Rad Onc Twitter

[Radonc 2013]

The analogy to a penny stock is hyperbole. Sure, maybe rad onc was in a bubble 10 or 15 years ago when it was IMRT full steam ahead for 44 fractions, take no prisoners, but I reject the analogy that we are trading at <$1 currently. Also, I do not "tell" students to go into radiation oncology. I advise them on the potential pros and cons and encourage them to take time to carefully reflect on their personal and professional priorities before making a specialty decision. I also encourage them to speak to docs in other specialties and consider lots of options before settling on rad onc if it's right for them.

I agree that maybe a bit of hyperbole to equate RadOnc as a penny stock. I would say a more appropriate analogy would be to a battered retail stock trading at 25% of all time highs. Many people think RadOnc is on the inevitable march towards bankruptcy, becoming JCPenney's over the next few years. Others, such as yourself, think that this is the beginning of a turnaround story and a good time to get in. The problem is that to turnaround any company, you need 2 key components: 1) a plan that investors believe in 2) faith in the management to execute the plan. I think the problem with our specialty, is that we don't have either of these components in place.

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[RickyScott]

I agree that maybe a bit of hyperbole to equate RadOnc as a penny stock. I would say a more appropriate analogy would be to a battered retail stock trading at 25% of all time highs. Many people think RadOnc is on the inevitable march towards bankruptcy, becoming JCPenney's over the next few years. Others, such as yourself, think that this is the beginning of a turnaround story and a good time to get in. The problem is that to turnaround any company, you need 2 key components: 1) a plan that investors believe in 2) faith in the management to execute the plan. I think the problem with our specialty, is that we don't have either of these components in place.

I think a penny stock is valid. Most medstudents today will not be employed as attendings when they graduate: Would love to wager that with Dan? The field would take over a generation to turn around, so not a great idea to get in while its low- Dont try to catch a falling knife

 

[deleted774703]

 

[elementaryschooleconomics]

Wow, Kavanagh demonstrating actual leadership. Cutting a spot and vowing not to SOAP? Dear everyone else: take notes!

 

[scarbrtj]

<Orson_Welles_Citizen_Kane_slow_clap.gif>

 

[metallica81788]

Wow, Kavanagh demonstrating actual leadership. Cutting a spot and vowing not to SOAP? Dear everyone else: take notes!

Great first step.

Now every other program do it. We're all waiting.

 

[thecarbonionangle]

The idea of voluntary contractions may lead to some decrease but not truly significant. There are too many bad programs out there where the service component vastly outsizes the education component. These programs would simply fall apart, as they should rightly fall apart and be burned down As these are absolute hell holes, but they will never let go of that residency spot unless you force them, you will have to pry it from their dead cold fingers. Many bad programs matched with warm body strategy and most places who went unmatched SOAPED. I know people at some of these terrible programs who told me essentially they interviewed and ranked ANYBODY. I know of multiple new residency programs in the works. With the new ASTRO election of a chair who started a new program 1 hr from pittsburgh in WV, we know what side ASTRO is on. These new programs will open. You just wait and see folks!

 

[deleted774703]

Great first step.

Now every other program do it. We're all waiting.

some are asking for that online which is nice to see. At end of one thread OU said they may contract too

I think best part of this is that it normalizes the convo instead of twitter saying it’s just SDN nonsense

 

[Haybrant]

Not going to say we spurred this action but we 100% spurred this action from Kavanaugh, just sad that it took 5 years

 

[elementaryschooleconomics]

Not going to say we spurred this action but we 100% spurred this action from Kavanaugh, just sad that it took us 5 years

"The best time to plant a tree was 20 years ago, the second best time is now."

 

[deleted774703]

Not going to say we spurred this action but we 100% spurred this action from Kavanaugh, just sad that it took us 5 years

we 100% spurred this despite so many ppl against us

I’m glad BK stepped up

what a contrast to other stooges

 

[radiation]

some are asking for that online which is nice to see. At end of 1st thread below OU said they may contract too

I think best part of this is that it normalizes the convo instead of twitter saying it’s just SDN nonsense

I agree this is great leadership from BK and support normalizing conversations that are not antagonistic. I think if people adopt an "I told you so" attitude, or perpetuate an us vs them rhetoric, its going to be harder to continue to make this mainstream conversation. I think that line of thinking makes people less likely to make changes for fear of the "i told you so" that comes with these types of changes

 

[elementaryschooleconomics]

I agree this is great leadership from BK and support normalizing conversations that are not antagonistic. I think if people adopt an "I told you so" attitude, or perpetuate an us vs them rhetoric, its going to be harder to continue to make this mainstream conversation. I think that line of thinking makes people less likely to make changes for fear of the "i told you so" that comes with these types of changes

Totally agree.

At the end of the day, I honestly don't care who was "right" or "wrong", or who took what side of an argument when.

Are people doing things that will likely strengthen the field of Radiation Oncology for future generations? Yes? Great, I'll buy them a drink whenever we can have ASTRO again.

 

[Haybrant]

Totally agree.

At the end of the day, I honestly don't care who was "right" or "wrong", or who took what side of an argument when.

Are people doing things that will likely strengthen the field of Radiation Oncology for future generations? Yes? Great, I'll buy them a drink whenever we can have ASTRO again.

the conversation the mainstream twitteratis are having is about 3-4 years behind us. It takes time to really wrap ones mind around the situation and all the iterations that come with it, they’re just catching up now which is a good thing. But ya you don’t have to care who was right or wrong, I do and I’ll take pride in knowing a few of us in 2014/15 were the first to spur the field in the correct direction if it finally goes that way.

 

[elementaryschooleconomics]

2020 is a wild year.

 

[Mandelin Rain]

Many of these positions are likely not federally funded. Is this just systems cutting back on unfunded positions due to COVID?

 

[medgator]

Many of these positions are likely not federally funded. Is this just systems cutting back on unfunded positions due to COVID?

Maybe, but I'll take it

 

[Chartreuse Wombat]

Many of these positions are likely not federally funded. Is this just systems cutting back on unfunded positions due to COVID?

Positions have been frozen since 1997 with few exceptions. All new positions outside of primary care are funded by health system or physicians groups.

 

[DebtRising]

Whatever the underlying reason, good to see programs finally cutting spots, even if temporarily.


The aggregate data is so obvious this field is oversubscribed and hurting trainees while only benefiting senior academics and private docs / administration alike, it’s immoral we still have this number of training slots.

 

[fiji128]

Whatever the underlying reason, good to see programs finally cutting spots, even if temporarily.


The aggregate data is so obvious this field is oversubscribed and hurting trainees while only benefiting senior academics and private docs / administration alike, it’s immoral we still have this number of training slots.

Agree on this has become an ethics/morals issue at this point.

It's good that a few programs are stepping up and announcing a cut back on positions. I hope this is permanent reduction and not a temporary one year Covid thing.

 

[elementaryschooleconomics]

Does Ralph want to kill this specialty??

Jesus Christ.

 

[scarbrtj]

Does Ralph want to kill this specialty??

View attachment 314327

Jesus Christ.

He doesn't wanna kill it. He's just Lennie, and we are the puppy or Curley's wife.

 

[Haybrant]

Someone really needs to confront Ralph ask him why he doesn’t plan to accept a reduced salary and donate for the years he made more than he should have. It’s the most fair question

 

[OTN]

Does Ralph want to kill this specialty??

View attachment 314327

Jesus Christ.

Here's some radical candor for you: Ralph Weichselbaum is a hypocrite of the highest order, intellectually dishonest, has little to no understanding of basic tenets of economics, and has no qualms sacrificing the dreams and hopes of a younger generation. He is one of the most damaging voices in all of radiation oncology.

 

[RadOncMegatron]

Resp

Here's some radical candor for you: Ralph Weichselbaum is a hypocrite of the highest order, intellectually dishonest, has little to no understanding of basic tenets of economics, and has no qualms sacrificing the dreams and hopes of a younger generation. He is one of the most damaging voices in all of radiation oncology.

I think Dr. Weichselbaum's reputation has taken a hit with Twitter. I think having a public Twitter account has some upside, but very big down side risk. Not worth it in my opinion if you are a non-famous clinician (i don't mean just famous in the field, but actually real life famous). If you're Dr. Oz, then it might be Ok.

 

[RickyScott]

and let’s not forget that Ralph also believes most radiation treatments should be delivered at large academic centers (not in community) which if turned into reality would also be horrible for job market. I am sure he doesn’t see any contradictions... almost everything he says is aligned with screwing new grads.

 

[Mandelin Rain]

What he actually means when he says "we are overpaid" is "my junior faculty are overpaid."

I'm not sure what "different kinds" of radiation oncologists refers to. Employed and unemployed?

 

[theradiator]

What he actually means when he says "we are overpaid" is "my junior faculty are overpaid."

I'm not sure what "different kinds" of radiation oncologists refers to. Employed and unemployed?

In terms of "radical candor", what does the group think of chairs who lead by not treating patients and serving as a full-time administrator? It seems like a bizarre concept that is not widely shared by other specialties where the academic chairs are also high volume physicians or surgeons.

 

[Mandelin Rain]

In terms of "radical candor", what does the group think of chairs who lead by not treating patients and serving as a full-time administrator? It seems like a bizarre concept that is not widely shared by other specialties where the academic chairs are also high volume physicians or surgeons.

Par for the course for Rad Onc

 

[medgator]

Par for the course for Rad Onc

In terms of "radical candor", what does the group think of chairs who lead by not treating patients and serving as a full-time administrator? It seems like a bizarre concept that is not widely shared by other specialties where the academic chairs are also high volume physicians or surgeons.

Are some of them even competent to still treat?

 

[elementaryschooleconomics]

I don't know what the metric is for "having a problem getting a job".

After the "I contacted 100+ places to get a job" Tweet, I've shifted my line of questioning to how the job search has gone in the past few years for folks I know personally.

I've discovered that reaching out to 50-100 places is fairly standard. Is that good? Is that not having a problem? Do any other specialties have to do this?

Dan Golden and his "reached out to ~40 places 7 years ago" seems pretty nice right about now.

 

[Haybrant]

told you guys these people are 3-4 years behind the curve, Ralph is basing this 100% on His residents getting jobs. I know for certain one person 3 years ago had to go to very non ideal location when her husband was in a very desireable one he had to give up his job to move. Sounds like Ralph doesn’t really speak with his residents very much which is why he thinks they shouldn’t get paid well

 

[OTN]

"It's cold outside right now where I am so global warming doesn't exist"

 

[scarbrtj]

I’m so glad to discover I’m not 100% insane

 

[elementaryschooleconomics]

I’m so glad to discover I’m not 100% insane

You strike me more as an "insanity prescribed to the 80% isodose line" kind of guy.

 

[Mandelin Rain]

I'm not ready to ascribe pure altruist motives to this.

I'm sure these departments have been charged to cut their budgets and losing 4 years of salary/benefits/match of a resident is >250k in instant savings.

Additionally, many departments have just experienced their first month of "more caring" residents from the first strained match 2 years ago. Perhaps they figure it's not worth the hassle moving forward. IDK.

Hope I'm wrong and this is a permanent trend.

 

[frijoles]

I'm not ready to ascribe pure altruist motives to this.

I'm sure these departments have been charged to cut their budgets and losing 4 years of salary/benefits/match of a resident is >250k in instant savings.

Additionally, many departments have just experienced their first month of "more caring" residents from the first strained match 2 years ago. Perhaps they figure it's not worth the hassle moving forward. IDK.

Hope I'm wrong and this is a permanent trend.

I don't think individual departments are responsible for paying resident salary / benefits. I believe it's the hospital with funds directed from Medicare.

 

[Mandelin Rain]

I don't think individual departments are responsible for paying resident salary / benefits. I believe it's the hospital with funds directed from Medicare.

There was a freeze on number of residency slots funded by Medicare years ago. New spots are funded by hospitals with revenue.

EDIT: it was the 1997 balanced budget act that froze resident spots. So any new spots since then, including 50% of rad onc spots eat hospital profit, already at DANGEROUSLY low levels.

 

[Lamount]

Does Ralph want to kill this specialty??

View attachment 314327

Jesus Christ.

Ha! Am I the only one who just thinks that this guy is intentionally trolling those on the other side the fence (i.e. SDN)? He strikes me as the sort who feeds on arguments and outrage and is stymied by calm, open-ended questions.

 

[elementaryschooleconomics]

Ha! Am I the only one who just thinks that this guy is intentionally trolling those on the other side the fence (i.e. SDN)? He strikes me as the sort who feeds on arguments and outrage and is stymied by calm, open-ended questions.

That gives him too much credit, I don't think he cares about SDN. I've spent a good chunk of time around him in-person, he strikes me as a "stream of consciousness" sort of person.

But maybe he's being intentionally antagonistic?

 

[StIGMA]

I don't think individual departments are responsible for paying resident salary / benefits. I believe it's the hospital with funds directed from Medicare.

Some departments do pay for salaries, but it may be for 1/4 - 1/2 of their residents or something like that. Or they have several different pots of money to fund salaries (VA contribution for 1-2 residents, department covers 4, private donations cover another), etc. So yeah cutting a spot would save money, but that is inconsistent with the entire trend of departments wanting to expand-- residents bring value to the department even if that is just faculty retention/recruitment for coverage, etc. I think the 'cut' has more to do with quality / not wanting to be labeled as an unmatched program, and perhaps to some degree setting a good example (MDACC).

 

[Radonky]

I'm not ready to ascribe pure altruist motives to this.

I'm sure these departments have been charged to cut their budgets and losing 4 years of salary/benefits/match of a resident is >250k in instant savings.

Additionally, many departments have just experienced their first month of "more caring" residents from the first strained match 2 years ago. Perhaps they figure it's not worth the hassle moving forward. IDK.

Hope I'm wrong and this is a permanent trend.

We can't at one side cry foul when chairs want to keep residents or expand, and at the other do a sincerity litmus test when they cut spots. It's great they are doing this, and it should be supported.

 

[Chartreuse Wombat]

Regardless of the motivation this is a good thing. There I said it. No sarcasm/cynicism/snark.

#radoncdownsize

 

[thecarbonionangle]

You’ll have to take those 3 spots from UC chair’s cold dead fingers before he gives them up. To be fair, This is not a unique position. Many people are silent, and you know why. He is at least telling you he is not cutting spots.

trully terrible programs have the same position. The new ASTRO president’s program has failed to match for many years and always SOAPS. These bad no good places are never cutting spots out of their own volition.

 

[medgator]

Regardless of the motivation this is a good thing. There I said it. No sarcasm/cynicism/snark.

#radoncdownsize

#cut1spot

 

[Chartreuse Wombat]

#cut1spot

Better.I don't tweet

 

[medgator]

Better.I don't tweet

Not as good as #0for2020, i agree

 

[evilbooyaa]

The usual suspects are running with it

 

[radiation]

 

[hbosch]

Regardless of the motivation this is a good thing. There I said it. No sarcasm/cynicism/snark.

#radoncdownsize

Absolutely agree. This is a big step forward, and makes me more hopeful! So I consider it to be huge.