Rad Onc Twitter

[deleted573262]

Don't be mean.

CCF is awesome. Their book is the best! (take that, Yale/UCSF/MDA)

Yes, the crappy programs should be the ones to close or contract. Would you rather Cleveland Clinic, MSKCC, etc. contract instead? Don't be dumb. The best institutions should be the ones to train residents. Sure, Stanford and WashU can afford to lose a spot or two, but ideally, if the residency police ever enforce proper case numbers and other reforms to ensure quality residency education, you can bet that CCF will come out on top.

As it should be.

Don't bite the PD that is on your/our side.

absolutely the excess slots are smaller training programs without established research, faculty, or pathways to rewarding careers. greatest volume of these are in other cities with brand name programs. ie, ny presbyterian programs, stony brook all living in the shadow of mskcc; tufts in the shadow of harvard; wake forest. even case western could be added to the list. these programs, as a result of being outcompeted, get less interesting patients, fewer clinical trials, and worse job outcomes.

what metrics do you think are important in deciding how to reduce # residency slots?

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[PhotonBomb]

KHE is knee deep in a fried Oreo somewhere

 

[Mandelin Rain]

I got into the misanthrope game because I saw a problem, not so much on the horizon but immediately in front of my face. A simple math problem. More docs + less demand = specialty in peril.

My end game wasn’t to have some academician agree me, because it was inevitable that eventually every one would agree there was a problem. My goal was to help push for a meaningful change to help improve the outcomes for med students, residents, and practicing docs. That’s the whole purpose of this site.

So, while it’s nice to hear that a few people are starting to admit there is an issue (even as 91% of their residents told them as much last year), I don’t think now is the time to take a victory lap. Now is the time to push for that meaningful change. What’s the plan? If MDACC and Harvard really are dropping their complement by 1 each, strongest kudos to them. That’s about 2% of the work that needs be done. And really, if they can do it, so can anyone else.

 

[metallica81788]

So, while it’s nice to hear that a few people are starting to admit there is an issue (even as 91% of their residents told them as much last year), I don’t think now is the time to take a victory lap. Now is the time to push for that meaningful change. What’s the plan? If MDACC and Harvard really are dropping their complement by 1 each, strongest kudos to them. That’s about 2% of the work that needs be done. And really, if they can do it, so can anyone else.

Problem is that the "anyone else" is mid-to-lower-tier programs of varying size (mostly small) and malignancy that will do anything to keep their precious residency coverage. Programs whose attendings "require" 100% or near 100% (11 months) of resident coverage should be the first to retract or not match. I wonder how many of those people are on RadOnc Twitter. My guess is not many.

 

[medgator]

Problem is that the "anyone else" is mid-to-lower-tier programs of varying size (mostly small) and malignancy that will do anything to keep their precious residency coverage. Programs whose attendings "require" 100% or near 100% (11 months) of resident coverage should be the first to retract or not match. I wonder how many of those people are on RadOnc Twitter. My guess is not many.

Best is to just shame them. Honestly with the way things are going, the bottom half of RadOnc will be lucky if they match at all

 

[metallica81788]

Best is to just shame them. Honestly with the way things are going, the bottom half of RadOnc will be lucky if they match at all

Agreed. We can just only hope their greedy selves don't SOAP for warm bodies.

 

[Mandelin Rain]

Best is to just shame them. Honestly with the way things are going, the bottom half of RadOnc will be lucky if they match at all

Yup. Come out and say, “These 25 programs are worthless, provide substandard training, and should go away. These 20 are too big and can lose 1-2 residents per year.”

That’s a powerful statement.

 

[medgator]

Yup. Come out and say, “These 25 programs are worthless, provide substandard training, and should go away. These 20 are too big and can lose 1-2 residents per year.”

That’s a powerful statement.

Not only that, they lack the longevity or alumni network/connections to even get your foot in the door for a job in all likelihood.

Back when we matched, no one cared about training when there were so few spots in the match to begin with, knowing you'd have a decent shot at a job somewhere with some positive aspect to it.

I bet applicants care more about job prospects than training quality

 

[elementaryschooleconomics]

To me, this is sort of a deafeningly political non-answer.

 

[medgator]

View attachment 285936


To me, this is sort of a deafeningly political non-answer.

Agreed

 

[gmsquid]

To be fair, I think it’s hard to pin down a number without proper research.

 

[medgator]

To be fair, I think it’s hard to pin down a number without proper research.

By the time that paper comes out, this field will be decimated. Use your gut and common sense. Things were better last decade when we had about half to 60% of the grads coming out

 

[elementaryschooleconomics]

To be fair, I think it’s hard to pin down a number without proper research.

Oh totally agree - the question was "would you encourage students to pursue RadOnc" and the answer was "maybe".

 

[RadOncDoc21]

By the time that paper comes out, this field will be decimated. Use your gut and common sense. Things were better last decade when we had about half to 60% of the grads coming out

Right, it’s like saying you want to await final publication to determine a treatment plan for your GBM patient.

 

[Mandelin Rain]

Oh totally agree - the question was "would you encourage students to pursue RadOnc" and the answer was "maybe".

 

[RadOncDoc21]

I'm less clear on that. If a great student with research and a good personality, would you encourage them to apply? If a fifth year student with no research, a failed step 2ck comes and asks, would you encourage them to apply? The world is not black and white and you are likely giving these students different advice, IMO.

I would tell both of them same exact thing: IMO, The job market sucks, your leaders failed you. I would discourage all med students at this time. I don’t think it matters what kind of med student applies, 200 residents/yr is too many!

 

[PhotonBomb]

So you’re saying the number should be zero.

He said more than zero.

That’s where you disagree with him?

Just say what you mean - you mean there should be zero spots a year.

 

[RadOncDoc21]

So you’re saying the number should be zero.

He said more than zero.

That’s where you disagree with him?

Just say what you mean - you mean there should be zero spots a year.

Zero would be a lot less likely to achieve than 200 which is where we are currently.

I’ll compromise and meet you in the middle... 100 sounds reasonable.

 

[deleted774703]

Zero would be a lot less likely to achieve than 200 which is where we are currently.

I’ll compromise and meet you in the middle... 100 sounds reasonable.

Just for the Record let’s not skip Dartmouth as a program that should never exist

And also I hear rumors penn state wants to start program. We have to make sure they don’t. I don’t think anything is set up yet thankfully

 

[OTN]

125-130 spots seems about right to me, based on the numbers over the years, maybe up to 135 if we want to be generous. Currently there are 211 spots offered.

125/211 = 59.2%.
130/211 = 61.6%
135/211 = 64%

Each program should reduce to ~60% of their total resident compliment, and should do it quickly. As far as coverage goes, academicians should be ashamed of not being able to function without a resident.

Reaction to even considering opening a new program right now should be swift from the "Twitterati" if they want to prove they actually care about their residents and their futures.

I would be very impressed if a program opened up a pathway to retraining in medical oncology or interventional oncology, which I think would go a loooong way in helping over the next few years.

Dr. Moghanaki's "take down an entire specialty" remark is a perfect display of why dissenting opinions need to be anonymous in this field.

 

[medgator]

Just for the Record let’s not skip Dartmouth as a program that should never exist

And also I hear rumors penn state wants to start program. We have to make sure they don’t. I don’t think anything is set up yet thankfully

So many damn new programs

 

[thecarbonionangle]

125-130 spots seems about right to me, based on the numbers over the years, maybe up to 135 if we want to be generous. Currently there are 211 spots offered.

125/211 = 59.2%.
130/211 = 61.6%
135/211 = 64%

Each program should reduce to ~60% of their total resident compliment, and should do it quickly. As far as coverage goes, academicians should be ashamed of not being able to function without a resident.

Reaction to even considering opening a new program right now should be swift from the "Twitterati" if they want to prove they actually care about their residents and their futures.

I would be very impressed if a program opened up a pathway to retraining in medical oncology or interventional oncology, which I think would go a loooong way in helping over the next few years.

Dr. Moghanaki's "take down an entire specialty" remark is a perfect display of why dissenting opinions need to be anonymous in this field.

Yup and yet you have multiple posters on here constantly encouraging people to out themselves on Twitter, some of these residents. Some people do not understand how things work at all SADLY

 

[RadOncDoc21]

Yup and yet you have multiple posters on here constantly encouraging people to out themselves on Twitter, some of these residents. Some people do not understand how things work at all SADLY

Right, not much to gain. I’m sure they will still think the same way except now they have a name to go after and attack personally.

 

[RadOncMegatron]

It just keeps getting better there are 11 exempt centers from the CMS ruling:

Tweet link:

 

[medgator]

It just keeps getting better there are 11 exempt centers from the CMS ruling:

View attachment 285993View attachment 285994View attachment 285995

Tweet link:

Aren't these the same PPS centers that get the highest reimbursement from Medicare? I bet none of them take medicaid either. Love it

 

[thecarbonionangle]

Right, not much to gain. I’m sure they will still think the same way except now they have a name to go after and attack personally.

Question is if these people are naive or have some sort of bad motive to partake in the destruction of people they disagree with. The same posters are also advocating for restrictions of expression/censoring of criticism of public figures , people who willingly post shameful sh&t under their own name. Really makes me wonder what side some of these posters are on. Beware, this ain’t China.

 

[thecarbonionangle]

It just keeps getting better there are 11 exempt centers from the CMS ruling:

View attachment 285993View attachment 285994View attachment 285995

Tweet link:

WOW the Mark Storey link is crazy. COH, MDACC, MOFFIT.... etc etc. of course these people are exempt, how corrupt. COH program should be shut down. Moffit contracted, anderson too. All of these programs should be cut. Damn SMH

 

[Reaganite]

WOW the Mark Storey link is crazy. COH, MDACC, MOFFIT.... etc etc. of course these people are exempt, how corrupt. COH program should be shut down. Moffit contracted, anderson too. All of these programs should be cut. Damn SMH

Hah, if COH shut down their residency, how would they staff their massive satellite expansion efforts? They are literally trying to buy out every oncology practice and xrt center in Southern California... USC not as bad, but starting to ramp up the satellite expansion efforts as well. The reimbursement disparities are so extreme for these cancer centers compared to everyone else that they can literally buy a private practice and double the profit the next year just by switching over to their cancer center rates. I'm not making these numbers up either. Have heard real numbers from former admins. The deck is totally stacked in their favor. If CMS really cared about the cost of cancer care, they would equalize the playing field...

 

[PhotonBomb]

Props to Former SDN heavy Hitter SimulD

 

[medgator]

Props to Former SDN heavy Hitter SimulD

Now let's see if KO will acknowledge any of Simul's (multiple) valid points. Expansion has hurt everyone in this field, minus those at the top of radonc Ivory towers who created it and benefitted from it

 

[Chartreuse Wombat]

Now let's see if KO will acknowledge any of Simul's (multiple) valid points. Expansion has hurt everyone in this field

Not everyone. Always winners and losers. Those at the top of the pyramid (academic Chairs, hospitals) benefit from cheap labor at every level.

 

[medgator]

Not everyone. Always winners and losers. Those at the top of the pyramid (academic Chairs, hospitals) benefit from cheap labor at every level.

Yes, should have obviously put in the group that started and benefitted from the problem

 

[Mandelin Rain]

There’s very little we can do. Why do you think we’re on SDN instead of ASTRO, ADROP, RRC, SCAROP meetings?

I disagree. I think SDN has been very successful in framing the problem and bringing it to the fore of applicant's minds, which lead to the poor match last year, which lead to increased awareness among academic departments, which lead to work force studies, which lead further decline in applicants, which lead to begrudging acceptance that there is indeed a problem. We get in the weeds sometimes here and at times can be completely obnoxious, but I think overall the issues have been honestly represented here.

In about a month we have a PD going from "don't listen to those angry "doctors"" to pledging not to SOAP. That is due to the ongoing dialogue here.

The problem has been framed and accepted as true. Now we need to push for accountability and solutions. Push to figure out who gets cut completely and who just loses a spot or two. We need to whittle this down fast, as there is already a glut.

#120in2020

 

[PhotonBomb]

Not everyone. Always winners and losers. Those at the top of the pyramid (academic Chairs, hospitals) benefit from cheap labor at every level.

Honestly speaking I think it’s more the Hospital admins than rad onc chairs.

We all know rad onc chairs. Few of them are business sharks.

 

[BobbyHeenan]

Simul bringing the heat there. Good for him.

The internet never forgets. Take a look back at old threads about the work force concerns. For all the "malcontents" on SDN, they were right.

SDN is Walter:

 

[medgator]

Honestly speaking I think it’s more the Hospital admins than rad onc chairs.

We all know rad onc chairs. Few of them are business sharks.

They still have a budget to deal with. Expansion and taking over satellites while screwing over new hires with more clinical work, less research time etc has made the chairs look good, I imagine

 

[PhotonBomb]

Right but rad onc chairs aren’t in charge of taking over hospitals. They are peons. The main hospital buys the smaller hospital, plants their name on it, and tells the chair ‘find a way to incorporate them in.’

 

[deleted774703]

Right but rad onc chairs aren’t in charge of taking over hospitals. They are peons. The main hospital buys the smaller hospital, plants their name on it, and tells the chair ‘find a way to incorporate them in.’

at this point I hope I can get even a bs academic satellite job.

Hey peon chair, I’m available!

 

[thecarbonionangle]

So what happened to sdn SimulD?

 

[medgator]

at this point I hope I can get even a bs academic satellite job.

Hey peon chair, I’m available!

"May the odds be ever in your favor."

Sigh

 

[elementaryschooleconomics]

I disagree. I think SDN has been very successful in framing the problem and bringing it to the fore of applicant's minds, which lead to the poor match last year, which lead to increased awareness among academic departments, which lead to work force studies, which lead further decline in applicants, which lead to begrudging acceptance that there is indeed a problem. We get in the weeds sometimes here and at times can be completely obnoxious, but I think overall the issues have been honestly represented here.

In about a month we have a PD going from "don't listen to those angry "doctors"" to pledging not to SOAP. That is due to the ongoing dialogue here.

The problem has been framed and accepted as true. Now we need to push for accountability and solutions. Push to figure out who gets cut completely and who just loses a spot or two. We need to whittle this down fast, as there is already a glut.

#120in2020

I think SDN has been extraordinarily effective. It's why I decided to stop lurking and become an active voice - in 20 years, I don't want to look back at this era of our specialty and think "yeah, I had opinions, but I kept them to myself and did nothing". What's that refrain? "First they came for my something something..." - you get the idea.

I actually think the ABR Board Exam Debacle (the actual exam itself coupled with the RIDICULOUS response) was the catalyst that pushed things over the edge. If I ever have time (you know, beyond the demands of my real job) I'd love to analyze that. I have a cross-country meeting I need to attend soon, maybe I'll do that on my 400 hours of flights.

 

[RadOncMegatron]

Right but rad onc chairs aren’t in charge of taking over hospitals. They are peons. The main hospital buys the smaller hospital, plants their name on it, and tells the chair ‘find a way to incorporate them in.’

This is right, but I also wonder how much responsibility hold? Some / little / none? If you take the power, glory, and responsibility, fair or unfair, should you not take some of the blame? Isn't that how leadership works?

 

[deleted774703]

This is right, but I also wonder how much responsibility hold? Some / little / none? If you take the power, glory, and responsibility, fair or unfair, should you not take some of the blame? Isn't that how leadership works?

expansion of hospitals and residency expansion 2 separate issues

chair providing satellite jobs after takeover is good

chair increasing residency spots without or after takeover is bad

 

[medgator]

chair providing satellite jobs after takeover is good

At a lower salary than the previous private/employed group got? Bad!

 

[deleted774703]

At a lower salary than the previous private/employed group got? Bad!

It's relative. 2 weeks ago it was bad.

Now, I just hope they keep the job open...

 

[BobbyHeenan]

expansion of hospitals and residency expansion 2 separate issues

chair providing satellite jobs after takeover is good

chair increasing residency spots without or after takeover is bad

Agree.

Appropriate response as a steward of the field is to staff the new clinic but not use it as a justification for more residents.

That falls on the chairs.

 

[thecarbonionangle]

expansion of hospitals and residency expansion 2 separate issues

chair providing satellite jobs after takeover is good

chair increasing residency spots without or after takeover is bad

Nonsense. They are swallowing up pp with partnership track and offering “academic” jobs for 300s with little room for more and increasing work demands. Many cities with healthier pp markets have been completely decimated by this.

 

[BobbyHeenan]

Nonsense. They are swallowing up pp with partnership track and offering “academic” jobs for 300s with little room for more and increasing work demands. Many cities with healthier pp markets have been completely decimated by this.

But I’m not sure chairs have any say. The hospitals are going to swallow the clinic no matter what.

Not sure chairs have a say there.

 

[deleted774703]

Nonsense. They are swallowing up pp with partnership track and offering “academic” jobs for 300s with little room for more and increasing work demands. Many cities with healthier pp markets have been completely decimated by this.

The chairs aren't swallowing up PP

The MBAs with hospital expansion are doing that and guess what it's not stopping, esp with the new HOPPS rule.

We now need chairs to push for new hirings at those sites.

 

[thecarbonionangle]

But I’m not sure chairs have any say. The hospitals are going to swallow the clinic no matter what.

Not sure chairs have a say there.

until chairs show me otherwise that they are not as evil as they seem, and they constanly re-inforce this through their actions or lack thereof or their ridiculous posts on social media,i’ll continue to hold negative views of that entire cabal