Rad Onc Twitter

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elementaryschooleconomics said:
View attachment 321242

Wally Curran steps down as director at Emory Winship – The Cancer Letter

In the spirit of Paul Wallner (this is the company that bought 21C).

These academics just keep showing their true colors. Spend the bulk of their career espousing the mission of truth and knowledge of academia, casting subtle aspersion on private practice/industry...but as soon as their payday arrives, they eagerly jump ship.

Thanks, Boomers. I'm glad you got yours while you killed this specialty.
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As it burns and bread lines begin, these so called “leaders” will slip in out the back door with a truck of money. Nothing to see here.

The currans, hararis, wallners, randalls, hallahans, steinbergs are gonna get paid. Old white men gotta go!
 
thecarbonionangle said:
As it burns and bread lines begin, these so called “leaders” will slip in out the back door with a truck of money. Nothing to see here.

The currans, hararis, wallners, randalls, hallahans, steinbergs are gonna get paid. Old white men gotta go!
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Couple years ago at rtog someone said something to Wally about the oversupply in residents and he said (maybe half jokingly) why should I care, I am not going to be around...
 
The hypocrisy in this move is amazing. Curran is the same guy who continually insisted that site specialized rad oncs should be providing care and that essentially community rad oncs are inferior because they are not site specialized. Then he joins 21C?? Wow.

elementaryschooleconomics said:
View attachment 321242

Wally Curran steps down as director at Emory Winship – The Cancer Letter

In the spirit of Paul Wallner (this is the company that bought 21C).

These academics just keep showing their true colors. Spend the bulk of their career espousing the mission of truth and knowledge of academia, casting subtle aspersion on private practice/industry...but as soon as their payday arrives, they eagerly jump ship.

Thanks, Boomers. I'm glad you got yours while you killed this specialty.
Click to expand...
 
RadDoc11 said:
The hypocrisy in this move is amazing. Curran is the same guy who continually insisted that site specialized rad oncs should be providing care and that essentially community rad oncs are inferior because they are not site specialized. Then he joins 21C?? Wow.
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What I've learned from folks in this field is that with few exceptions only take whatever nuggets of wisdom they have regarding the clinical practice of the field in the office setting and ignore any other commentary. Especially those regarding clinic workflow and quality of services rendered. That comment was probably spurred on by him being hurt that a community rad onc "stole" some of his patients that week or something.

People are fickle, people are also motivated by self-interest.
 
www.pewresearch.org

Differences in How Democrats and Republicans Behave on Twitter

Entering the peak of the the 2020 election season, social media platforms are firmly entrenched as a venue for Americans to process campaign news and engage in various types of social activism. But not all Americans use these platforms in similar ways.
www.pewresearch.org www.pewresearch.org

I await the LBA from ASTRO 2021 breaking down RO Twitter according to views on the Job Market
 
medgator said:
Speaking of

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When we're looking at employment data right now, we're only looking at the outcome. The real study we need to do in these expansion years is how much work went into obtaining that outcome. Dan Golden said in 2013 it was 40 applications for 2 job offers, Ashwin Shinde said he contacted over 100 places in his 2019-2020 job search with a 10% return on interviews.

Both of those folks are a "yes" in the binary employment metric, but is that metric the full story? I would argue it is not. Many of us, myself included, needed to reach out to dozens and dozens of people and places for just a chance at a job. However, this study is practically impossible (at least if you want accurate retrospective data).

The unemployment metric isn't here...yet. All available data says we're heading in that direction. But looking at where the field came from over the last 20 years, and its current trajectory, and concluding "this is fine", is foolish at best and intentionally disingenuous at worst.

It's the equivalent of a primary care doctor looking at an obese 30 year old male who smokes 2 packs per day and not recommending behavioral interventions because "he hasn't had a heart attack! Where's the heart attack data?!?!"
 
elementaryschooleconomics said:
When we're looking at employment data right now, we're only looking at the outcome. The real study we need to do in these expansion years is how much work went into obtaining that outcome. Dan Golden said in 2013 it was 40 applications for 2 job offers, Ashwin Shinde said he contacted over 100 places in his 2019-2020 job search with a 10% return on interviews.

Both of those folks are a "yes" in the binary employment metric, but is that metric the full story? I would argue it is not. Many of us, myself included, needed to reach out to dozens and dozens of people and places for just a chance at a job. However, this study is practically impossible (at least if you want accurate retrospective data).

The unemployment metric isn't here...yet. All available data says we're heading in that direction. But looking at where the field came from over the last 20 years, and its current trajectory, and concluding "this is fine", is foolish at best and intentionally disingenuous at worst.

It's the equivalent of a primary care doctor looking at an obese 30 year old male who smokes 2 packs per day and not recommending behavioral interventions because "he hasn't had a heart attack! Where's the heart attack data?!?!"
Click to expand...
The thing is, we've been there before and you know what they say about people that forget history.
 
Exactly what number is an acceptable unemployment number for a handful of people that did 4 years med school, 5 residency (in one of the most competitive fields out there at time of match)?

If you expand residency programs the imperative is on you to show that needed to be done (not so fast, Chairmen...your own department growing doesn’t mean the US needs more rad oncs). It’s perverse to expand then say your endpoint of literally unemployed highly trained people isn’t high enough to b*tch about.
 
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Simul and Shah vs junior gaslighter throwdown. Dreams do come true

1603670683795.png
 
BobbyHeenan said:
Simul telling her the truth.

Precautionary principle and absence of evidence does not mean evidence of absence.

These people need to read Taleb.
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Precisely.

We're all looking at the same, somewhat limited, somewhat conflicting data. The one point that is constant is that we are producing an excess of Radiation Oncologists every year.

So really the question people need to ask themselves is, using the most conservative metric from ASTRO 2020: do you think producing an excess of 70 Radiation Oncologists every year is appropriate? If so, why? If not, why wait until unemployment spikes before demanding action?

I personally believe it's already too late to turn this ship around, but if we wait until unemployment numbers measurably increase - not only is the ship far off course, but you're yelling about the iceberg you just saw while clutching a floating piece of broken door as you freeze to death.
 
BobbyHeenan said:
Exactly what number is an acceptable unemployment number for a handful of people that did 4 years med school, 5 residency (in one of the most competitive fields out there at time of match)?

If you expand residency programs the imperative is on you to show that needed to be done (not so fast, Chairmen...your own department growing doesn’t mean the US needs more rad oncs). It’s perverse to expand then say your endpoint of literally unemployed highly trained people
Click to expand...
BobbyHeenan said:
Simul telling her the truth.

Precautionary principle and absence of evidence does not mean evidence of absence.

These people need to read Taleb.
Click to expand...
Where is the data that wearing masks decreases COVID?
 
Zahramar said:
And the throwdown continues ! An enlightened junior faculty member joins the fray ! The highlight of ASTRO2020. Rad Onc truly rocks
View attachment 321354
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I find it odd that Dr Professor Goodman was the co-author on one paper that indicated job market was number one concern. Does she think her peers are out of touch?
 
Its clear that from Goodman's papers/work that she agrees that there are too many rad onc resident spots and that the job market is a concern. She's advocating for a more balanced discussion and saying we should collect data showing the market is bad (I agree with all of you, hard to do this, other than anecdotes and some data i.e. ARRO survey data) but everyone knows its true.

Let's not flame Goodman for seeking to quantify with data what we all already know to be true
 
imhopeful432 said:
Its clear that from Goodman's papers/work that she agrees that there are too many rad onc resident spots and that the job market is a concern. She's advocating for a more balanced discussion and saying we should collect data showing the market is bad (I agree with all of you, hard to do this, other than anecdotes and some data i.e. ARRO survey data) but everyone knows its true.

Let's not flame Goodman for seeking to quantify with data what we all already know to be true
Click to expand...

It's important to understand that when Dr. Goodman says she wants data showing the market is bad, she is explicitly asking that doctors who have dedicated their entire professional lives to learning a craft are not able to get a job practicing said craft. She is asking for pain, suffering, and misery to be present, documented, researched, and published upon before action must be taken. This is immoral.
 
imhopeful432 said:
Its clear that from Goodman's papers/work that she agrees that there are too many rad onc resident spots and that the job market is a concern. She's advocating for a more balanced discussion and saying we should collect data showing the market is bad (I agree with all of you, hard to do this, other than anecdotes and some data i.e. ARRO survey data) but everyone knows its true.

Let's not flame Goodman for seeking to quantify with data what we all already know to be true
Click to expand...
Goes back to the idea that we need a trial proving parachutes work. What exactly does this data look like before we should intervene?
 
imhopeful432 said:
Its clear that from Goodman's papers/work that she agrees that there are too many rad onc resident spots and that the job market is a concern. She's advocating for a more balanced discussion and saying we should collect data showing the market is bad (I agree with all of you, hard to do this, other than anecdotes and some data i.e. ARRO survey data) but everyone knows its true.

Let's not flame Goodman for seeking to quantify with data what we all already know to be true
Click to expand...

I don’t see a need to quantify data before taking action.
And what’s the data, showing jobs are generally less desirable; pay less, less lateral/upward mobility, etc? The only thing that would be a hard stop to contract is unemployment, and there’s little to no chance to show that. People are able to get jobs no matter how undesirable it is... and once things are that bad it’s already too late.

point being that any data we would get isn’t going to be used in any real way. We already know what’s happening. And the only real trigger (pure unemployment) is not happening (at least I’ve not heard of this) so the data won’t contribute to making meaningful change (contraction).

this is a red herring argument and she knows it. “Let’s not scare everyone that’s there’s no job market” is NOT the issue! It’s the quality of the market!
1603678583564.png


it’s also hard for me to contemplate pushing this agenda when Dr Goodman had her contract rescinded/rewritten and then put back in place with significantly delayed start date
 

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OTN said:
It's important to understand that when Dr. Goodman says she wants data showing the market is bad, she is explicitly asking that doctors who have dedicated their entire professional lives to learning a craft are not able to get a job practicing said craft. She is asking for pain, suffering, and misery to be present, documented, researched, and published upon before action must be taken. This is immoral.
Click to expand...

I don't think that's true. Some alarmists say that all graduating rad onc residents will be unemployed - clearly the data don't show that is true.

But we could show job satisfaction data (would rad oncs 5 years out from residency pick the same specialty), income data (is it going down?), geographic preferences (ARRO data show some of this), etc.

I do think the concerns about unemployment ARE going to happen in 5, 6, or 10 years for graduating residents if we stay at 200/year, and you cannot show that with current data unfortunately
 
StIGMA said:
I don’t see a need to quantify data before taking action.
And what’s the data, showing jobs are generally less desirable; pay less, less lateral/upward mobility, etc? The only thing that would be a hard stop to contract is unemployment, and there’s little to no chance to show that. People are able to get jobs no matter how undesirable it is... and once things are that bad it’s already too late.

point being that any data we would get isn’t going to be used in any real way. We already know what’s happening. And the only real trigger (pure unemployment) is not happening (at least I’ve not heard of this) so the data won’t contribute to making meaningful change (contraction).

this is a red herring argument and chelain knows it
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Fair - but I would argue they (Goodman, etc) are trying to push for stricter ACGME requirements, residency program shrinkage, no SOAPing, flaming programs that expand/SOAP - although yes, unfortunately, unsuccessfully, so far. But I do think they are part of the solution...despite the lack of data as she says
 
OTN said:
It's important to understand that when Dr. Goodman says she wants data showing the market is bad, she is explicitly asking that doctors who have dedicated their entire professional lives to learning a craft are not able to get a job practicing said craft. She is asking for pain, suffering, and misery to be present, documented, researched, and published upon before action must be taken. This is immoral.
Click to expand...

Hi everyone - this is Chelain.

I hope you all know that I've spent a lot of time over the past 2-3 years advocating for residents, encouraging the ACGME to impose greater minimum requirements for accreditation of residency programs, conversing with leaders in the field regarding what has been happening regarding residency expansion, discussing with the ABR regarding issues to do with the qualifying examinations and the need for virtual examinations - and also amplifying the voices of those discussing the job market. We spent a lot of time collecting data for the ARRO graduating resident survey this year. We also submitted a proposal to ASTRO for a prospective workforce database/registry for graduating residents, which was well received.

I am in agreement with much of what Chirag and others have said. But, it's hard to watch people who spend a lot of time and energy working on these issues get ganged up on in a public forum. I find it stressful to see anonymous people say there are no jobs when I know that if I had been reading these comments as a 3rd or 4th year medical student they would have profoundly influenced my decision to go into radiation oncology.

I'm not saying we need "proof" the job market sucks - if such data exists it would obviously be catastrophic. But, the number of posts on twitter saying how horrible things are in response to perhaps some favorable data is also irresponsible and unfair. I'm not a gaslighter. I haven't drunk the Kool-Aid. I'm not asking for people to demonstrate "pain and misery" prior to advocating for change - I've been advocating for change for a while now. The only thing I've tried to do is present and discuss the data - that's the only thing I asked for.

Chelain
 
radoncqs said:
Hi everyone - this is Chelain.

I hope you all know that I've spent a lot of time over the past 2-3 years advocating for residents, encouraging the ACGME to impose greater minimum requirements for accreditation of residency programs, conversing with leaders in the field regarding what has been happening regarding residency expansion, discussing with the ABR regarding issues to do with the qualifying examinations and the need for virtual examinations - and also amplifying the voices of those discussing the job market. We spent a lot of time collecting data for the ARRO graduating resident survey this year. We also submitted a proposal to ASTRO for a prospective workforce database/registry for graduating residents, which was well received.

I am in agreement with much of what Chirag and others have said. But, it's hard to watch people who spend a lot of time and energy working on these issues get ganged up on in a public forum. I find it stressful to see anonymous people say there are no jobs when I know that if I had been reading these comments as a 3rd or 4th year medical student they would have profoundly influenced my decision to go into radiation oncology.

I'm not saying we need "proof" the job market sucks - if such data exists it would obviously be catastrophic. But, the number of posts on twitter saying how horrible things are in response to perhaps some favorable data is also irresponsible and unfair. I'm not a gaslighter. I haven't drunk the Kool-Aid. I'm not asking for people to demonstrate "pain and misery" prior to advocating for change - I've been advocating for change for a while now. The only thing I've tried to do is present and discuss the data - that's the only thing I asked for.

Chelain
Click to expand...

Thanks for coming on here! These conversations should be long-form and are not suited to Twitter.

I personally post here with the intent of dissuading those medical students and hope they look elsewhere. Of course there are jobs, there will always be jobs. That is not the argument. The argument is that there is an extreme level of uncertainty in jobs for people who have done at least 4 years of undergrad, 4 years of medical school, and 5 years of residency. Struggling to get "a" job after 13+ years of training is not reasonable when there are alternatives.

As someone said on Twitter - SDN has been preaching doom and gloom for years now. And for years, it was mostly ignored. So what's different? The data is different, the numbers are there (though not the unemployment data you ask for). Medical students are smart adults. They're making this decision for themselves. Dropping from 233 to 109 US MD Seniors is not due to Twitter trolls or SDN misanthropes. It's from intelligent people making intelligent decisions.

I sleep better at night imagining that I've helped even one medical student look for a different specialty.
 
imhopeful432 said:
I don't think that's true. Some alarmists say that all graduating rad onc residents will be unemployed - clearly the data don't show that is true.

But we could show job satisfaction data (would rad oncs 5 years out from residency pick the same specialty), income data (is it going down?), geographic preferences (ARRO data show some of this), etc.

I do think the concerns about unemployment ARE going to happen in 5, 6, or 10 years for graduating residents if we stay at 200/year, and you cannot show that with current data unfortunately
Click to expand...

The US is going through the same thing that Canada once did. The job situation was discussed internally at the Canadian version of ASTRO (CARO) many years ago. I don't have the PowerPoint presentation unfortunately.

Pre-COVID the US was about 10 years behind Canada I'd say. Things have now accelerated.

I personally know Canadian graduates who could not get a job (yes, even MD PhD ones who graduated from "that place" with 1 to 2 year fellowships done with rad onc giants in the field). They were unemployed for a time until they sought employment in the United States or in an oil rich Middle Eastern country.

I know others who have given up on rad Onc employment and have taken a corporate job. Others who retrained in family medicine (it's only 2 years in Canada)

And these folks applied to every single job. Even in places where it's winter 11 months of the year. Unemployment will come. Residency spots will be slashed. Fellowships will be normalized. It'll become like pathology. I've seen this movie before.
 
The data being obtained are not able to determine how much worse things are over time (compensation, partnership timelines, etc.)

Point being even though most 2020 residents are satisfied, does not mean things are still OK out there on the market. The interpretations of this data are open for debate... and it's irresponsible to use positive survey numbers to try to silence people.

So you or ABR or ASTRO or whoever can discuss the data... it's all being used for an agenda, and that agenda is wrong. I'll believe my own two eyes.

If anyone thinks these data are being obtained without an agenda in mind, I have a couple of bridges to sell you. Most of these things start at the ASTRO committee/board level (or among other senior leadership) with specific agendas and end goals in mind. Dr. Goodman has been discussing this with leaders in our field! Great... and you are doing work that is harmful even if you don't realize it. I will be shocked if leadership uses your data to lead residency contraction efforts, and I hope to be proven wrong.

I believe that your motivations are good. I do not believe that the motivations of those who support you are necessarily good. It is a tricky situation to be a junior person in this field as you are not an independent entity but tied to a job, professional organization, etc that holds you accountable. In the past few months I have seen 3 very senior people pushed out of positions for not acquiescing to superiors (tenured full professor or above level)-- what hope to we have as juniors? At least consider that a 2020 graduate survey can be utilized to reinforce the false narrative that everything is fine... and that those supporting this task know that these sorts of surveys bolster their argument to keep training more residents!

Anyone regularly reading this forum may know I don't discuss the job market. But this is too important to sit on the sidelines. Others please write, speak up!
 
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elementaryschooleconomics said:
Thanks for coming on here! These conversations should be long-form and are not suited to Twitter.

I personally post here with the intent of dissuading those medical students and hope they look elsewhere. Of course there are jobs, there will always be jobs. That is not the argument. The argument is that there is an extreme level of uncertainty in jobs for people who have done at least 4 years of undergrad, 4 years of medical school, and 5 years of residency. Struggling to get "a" job after 13+ years of training is not reasonable when there are alternatives.

As someone said on Twitter - SDN has been preaching doom and gloom for years now. And for years, it was mostly ignored. So what's different? The data is different, the numbers are there (though not the unemployment data you ask for). Medical students are smart adults. They're making this decision for themselves. Dropping from 233 to 109 US MD Seniors is not due to Twitter trolls or SDN misanthropes. It's from intelligent people making intelligent decisions.

I sleep better at night imagining that I've helped even one medical student look for a different specialty.
Click to expand...

I swear to you that there will be unemployment. Abandon this notion that US rad onc is somehow different than Canadian rad onc. It isn't

There is nothing more depressing than listening to someone who graduated from the biggest rad onc program in Canada and they couldn't even find a job in the most barren part of Canada with a Linac. It has happened. Would have been more frequent had they not slashed positions throughout the country.
 
Zahramar said:
I swear to you that there will be unemployment. Abandon this notion that US rad onc is somehow different than Canadian rad. It isn't

There is nothing more depressing than listening to someone who graduated from the biggest rad onc program in Canada and couldn't even find a job in the most barren part of Canada with a Linac. It has happened. Would have been more frequent had they not slashed positions throughout the country.
Click to expand...

Oh there will definitely be unemployment - but there will always be people retiring or moving jobs, so there will always be some level of jobs "available". I just think it's important to acknowledge this to keep people from saying "those SDN idiots say there are no jobs, but I know so-and-so who got hired at [institution]".

A crude analogy is - people win millions of dollars every month playing the lottery. People definitely win the lottery if they play. But who would recommend someone play the lottery based on that? No one!
 
until places like MDACC have their own in breadlines after golden handshake, satellites are simply not enough, then they will finally admit there is “data”. Until then you will see lots of winking going on. Trust me 😉
 
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