Rad Onc Twitter

[medgator]

Ralph needs to quit while he is behind

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[Mandelin Rain]

Henry Ford was definitely an unemployed buggy driver first.

Wright brothers? Buggy drivers.

Elon Musk’s grandpa was a buggy driver.

Yup, a massive expansion of buggy drivers is what directly led to transportation as we know it now.

 

[Mandelin Rain]

This man simultaneously believes that:

1. 1 Gy of radiation will cause 4% of people to die of cancer and 7% of people to die of heart disease

2. We should massively expand our ranks to find new indications (except deadly acute viral illness, apparently) To give more people much greater than 1 Gy of radiation

Seems incongruous

 

[elementaryschooleconomics]

RaDIcAl CaNDOr:

For the medical students playing along at home -

1) Most chairs of academic Radiation Oncology departments make $600-900k/year
2) Many (not sure %) see zero-few patients/year
3) Salaries like that are only possible through reimbursement of technical specialities (Pediatrics chairs do not make that much)
4) Despite what they may say, having residents allows academic attendings to generate AT LEAST the same RVUs as private practice (SOURCE)
5) For Ralph to take the argument on an individual level ("former resident X makes more than current chair Y") misses the point entirely
6) Ralph Weichselbaum needs to get off Twitter, or needs to learn how to block people - he's taking a beating and is on the wrong side of history

 

[medgator]

RaDIcAl CaNDOr:

6) Ralph Weichselbaum needs to get off Twitter, or needs to learn how to block people - he's taking a beating and is on the wrong side of history

Boomer can't block tweets apparently

 

[CaesarRO]

This is absolutely ridiculous and is actually not data driven.

I'm planning to make an entirely separate post about this (once my regular job stops demanding so much of my time), but the RAND Corporation report from 2013 studies this. Basically, they found (per MGMA data) that the ratio of academic attending to private practice billing is virtually the same in Radiation Oncology:

View attachment 294855

Obviously, Hallahan was correct about the salary...also discussed in the report:

View attachment 294856

But, to imply that salaries are higher in academics because of "low supply" while RVUs are similar between academic and private practices is just ludicrous. The increased salaries were/are one of the ways academic programs were forced to compete.

As academic satellites expand and private practices decrease (not to mention decreased reimbursement via APM), salaries will also decrease.

Fret not, Dr Hallahan.

Sorry for the nitpick of an old post, but it was just linked as a databsource above and I noticed this missing link in the data presented: the first table is ratio of salaries academic vs PP at 100% clinical productivity.

The salaries in table 2 don't specify for the academics what % of their time is academic.

I'm sure that's very hard to come by and quantify and likely has lots of variability.

I don't think that that substantively changes any of the arguments. Just means the data is still rather speculative imo.

 

[elementaryschooleconomics]

Sorry for the nitpick of an old post, but it was just linked as a databsource above and I noticed this missing link in the data presented: the first table is ratio of salaries academic vs PP at 100% clinical productivity.

The salaries in table 2 don't specify for the academics what % of their time is academic.

I'm sure that's very hard to come by and quantify and likely has lots of variability.

I don't think that that substantively changes any of the arguments. Just means the data is still rather speculative imo.

Definitely a limitation and probably the most common critique I've encountered when bringing this data up in various arenas. It would have been nice for them to include that dimension, but I think that would have to come in a RadOnc-specific economic study. It's probably a bridge too far in a study which includes disparate specialties.

 

[CaesarRO]

Definitely a limitation and probably the most common critique I've encountered when bringing this data up in various arenas. It would have been nice for them to include that dimension, but I think that would have to come in a RadOnc-specific economic study. It's probably a bridge too far in a study which includes disparate specialties.

That's also probably one of the biggest fudge factors for academic positions. I wonder how many academics actually get as much protected time from clinic as they have on paper

 

[BobbyHeenan]

Isn't the argument of "we need more residents so that we find the most imaginative ones" the exact same argument as "we need to train more residents so they we fill these rural maldistribution problems?"

 

[RickyScott]

Isn't the argument of "we need more residents so that we find the most imaginative ones" the exact same argument as "we need to train more residents so they we fill these rural maldistribution problems?"

It is more puerile-when you think about it, it crosses the line to bat s-crazy.

 

[BobbyHeenan]

It is more puerile-when you think about it, it crosses the line to bat s-crazy.

Either way it not only doesn't work, but it makes things worse.

 

[Mandelin Rain]

The most imaginative guy in the bread line is still in the bread line.

 

[medgator]

RaDIcAl CaNDOr:


6) Ralph Weichselbaum needs to get off Twitter, or needs to learn how to block people - he's taking a beating and is on the wrong side of history

 

[Chartreuse Wombat]

I doubt he will be able to resist. he is clearly addicted to social media. One wonders what else he does.

 

[thecarbonionangle]

I doubt he will be able to resist. he is clearly addicted to social media. One wonders what else he does.

he cures cancer!

 

[frijoles]

Who is Emily Song? Tried searching for her but not finding anything.

 

[medgator]

 

[domestique]

Who is Emily Song? Tried searching for her but not finding anything.

she is no one and she is everyone. it's a pen-name, nome d'arte, nom de plume, you get the idea.

 

[thecarbonionangle]

The washu chair is most def one of worst guys in RO, trained by UC (connection??!!), and must be rooted out. He ran a hit job on his own faculty Dr. Shah. Guy is a total trash clown bully chair that should be an untouchable in a field with good vision. Guy should be taking the backdoor stairs, does not deserve a spot in anybody’s table.

 

[domestique]

Agree. he's also totally incompetent as a clinician.

 

[elementaryschooleconomics]

I was waiting for someone to make the argument that Hallahan was "simply pointing out an economic principle".

The Letter to the Editor reads:

- we think there's a shortage
- this is causing an increase in salaries for academic attendings
- we want to increase the number of attendings
- [unstated conclusion: thereby decreasing the salaries of academic attendings]

Hallahan could have used several other metrics to make his point about a shortage (if it were true):

- poor patient outcomes
- long wait times to see a RadOnc (i.e. booking a Derm appointment)
- perceived poor care by patients
- physician burnout
- etc etc

Why in the world would you reach for the "academic salary increase" argument if any other meaningful point could be used? Oh, that's right - because he couldn't then, and he can't now. Additionally, physician reimbursement is not tied directly to workload/patient volume, otherwise Family Medicine folks would be pulling down $1.5mil/year.

(preaching to the choir on this forum, I know - this post is for the lurkers)

 

[Mandelin Rain]

I was waiting for someone to make the argument that Hallahan was "simply pointing out an economic principle".

The Letter to the Editor reads:

- we think there's a shortage
- this is causing an increase in salaries for academic attendings
- we want to increase the number of attendings
- [unstated conclusion: thereby decreasing the salaries of academic attendings]

Hallahan could have used several other metrics to make his point about a shortage (if it were true):

- poor patient outcomes
- long wait times to see a RadOnc (i.e. booking a Derm appointment)
- perceived poor care by patients
- physician burnout
- etc etc

Why in the world would you reach for the "academic salary increase" argument if any other meaningful point could be used? Oh, that's right - because he couldn't then, and he can't now. Additionally, physician reimbursement is not tied directly to workload/patient volume, otherwise Family Medicine folks would be pulling down $1.5mil/year.

(preaching to the choir on this forum, I know - this post is for the lurkers)

"Mentioned Elsewhere" = SDN.

I'm telling you, any collusion noted between chairmen to drive down salaries would be pretty easy to suss out, and would be totally illegal. If the guy felt comfortable enough to put his plot in the specialty's chief journal, he probably felt comfortable enough to send some emails around.

 

[OTN]

Oh come on, Michalski. How dumb does he think everyone is? He thinks Hallahan just threw that out there to point out a principle of economics? In a radiation oncology journal? To what end? What would be the possible point, other than the obvious one?

I know he has to defend his chair on Twitter, but at least try to accurately assess the intelligence of those with whom you're debating.

FWIW, I spoke with some lawyers about this. The writing in the Red Journal itself does not constitute a monopolistic restraint of trade, but emails between chairs and departments about the same subject potentially could.

 

[StIGMA]

FWIW, I spoke with some lawyers about this. The writing in the Red Journal itself does not constitute a monopolistic restraint of trade, but emails between chairs and departments about the same subject potentially could.

https://www.astro.org/ASTRO/media/ASTRO/AffiliatePages/SCAROP/PDFs/SCAROPSurvey_orderform.pdf

http://scarop.org/documents/BrinkerhofFeig.pdf

"The SCAROP Financial Survey is an important management resource for all department chairs. You may be most familiar with the compensation tables, but it is worthwhile to review the benchmarking and new wRVU analysis contained in this year's report... I encourage you to purchase it."

"This information allows users to evaluate and compare faculty and nonfaculty compensation and bonuses."

 

[Mandelin Rain]

How is that **** not illegal? Honest question.

No other job would allow this. Can you imagine the outrage if WalMart, Target, Kroger, etc... released detailed salary information of all their similar employees pooled together? Maybe they do and I'm just naive. Probably.

 

[Mandelin Rain]

If you’re still paying astro dues, you’re doing it wrong.

 

[Mandelin Rain]

FWIW, I spoke with some lawyers about this. The writing in the Red Journal itself does not constitute a monopolistic restraint of trade, but emails between chairs and departments about the same subject potentially could.

I would definitely gofundme a couple hours to draft a FOIA to query all public institution chairpeoples’ emails from 2012-2014, keyword: salary, budget, expansion, expand, resident, suppress, pay, hire, junior faculty, supply, demand, etc...

 

[hbosch]

I would definitely gofundme a couple hours to draft a FOIA to query all public institution chairpeoples’ emails from 2012-2014, keyword: salary, budget, expansion, expand, resident, suppress, pay, hire, junior faculty, supply, demand, etc...

I would too!!! Please let’s do this!!!

 

[Palex80]

6) Ralph Weichselbaum needs to get off Twitter, or needs to learn how to block people - he's taking a beating and is on the wrong side of history

Or he needs a brain MRI.

 

[medgator]

Or he needs a brain MRI.

Namenda stat

 

[taserlaser]

Who wants to be the new editor in chief haha?

 

[OTN]

Who wants to be the new editor in chief haha?

Tweet not available, what happened here?

Edit: Also, "lucky" to be a physician? No hard luck or perseverance for Dr. Song I see, nope just pure luck. Time for some more radical candor: RW is a jerk of the highest order. "Jerk" is too light, obviously, but SDN is a family website, see.

 

[taserlaser]

Tweet not available, what happened here?

Edit: Also, "lucky" to be a physician? No hard luck or perseverance for Dr. Song I see, nope just pure luck. Time for some more radical candor: RW is a jerk of the highest order. "Jerk" is too light, obviously, but SDN is a family website, see.

I think they may have edited and just reposted it. Editor in chief application for red journal is now Aug 15th. Will be interesting to see who ends up taking it

 

[elementaryschooleconomics]

I think they may have edited and just reposted it. Editor in chief application for red journal is now Aug 15th. Will be interesting to see who ends up taking it

*checks my CV*

"It appears I have co-authored a classic NCDB analysis - where do I email my application?"

 

[medgator]

he cures cancer!

Public health announcements too

 

[thecarbonionangle]

Public health announcements too

Perchance lacks self awareness but not wrong. USA is a massive pariah state banned from traveling all over the world. People here really are proud of their ignorance.

 

[Neuronix]

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

#radoncdownsize

I will agree. At least we're getting recognition and some buy in from a few programs.

How many programs can we get to sign onto this? I would love a cut 1 spot pledge, no expansions, and no SOAP pledge from a majority of rad onc programs with requirements that make it very difficult to open a new program. That would go a long way to fixing the problem.

2019 had 211 positions offered, most of which were filled either in match, SOAP, or post-SOAP.
2020 had 192 positions offered, again most of which were filled.

Where do we need to be? I've argued before based on review of Ben Smith's last paper on the topic in the appendix that the number probably needed to be 140/year several years ago. Smith himself is saying 150/year.

So where will we be for positions offered in 2021? If a few programs temporarily cut a spot we'll be at maybe 180? Still too many. If we don't fill in the SOAP or post-SOAP and programs don't make sure they rank to match (i.e. actually keep the standards high like they were through the 2000s and early 2010s), we could probably get down to 150ish. The problem is you need chairs like at Kentucky or WVU to actually care enough to do something like that, and I have a hard time seeing that happening. My conversations in the real world with a lot of chairs and PDs are still very head in the sand, like this is a temporary COVID related issue or manufactured by SDN, and they will still try to expand or open new programs in the near future...

 

[fiji128]

If you disregard training programs need for cheep labor, I think to restore things back to health, ie like about what you see in other specialties in terms of supply and demand, we need something like 50 training spots. If a real shortage for rad oncs emerges then increase spots slowly from there. I am not sure 150 spots will come close to addressing the over supply in this field given hypofx, decreasing utilization, APM and 0 fx RT for our most common cases, no supervision rule all of which will be more widely implemented over the next 5 years.

If in last year's application cycle there was 113 US MD applicants I would guess this year it will be around 60 to 80 as the current crop of potential applicants likely wrote off rad onc and did not invest anything in it very early in their search for a specialty after reading what's been posted on SDN for the past 3 to 4 years. So given that demand 150 is still waaaay to many spots. Unfortuntely everyone's hands are tied because of antitrust laws. That's our specialty's new mantra 0 fx and 0 anti trust lawsuits, this is what we stand for.

 

[RickyScott]

If you disregard training programs need for cheep labor, I think to restore things back to health, ie like about what you see in other specialties in terms of supply and demand, we need something like 50 training spots. If a real shortage for rad oncs emerges then increase spots slowly from there. I am not sure 150 spots will come close to addressing the over supply in this field given hypofx, decreasing utilization, APM and 0 fx RT for our most common cases, no supervision rule all of which will be more widely implemented over the next 5 years.

If in last year's application cycle there was 113 US MD applicants I would guess this year it will be around 60 to 80 as the current crop of potential applicants likely wrote off rad onc and did not invest anything in it very early in their search for a specialty after reading what's been posted on SDN for the past 3 to 4 years. So given that demand 150 is still waaaay to many spots. Unfortuntely everyone's hands are tied because of antitrust laws. That's our specialty's new mantra 0 fx and 0 anti trust lawsuits, this is what we stand for.

Do a thought experiment with 0 spots for a few years; would still not fix the problem. Declining utilization, plus radoncs working well into their 70s...

 

[elementaryschooleconomics]

Do a thought experiment with 0 spots for a few years; would still not fix the problem. Declining utilization, plus radoncs working well into their 70s...

The number of folks who graduated medical school - or even residency - in the late 80s/early 90s planning on practicing for another 10 years...they're killing me.

 

[Gfunk6]

Here's some data for you:

 

[domestique]

savage Emily R Song strikes again

 

[Neuronix]

RSNA for radiologists is also free for members.

 

[thecarbonionangle]

Do a thought experiment with 0 spots for a few years; would still not fix the problem. Declining utilization, plus radoncs working well into their 70s...

this is why the grandfathering thing needs to be reversed. Many of these people should not be out in practice. Revoke this nonsense. Cutting spots is not enough. Im not dumb enough to think this is happening as many of our “leaders” are grandfathered. Upcoming ASTRO president Started a new program and has gone unfilled every yr and they SOAP. These people do not care at all. I know of MULTIPLE new programs in the works. This nonsense has got to stop. The quote from the jungle is very relevant here, chairs will always have head in sand because they have multiple nefarious incentives not to understand. We all know Randall does not give a F, if you had any doubt, most of the others think just like him, his nonsense is not unique to Lexington.

 

[elementaryschooleconomics]

this is why the grandfathering thing needs to be reversed. Many of these people should not be out in practice. Revoke this nonsense. Cutting spots is not enough. Im not dumb enough to think this is happening as many of our “leaders” are grandfathered. Upcoming ASTRO president Started a new program and has gone unfilled every yr and they SOAP. These people do not care at all. I know of MULTIPLE new programs in the works. This nonsense has got to stop. The quote from the jungle is very relevant here, chairs will always have head in sand because they have multiple nefarious incentives not to understand. We all know Randall does not give a F, if you had any doubt, most of the others think just like him, his nonsense is not unique to Lexington.

Agreed. I matched at the height of RadOnc's competitiveness, and am now flying around the country to take board exams in physics to hopefully land a job in a town of 3,000 people while there are folks who graduated residency in 1975 when discovering the structure of DNA was still the height of medical science practicing in NYC still blown away that we don't use grease pencils on films.

 

[fiji128]

"I know of MULTIPLE new programs in the works."

Only one I've heard of is Penn State in Hershey. Any others you care to name?

 

[scarbrtj]

Agreed. I matched at the height of RadOnc's competitiveness, and am now flying around the country to take board exams in physics to hopefully land a job in a town of 3,000 people while there are folks who graduated residency in 1975 when discovering the structure of DNA was still the height of medical science practicing in NYC still blown away that we don't use grease pencils on films.

All students: that ↑↑ this guy ↑↑ is having ANY job-finding pain is a huge indictment of rad onc, a big blinking red light saying STAY AWAYYYYY.

 

[medgator]

"I know of MULTIPLE new programs in the works."

Only one I've heard of is Penn State in Hershey. Any others you care to name?

NYMC Westchester put that on their wishlist when looking for a new chairman. Also wouldn't surprise if Baptist/Miami cancer institute was thinking about it...

 

[evilbooyaa]

NYMC Westchester put that on their wishlist when looking for a new chairman. Also wouldn't surprise if Baptist/Miami cancer institute was thinking about it...

If they're looking to hire a fellow they're likely looking to start a residency program with good ol' Minesh Mehta

 

[fiji128]

If they're looking to hire a fellow they're likely looking to start a residency program with good ol' Minesh Mehta

Yikes, absolutely crazy in this environment. Obviously anyone trying to do this could give two *** about their trainees but I'm sure it looks nice on their CVs and adds to the department and chair's "prestige."