 years when there hasn't been a concomitant increase in patients or treatment indications isn't rocket science. Waiting for a stronger signal of changes to the employment situation (established patterns of decreased income, persistent unemployment, sustained increase in fellowship training) are likely the type of data Dr. Randall is looking for, but that means many wasted years of talent just to have "objective evidence."

To be fair, I do not think there is high quality published data saying there is currently excess capacity. But as with 'gray zones' in medicine, we often times rely upon expert opinion to drive decision making. Unfortunately, Dr. Randall seems to be dismissive of such expert opinions, even though the message is generally consistent i.e. "we are training too many."

 

[Burt Radnolds]

Pretty unfortunate that the second most highly paid rad onc at UK makes $299k though

Some academic positions have unique revenue streams where you can have paychecks coming from multiple entities, some of which are not publicly disclosed. I used to have a position like this and everyone in the in-laws family thought they knew what I made, but it was actually much higher, which was how I preferred it.

 

[radoncopotamus]

https://www.kentucky.com/news/databases/article235380877.html

You can see that Randall's current yearly is listed at $650,000 on top of that ridiculous pension number. I know people who have inquired about the jobs recently posted for the University of Kentucky and their various satellite operations and the pay about $240,000ish for new/recent grads. What US grad would sign up for Rad Onc knowing what awaits them is some job 60 miles outside of Lexington, KY, for probably less then what the local internist makes who at least has infinitely more work flexibility. How much of Randall's compensation is tied to getting the lowest cost grad he can find for staffing? Seems like some one claiming he wants to see "data" should disclose that.

The mentality that every position everywhere needs to be filled for whatever salary and whatever practice situation is super dangerous for the long term health of the specialty. I've actually heard similar sentiment from old rad onc "leaders" at ASTRO a few years back, that what they are really worried about is some center somewhere is unstaffed and patients go without RT. Why not just increase the resident number to 250? Maybe then starting pay could go down to $175,000/year and every position 4 hours from an airport would have 10 applicants and fill immediately. Of course the specialty at that point would probably be 85% non matched fmg picked up in the SOAP.

This is fake news. UK offered >$320k for their main campus position for new grads.

 

[Chartreuse Wombat]

This is fake news. UK offered >$320k for their main campus position for new grads.

I think the lower number was for the satellite. More to the point did the main campus position fill? The youngest member of the faculty on the website completed training in 2017.

 

[medgator]

This is fake news. UK offered >$320k for their main campus position for new grads.

Dr Randall certainly wouldn't mind getting those grads cheaper like the chair of WUSTL wants them

 

[radoncopotamus]

I think the lower number was for the satellite. More to the point did the main campus position fill? The youngest member of the faculty on the website completed training in 2017.

I heard that it filled. Probably with a new grad that graduated June 30, so website not likely to be updated yet to reflect that I'd guess?

 

[Neuronix]

This is fake news. UK offered >$320k for their main campus position for new grads.

25th percentile AAMC assistant professor

(4 lyfe)

Depends on the year and place whether they seem to want to use $300k as the round number or $320k as the 25th percentile assistant professor benchmark. This or some variation is exceedingly common in academics.

 

[elementaryschooleconomics]

25th percentile AAMC assistant professor

(4 lyfe)

Neuronix out here running AI algorithms on the breadlines to figure out optimal mold control

 

[medgator]

25th percentile AAMC assistant professor

(4 lyfe)

Depends on the year and place whether they seem to want to use $300k as the round number or $320k as the 25th percentile assistant professor benchmark. This or some variation is exceedingly common in academics.

That's entry level hospitalist salary around my neck of the woods