Rad Onc Twitter

  • Thread starter Thread starter deleted1002574
  • Start date Start date
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Members don't see this ad.
KHE88 said:
I realized there were trade-offs and I went out there a bit rosy-eyed thinking I was providing some kind of service to patients who previously had not been getting good consistent cancer care. Nope. Turns out hospital has no interest in spending a dime as soon as you sign on that line. My salary is ok (but I was promised a significant production incentive that turned out to be the proverbial carrot so there's that) and it's the only thing that haven't not lived up to yet, but I'm not dumb enough to think that's going to last. I can see what they've done to older docs. Once they know you've built a house and have kids in school, they will start chipping away at you to see what they can get away with without you leaving When they finally push you too far and you submit your resignation they will come back and offer you some but not all of what they took away and act like they are doing you a favor and really bending them over. I've seen it happen already to two other specialists in less than a year. Hell, I have nothing tying me down. My s.o. bailed on me, I live in a sheithole duplex with walmart furniture, nothing is keeping me here and they are still basically doing everything they can to nudge me over the edge to the point I just don't show up. The patients are the only reason I still do at this point. I feel genuinely terrible that so many of the woke academics act like these deplorables and the poor care the receive aren't even worth discussing. Real issues are the ghost in the machine that holds back women and minorities from positions in the big city university centers. I'll take a paycut to go somewhere that isn't run by pathologic liars, which by the way, I am assured is "standard industry practice." From what I've seen in talking to other hospital systems, that may be the only truth they've told. That lying and screwing over doctors with unethical contracts and empty promises is in fact "standard industry practice."
Click to expand...
I’ve seen this happen to people in PP too. The interview is all cheerful, democratic- we don’t stab each other in the back, we don’t steal your patients, everyone is involved with decisions in the practice, everyone partners on time- then decisions are made behind your back without your input controlling your life, patients are stolen from you or alternatively dumped on you (but oh we’re fair everyone gets the same pay- not fair when some people don’t work and others are driven like oxen), partnering is delayed...the hospitals have always done this crap, some toxic PP have always done it, but more and more people are going to get away with it for longer (meaning they will hold on to the doctors for longer because it will be harder for those doctors to make lateral moves) with a bad market....but at least in a larger city getting and holding onto strong physics is easier...again not saying all physicists in small towns are bad, just that they will be harder to replace if they are bad or they leave.
 
Carotenoid said:
so essentially all good people live in big cities...
Click to expand...

I think people have their preferences on whether they want to live in a big city, are agnostic, or specifically DON'T want to live in a big city. I believe having any of those 3 preferences does not inherently make you any sort of thing.

If people have a preference to live in a big city, that does not make them an evil person, just as a person who enjoys living in rural areas does not make them an evil person.

Regardless of your opinions and preferences on living and working in an urban, suburban, or rural environment, please do not directly insult other SDN members. One user warned.
 
evilbooyaa said:
I think people have their preferences on whether they want to live in a big city, are agnostic, or specifically DON'T want to live in a big city. I believe having any of those 3 preferences does not inherently make you any sort of thing.

If people have a preference to live in a big city, that does not make them an evil person, just as a person who enjoys living in rural areas does not make them an evil person.

Regardless of your opinions and preferences on living and working in an urban, suburban, or rural environment, please do not directly insult other SDN members. One user warned.
Click to expand...

ucla now posting about a zoom for prospective residents on twitter. I wonder how many of these we are going to see
 
MegaVoltagePhoton said:
ucla now posting about a zoom for prospective residents on twitter. I wonder how many of these we are going to see
Click to expand...

Rad Onc Rank List Meeting in February 2021:

They logged onto our August Zoom call! Nice, that shows tremendous interest in the field and in this program in particular. Step scores >200, pass in all clerkships, ERAS mostly complete, 1 DUI like 4 years ago. That's a rank to match!
 
fiji128 said:
Rad Onc Rank List Meeting in February 2021:

They logged onto our August Zoom call! Nice, that shows tremendous interest in the field and in this program in particular. Step scores >200, pass in all clerkships, ERAS mostly complete, 1 DUI like 4 years ago. That's a rank to match!
Click to expand...
One more attribute-they follow the sycophants on Twitter #radoncrocks
 
MegaVoltagePhoton said:
ucla now posting about a zoom for prospective residents on twitter. I wonder how many of these we are going to see
Click to expand...

I imagine most programs are going to do something along these lines. It becomes a rat race - as soon as one program does it, every other program has to scramble to do the same. Programs know (whether they admit it or not) they need to sell themselves to the good applicants, not the other way around. Programs that at all care about the quality of their residents will definitely have 'reach out' sessions in order to secure the best applicants.

The lower tier programs may be less likely to have 'reach out' sessions as their focus is just on matching any warm body rather than any actual standards.
 
medgator said:
Click to expand...

Looking back, this has been building during my residency. The talk of how palliative cases are the hardest because there are so many options (iow, the easiest) to now calling it PRT. We're trying to upsell the technically simplest scenario because all the cool ****s being taken away from us. Concurrently, somehow, we're also downselling the philosophically most interesting and complex scenario by guilting everyone into giving a single fraction.
 
So, thinking through this.

To be in the network you have to offer same day sim and treat in 1 fraction.

Obvious question, if the patient is sitting across from you, why aren’t you just offering them the same day sim and treat in 1 fraction option? Like right now? Today. They are there. Sim and treat them. No extra travel. No network needed. Why are you now looking to punt this patient to a local guy that you expect to do the job that you could do right now?

Obvious answer, now that we have fraction shamed each other into 1 fraction everything, the monetary rewards are no longer worth the disruption of daily clinic flow for these academic departments to give the treatment they prescribe others do.

TL;DR, “the bone mets ain’t worth our time anymore.”
 
Mandelin Rain said:
So, thinking through this.

To be in the network you have to offer same day sim and treat in 1 fraction.

Obvious question, if the patient is sitting across from you, why aren’t you just offering them the same day sim and treat in 1 fraction option? Like right now? Today. They are there. Sim and treat them. No extra travel. No network needed. Why are you now looking to punt this patient to a local guy that you expect to do the job that you could do right now?

Obvious answer, now that we have fraction shamed each other into 1 fraction everything, the monetary rewards are no longer worth the disruption of daily clinic flow for these academic departments to give the treatment they prescribe others do.

TL;DR, “the bone mets ain’t worth our time anymore.”
Click to expand...

Moreover, it further pushes us towards cookbook medicine, and the transformation of the Radiation Oncologist from physician to technician.

"How ever will I treat this spine met? Better pull up the guidelines!"
 
The authors lay out exactly what they’ll use this service for:

“ The network providers would adhere to established PRT principles, including minimizing travel burden (i.e. same day set-up and treatment), offering low-complexity treatments (two-dimensional or three-dimensional techniques), prescribing single/hypofractionated regimens when appropriate, and offering supportive therapies to maximize quality-of-life.”

No mention of passing RTOG QA for hippocampal sparing WBRT, or SBRT capability for oligomets, or SRS capability for brain/spine mets. They’ll be keeping those, obviously. They go out of their way to tell you, you are not worthy of those patients, only "low complexity treatments".

They are describing one VERY specific situation above. Symptomatic bone mets. They want you to be their pain clinic/hospice med prescriber and drop your clinic to treat their patient, today. That is transparently what the paper is stating. Gross.
 
Last edited:
A lot of times... many times... most times, the SRS I’m doing is “palliative” and meets all their other requirements (3D, sim and treat same day, single fraction, etc).

Hope I get picked to be in The Good ‘Ol Boys’ Palliative Network!
 
Wow they really are something with this, how does crap like this get published. Maybe the network requires completion of a 1 year palliative fellowship?
 
Do you still have to pay $750 to submit something to Advances in Rad Onc? I can't believe this proposal is a real thing. Even if you are or are not a "certified member" of this ridiculous network doesn't a referring physician just send the patient to the closest RT center anyways, especially for something like palliation?

Great example of how clueless academic folks can be just trying to invent sh***t that they can put on their CV's.

I'd be embarrassed to attach my name to something like this,

Anish Butala, UPenn
Graeme Williams, UPenn
Hiral Fontanilla, Princeton Radiation Oncology
Kavita Dharmarajan, MSSM
Joshua Jones, UPenn
 
Last edited:
Imagine though that this garbage paper is probably written by some highly qualified resident who matched in “peak rad onc” to UPenn, expecting some academic high hitting work perhaps, only to pay 750 (or is it more?) to publish a crappy opinion piece on what is a bald faced attempt to dump on “local” docs?
 
MegaVoltagePhoton said:
Imagine though that this garbage paper is probably written by some highly qualified resident who matched in “peak rad onc” to UPenn, expecting some academic high hitting work perhaps, only to pay 750 (or is it more?) to publish a crappy opinion piece on what is a bald faced attempt to dump on “local” docs?
Click to expand...
This is so obnoxious given what it takes to match in radonc over past 15 years in this field Can you imagine surgeons being credentialed to put in a port etc.
 
I am so over academic Radiation Oncology. It is just a cesspool of ego and people clapping themselves on the back for doing NOTHING. Publishing garbage papers to pad their CV so other academics can speak platitudes about their accomplishments in a vacuum of circle jerk. It's disgusting, gratuitous careerism. It's about the specific academician, not the patients.

Oh yeah guys remember those pesky patients? Yeah the people we're supposed to be in charge of helping? Let's try to focus up a little bit instead of finding your next novel angle for your high impact SEER study.

The things I've seen academic attendings do - I wouldn't want my family member treated like that. But they get away with it because of the clout of the institution they work for. Your institution's reputation is NOT YOUR REPUTATION. Just because you share a letterhead does not mean you earned that reputation. You can't just craft your practice around empty ladder climbing.

Oh wait yes you can. By all means continue to shame the community docs. The only upside to the the oversupply and poor academic job market secondary to COVID is the mass exodus of top class resident into the community. When 100 MD-PhDs show up in rural private practice next year, perhaps there will be slightly less mud slinging.

Or not. Enjoy the height of that horse guys.
 
RadOnc0520 said:
Lol that is quite insulting. They think PP docs are so incompetent that they need guidance for palliative cases? Why not just give a phone call to your local docs? Give me a break.
Click to expand...

It’s nonsense. Especially from these large tertiary centers like penn that use community practices as a cash cow.

They are all about financial tox and travel times until ofcourse protons maybe an option then all bets are off.
 
evilbooyaa said:
This *****ic article from these Penn idiots are the latest example that *******es continue to exist in visible numbers in academics.

Academics gonna academic. Literally like 6-8 paragraphs with zero content, no actual information. Just an uninformed musing.
Click to expand...

This is exactly why I use SDN. I can muse here...AND I DON'T FEEL THE NEED TO PUT MY MUSINGS ON MY CV.
 
RickyScott said:
This is so obnoxious given what it takes to match in radonc over past 15 years in this field Can you imagine surgeons being credentialed to put in a port etc.
Click to expand...
Oh man you hit it. Totally different mindset in rad onc. Elitism is not just a word it’s a lifestyle.

“We only refer to surgeons who can put in ports quickly and properly using the minimum reimbursed procedure codes possible. We make sure all board certified surgeons get further credentialed by the American Society of Port Placers.”
 
RickyScott said:
UPenn charges imrt rates for protons and openly boasts that they do well financially from this arrangement. Imagine how high the negotiated imrt reimbursements must be to support a 200 million dollar proton center. They are likely to be a prime offender in terms of financial toxicity.
Click to expand...

but they are on a REGISTRY. It’s research.
...right?
 
RickyScott said:
UPenn charges imrt rates for protons and openly boasts that they do well financially from this arrangement. Imagine how high the negotiated imrt reimbursements must be to support a 200 million dollar proton center. They are likely to be a prime offender in terms of financial toxicity.
Click to expand...

Their 3D prices are what most places get for IMRT. It’s an empty statement.
 


KO strikes again, as he misses the obvious: Instead of this ridiculous proposal, you could just Google the closest radiation center to the patient, check whichever credentials you think are important, and refer as you like. You know, like basic common sense should tell you to do. It should be downright embarrassing that the authors think this is something that needs "scholarship".

Also, I have yet to hear an adequate explanation as to why the 2x retreatment rate with 8 Gy x 1 vs 30 in 10 in the RTOG trial doesn't matter. Seems to me that's the most important endpoint to consider.
 
OTN said:

Also, I have yet to hear an adequate explanation as to why the 2x retreatment rate with 8 Gy x 1 vs 30 in 10 in the RTOG trial doesn't matter. Seems to me that's the most important endpoint to consider.
Click to expand...

8 Gy x1 vs 8 Gy x 2 vs 400 x5 or 300 x 10- that is the art of palliation and where a fellowship comes in. We may need to deploy complex statistical or math models like an Recursive Partitioning Analysis to decide what fractionation is best for each patient and may have to lean on these docs from upenn for guidance. Or maybe they could just tell you what they want when they pick up the phone and call you.
 
The good news is, we now have another modality, PRT. There's potential here to develop SPRT, IGPRT, even IMPRT. I can already see the IMPRinT trial coming out where patient's are referred to and treated by a community center so quickly they don't even talk to another human being outside the billing office.
 
To be fair...I'm sure not every community rad onc practice would be certified for "PRT" under whatever metric they have. There's at least one practice in my metro area that routinely gives 15-23 fractions for bone mets. I think everyone would be happy to steer patients away from these practices. I don't necessarily think creating a network for palliative radiation is the answer, though. APM should be sufficient at weeding these fractionation schemes out.
 
sigh. I hear everyone's frustration with this paper and can't help but agree that some academicians are milking this covid crisis every which way to get papers cranked out for their own benefit. I am not in PP but have 100% confidence in all of you who are. The only things that I favor should probably be treated at an academic center are peds/sarcomas. Peds because of access to protons/cog trials and sarcomas not so much because academic radoncs do anything special technique-wise, but because the pathology review and multi-D management at a designated sarcoma center is critical (and which has been shown to improve outcomes).

The fact that palliative radonc, which is the bread and butter of our specialty that most PGY-3's by now should be able to do on his/her own is being spun as something that requires a network to give a "stamp" of approval is embarrassing. Everyone involved, including the authors and editors of the journal, should feel ashamed for publishing such a piece. The worst part is the implication that COVID is responsible for this "ah-ha" realization that palliative RT can/should be delivered locally..
 
Did anyone notice how penn low key matched 5 spots last year instead of 4? Continue the great work penn! Maybe you can offer your residents a palliative fellowship when they cant find jobs. They certainly need an entire yr to learn how/who to refer palliative cases to.
 
Am I naive to think the number of 20 fraction bone met factories in 2020 is incredibly low?

We don’t need another check box, line item budget certification money waste to “solve” an incredibly small (?barely existent?) problem. It’s paternalistic and a waste of time and resources.

If you’re so worried about it pick up the phone and call the rural rad onc, tell the patient too your recommended number of fractions. It's pretty rare that a patiebt comes to me from *insert major academic cebter* with clear recs and I’m like “nah, here at my place we do it this way...”
 
BobbyHeenan said:
Am I naive to think the number of 20 fraction bone met factories in 2020 is incredibly low?

We don’t need another check box, line item budget certification money waste to “solve” an incredibly small (?barely existent?) problem. It’s paternalistic and a waste of time and resources.

If you’re so worried about it pick up the phone and call the rural rad onc, tell the patient too your recommended number of fractions. It's pretty rare that a patiebt comes to me from *insert major academic cebter* with clear recs and I’m like “nah, here at my place we do it this way...”
Click to expand...
I am sure it happens very rarely, and when it does, sets off confirmation bias that it is rampant. Worst palliative case I have ever seen was by a vice chair at nccn center.
 
I have zero concern with patients referring palliative RT cases to the community -why would I want to make a patient with metastatic cancer spend so much time traveling? With definitive or quasi-definitive cases, I have to concerns that occasionally cause me pause:
1) technology/physics support. Not all PP clinics by me have a 4D CT, not all use daily CBCT for thoracic/abdominal cases. Truth is, I know a few that are top notch, I know a few that have horror stories, and the rest are an unknown
2) I will often offer an aggressive/complex treatment with hypofractionated dose painting/SIB (usually in the context of a patient with a big tumor who can’t get chemo... or has oligoprogression). I can’t be certain that any other doctor (PP or academic) would offer the patient what I offered, because it is commonly “outside the box”. For some reason, these patients make up a decent chunk of my census and may actually be becoming my niche

I have no doubt (especially from conversations here) that there are some excellent physicians in private practice, many of whom are far better clinicians than myself... but there are some legit unknowns and I don’t have time to research every clinic in 100 mile radius.


I don’t know what the solution is. Maybe I should reach out to them or they should reach out to us. I just wanted to let you know that it isn’t “elitism”, at least speaking personally... it’s more that PP is a bit of a black box... and we can’t always be sure that another competent physician in a different practice would approach things the same way. If the patient wants a second opinion, that’s just fine... but often they want to feel like their whole team is in agreement.
 
As much as the paper is a pile of trash, we should leave the residents out of it. I don't feel they are completely absolved - but everyone knows there is a different power dynamic, especially for senior residents going into one of the worst job markets rad onc has experienced.
 
RickyScott said:
I am sure it happens very rarely, and when it does, sets off confirmation bias that it is rampant. Worst palliative case I have ever seen was by a vice chair at nccn center.
Click to expand...

Agree. We all have cases /anecdotes that shape us and decision making but should not set policy.

I have zoom/meetings/accreditation/certification burnout so I’m sensitive to the notion that we’d need another one just to do something a PGY3 could do.

you will never stamp out every last bad physician with good intentions programs.
 
Radonky said:
As much as the paper is a pile of trash, we should leave the residents out of it. I don't feel they are completely absolved - but everyone knows there is a different power dynamic, especially for senior residents going into one of the worst job markets rad onc has experienced.
Click to expand...

they wrote it. They should be shamed for it.
 
StIGMA said:
they wrote it. They should be shamed for it.
Click to expand...

considering this forum routinely claims it is pro-resident, this is a remarkably mean-spirited statement. Most rad onc residents have never been in any environment OTHER than academic medical centers. why would you blame the residents for this opinion piece when there’s no reason they’d have acquired the experience and perspective of a community physician? If/when they enter community practice I’m sure they’ll see things the way you do
 
Krukenberg said:
considering this forum routinely claims it is pro-resident, this is a remarkably mean-spirited statement. Most rad onc residents have never been in any environment OTHER than academic medical centers. why would you blame the residents for this opinion piece when there’s no reason they’d have acquired the experience and perspective of a community physician? If/when they enter community practice I’m sure they’ll see things the way you do
Click to expand...
Im a resident (I believe you still are too?). I feel like residents shouldn’t be coddled- rather treated fairly for what they do. Like all professionals.

If they don’t have the experience to write it, if they don’t want to defend their views or experience on the subject, if they don’t want to open themselves to ridicule, they shouldn’t put their names on it. Do you think someone reading the paper 10 years from now will know/ care that they wrote it as a pgy5? If they didn’t think they were writing something controversial, that’s on them. I know residents right now refusing to put their name on papers about controversial RT topics.

If they were medical students I would agree with you and not have written that.
 
Last edited:
Lamount said:
With definitive or quasi-definitive cases... I will often offer an aggressive/complex treatment with hypofractionated dose painting/SIB (usually in the context of a patient with a big tumor who can’t get chemo... or has oligoprogression). I can’t be certain that any other doctor (PP or academic) would offer the patient what I offered, because it is commonly “outside the box”.
Click to expand...
And if one does any of this fanciness and tries to get in the PRT network, no network for you. Because in the PRT network they only countenance the low-complexity treatments (namely 2D/3D). "Outside the box" (for mets... or maybe oligoprogression) means "you suck" in the community center... to some extent, just looking at the premise outlined in the paper.
 
aspiring rapper said:
The program will need extra manpower to see patients at their 2 new community proton centers.

Click to expand...

It may be ok for the normy rad oncs to treat a bone met.


But please, it’s definitely worth it to get on a plane to get your prostate zapped with our protons. No way they can do that.

www.pennmedicine.org

Cycling Through Prostate Cancer Treatment: Bill's Story - ACC

Always active, Bill wasn't ready to let treatment for prostate cancer slow down his life, or his participation in his favorite activity, cycling.
www.pennmedicine.org
 
Krukenberg said:
considering this forum routinely claims it is pro-resident, this is a remarkably mean-spirited statement. Most rad onc residents have never been in any environment OTHER than academic medical centers. why would you blame the residents for this opinion piece when there’s no reason they’d have acquired the experience and perspective of a community physician? If/when they enter community practice I’m sure they’ll see things the way you do
Click to expand...
So you're basically excusing those residents' collective ignorance on a topic rather than wondering why they didn't get it right in the first place? Ok?

That journalistic mistake will follow them for the rest of their lives. Should be an interesting interview topic if/when they decide to interview outside of academics
 
medgator said:
So you're basically excusing those residents' collective ignorance on a topic rather than wondering why they didn't get it right in the first place? Ok?

That journalistic mistake will follow them for the rest of their lives. Should be an interesting interview topic if/when they decide to interview outside of academics
Click to expand...

I’m sure this piece in ARO will be discovered and topmost on the minds of good PPs interviewing them 😏
 
You must log in or register to reply here.

Similar threads

uchihastan
Rad Onc vs. Heme/Onc
Replies
18
Views
2K
medgator
M
B
Rad Onc Procedures and RVUs
Replies
35
Views
5K
CurbYourExpectations
CurbYourExpectations
D
Saving Rad Onc
2
Replies
60
Views
7K
RickyScott
R
TheWallnerus
Rad Onc is in a dark place
Replies
13
Views
3K
RickyScott
R
M
Rad Onc Oral Boards: To quote or not quote studies?
Replies
4
Views
539
alwaysbeIMRTing
A
Top