Rad Onc Twitter

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thecarbonionangle said:
I doubt there was any specific thing that triggered. Bottomline if you disagree with the powers you are seen as a “bad apple” and “not a team player”. That sometimes has consequences.
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There is a reason why we respect Simul because he was doing something that was brave as we knew it could detrimental to his career. It's obvious that he was told to hush, but by WWC? Seems odd. I know that they want my head on a platter, but SimulD too?

@radoncqs is definitely one of the good folks. She should get credit for bringing attention to this issue. Keep going even though it's much harder as an attending!
 
Strongly agree Chelain is one of the good ones fighting this fight, and I strongly disagree that "WWC" had anything to do with his leaving Twitter. It makes us look a little ridiculous to court the idea, to be honest.

There are plenty of powerful people who wanted his voice silenced, and to be frank, I would put the most likely culprits squarely in the "Good Old Boys" demographic...but important to realize that 'Boys' includes plenty of women leaders of radonc in the older generation as well.
 
OTN said:
Strongly agree Chelain is one of the good ones fighting this fight, and I strongly disagree that "WWC" had anything to do with his leaving Twitter. It makes us look a little ridiculous to court the idea, to be honest.

There are plenty of powerful people who wanted his voice silenced, and to be frank, I would put the most likely culprits squarely in the "Good Old Boys" demographic...but important to realize that 'Boys' includes plenty of women leaders of radonc in the older generation as well.
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Sure but let's make sure Chelain understands how many of us feel:

radoncqs said:
.



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.





Chelain
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I don't think that's representative of how the majority of us on SDN feel and it isn't fair to paint us with that brush.

Simul absolutely nailed it with his Twitter post discussing longer tracks to partnership, no partnership, less/no protected time etc. There are still jobs. They just s*****r as time goes on
 
medgator said:
Sure but let's make sure Chelain understands how many of us feel:



I don't think that's representative of how the majority of us on SDN feel and it isn't fair to paint us with that brush.

Simul absolutely nailed it with his Twitter post discussing longer tracks to partnership, no partnership, less/no protected time etc. There are still jobs. They just s*****r as time goes on
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Not only did he nail it, but because he wasn't anonymous, he's no longer saying it.
 
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Lots of physicians, ready to work!
 
I think I missed the whole Twitter train... so perhaps I lack contextual understanding to ask what I am about to ask. What is the big deal?

It used to be that twitter was a platform for people to provide their friends with unrequested mundane status updates about what they had for dinner. All-of-a-sudden, it is so germane to existence that blocking a Tweet results in a congressional investigation.

I don't know Simul personally, but I am sure he is doing just fine.
 
Lamount said:
I think I missed the whole Twitter train... so perhaps I lack contextual understanding to ask what I am about to ask. What is the big deal?

It used to be that twitter was a platform for people to provide their friends with unrequested mundane status updates about what they had for dinner. All-of-a-sudden, it is so germane to existence that blocking a Tweet results in a congressional investigation.

I don't know Simul personally, but I am sure he is doing just fine.
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No doubt. The issue is the idea that we're wrong in here for the anonymity, and that allows us to be dismissed more easily. Then, when someone is non anonymous and reasonable, they're presumably influenced to not only stop, but erase all evidence...
 
Ray D. Ayshun said:
Are they emailing residents now?
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I basically put my name and CV into any and every recruiter database I could find. I get a lot of shotgun emails and phone calls now. Here's how it usually goes:

"Hi Dr Elementary, I'm Tom from Recruitment-R-Us. I see you're looking for Radiation Oncology jobs. Is there a particular region you're interested in? I have just a few openings, one in West Virginia, one in Mississippi, would those interest you?"

I then tell them what I would be interested in.

"Great! Let me make some calls and I'll get back to you!"

Narrator: Dr Elementary never hears back from them.
 
elementaryschooleconomics said:
I basically put my name and CV into any and every recruiter database I could find. I get a lot of shotgun emails and phone calls now. Here's how it usually goes:

"Hi Dr Elementary, I'm Tom from Recruitment-R-Us. I see you're looking for Radiation Oncology jobs. Is there a particular region you're interested in? I have just a few openings, one in West Virginia, one in Mississippi, would those interest you?"

I then tell them what I would be interested in.

"Great! Let me make some calls and I'll get back to you!"

Narrator: Dr Elementary never hears back from them.
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There's like 6 metro areas >250000 in those two states.
 
elementaryschooleconomics said:
I basically put my name and CV into any and every recruiter database I could find. I get a lot of shotgun emails and phone calls now. Here's how it usually goes:

"Hi Dr Elementary, I'm Tom from Recruitment-R-Us. I see you're looking for Radiation Oncology jobs. Is there a particular region you're interested in? I have just a few openings, one in West Virginia, one in Mississippi, would those interest you?"

I then tell them what I would be interested in.

"Great! Let me make some calls and I'll get back to you!"

Narrator: Dr Elementary never hears back from them.
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better open up your mind to those places.
 
WV has beautiful mountains and people. Great architecture in Mississippi and good people. I hear they might get rid of the confederate flag within the state flag? Very up and coming area. Oxford is known to be very nice. You’re also driving distance to awesome beaches in Alabama and Emerald coast in Florida. Both are “sportsman paradises”. What else would you possibly need outside of huntin’ and fishin’?!
 
thecarbonionangle said:
WV has beautiful mountains and people. Great architecture in Mississippi and good people. I hear they might get rid of the confederate flag within the state flag? Very up and coming area. Oxford is known to be very nice. You’re also driving distance to awesome beaches in Alabama and Emerald coast in Florida. Both are “sportsman paradises”. What else would you possibly need outside of huntin’ and fishin’?!
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New season coming in 2021: Watch as Coach Wallner works to convince a handful of California RadOnc residents that taking a job at a rural freestanding center 2,000 miles from their family is Choosing Wisely!
 
elementaryschooleconomics said:
View attachment 321858

New season coming in 2021: Watch as Coach Wallner works to convince a handful of California RadOnc residents that taking a job at a rural freestanding center 2,000 miles from their family is Choosing Wisely!
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I think that center is still technically in the same metro area as their family, so good to hear they got the geography they wanted.
 
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You guys are super funny. I have a lot more knowledge about rad onc now based on you guys. We had 1 lecture on it (during peds didactics for some reason idk why) and i remember everyone fell asleep and which sealed rad onc's fate in our hearts at least haha.
 
One fraction lung SBRT.
This kind of single fraction SBRT is probably good for the pts and insurance companies, but it will kill this dying field.
Hundreds or thousands of radoncs, RNs, dosimetrists, therapists, physicists may have to drive Uber to make ends meet...

PS: We will be become the one-shot surgeon...

 
Radonc90 said:
One fraction lung SBRT.
This kind of single fraction SBRT is probably good for the pts and insurance companies, but it will kill this dying field.
Hundreds or thousands of radoncs, RNs, dosimetrists, therapists, physicists may have to drive Uber to make ends meet...

PS: We will be become the one-shot surgeon...

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Agree. However, look on the bright side... one fraction of radiation is still better than no fractions like we’re trying to help med onc achieve In all other disease sites.
 
Radonc90 said:
One fraction lung SBRT.
This kind of single fraction SBRT is probably good for the pts and insurance companies, but it will kill this dying field.
Hundreds or thousands of radoncs, RNs, dosimetrists, therapists, physicists may have to drive Uber to make ends meet...

PS: We will be become the one-shot surgeon...

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It’s hard to get past the fact that the image clearly shows a locally advanced lung cancer.

From a pragmatic perspective, it’s hard to imagine that this is going to be forced on anyone. Additionally, the “safe zone” for this treatment is more restricted than treatments with more fractions. I don’t know about others, but those who would qualify for this treatment make up a small fraction of my ablative population.
 
Lamount said:
It’s hard to get past the fact that the image clearly shows a locally advanced lung cancer.

From a pragmatic perspective, it’s hard to imagine that this is going to be forced on anyone. Additionally, the “safe zone” for this treatment is more restricted than treatments with more fractions. I don’t know about others, but those who would qualify for this treatment make up a small fraction of my ablative population.
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Technically, you are right, but it reveals the bizzare mindset/psychology of those hellbent on reducing the footprint of xrt in oncology (while expanding residencies) . Who would even think this is worthy of putting forth the research effort- going from 4 fractions to one fraction? What if medoncs started asking questions like- can we give cisplatin every 25 days instead of 21 during head and neck cancer treatment?
Edit: pi is Gregory Videtic who is smart and a good guy but wtf?
 
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Cleveland Clinic people are on salary, so they can play with different # fractions w/o repercussion on their pocket.
At least they get a pub and share on Twitter lol...
 
RickyScott said:
Technically, you are right, but it reveals the bizzare mindset/psychology of those hellbent on reducing the footprint of xrt in oncology (while expanding residencies) . Who would even think this is worthy of putting forth the research effort- going from 4 fractions to one fraction? What if medoncs started asking questions like- can we give cisplatin every 25 days instead of 21 during head and neck cancer treatment?
Edit: pi is Gregory Videtic who is smart and a good guy but wtf?
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sometimes it does make a difference


 
medgator said:
Salaried folks are incentivized to reduce fractions or not treat.... They get paid the same!
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There is a reason for that. One fraction SBRT @ Cleveland Clinic pays out about $75,000 whereas I have to argue with a senile Internist from EvilCore to convince them to pay me $19,000 for five fraction SBRT.

If you paid me $75,000 per treatment course regardless of modality or fractionation I would be absolutely delighted to take a salary.
 
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Gfunk6 said:
There is a reason for that. One fraction SBRT @ Cleveland Clinic pays out about $75,000 whereas I have to argue with a senile Internist from EvilCore to convince them to pay me $19,000 for five fraction SBRT.

If you paid me $75,000 per treatment course regardless of modality or fractionation I would be absolutely delighted to take a salary.
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True but then thoracic surgeons will either start doing it on their own or start hiring “thoracic trained radiation oncology fellows” for their SBRT lung mills. Then insurance companies catch on and make it cheap. Hopefully by then we learn from the mistakes of our predecessors with IMRT and urology or we make tons of cash like they did!
 
Gfunk6 said:
There is a reason for that. One fraction SBRT @ Cleveland Clinic pays out about $75,000 whereas I have to argue with a senile Internist from EvilCore to convince them to pay me $19,000 for five fraction SBRT.

If you paid me $75,000 per treatment course regardless of modality or fractionation I would be absolutely delighted to take a salary.
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Gfunk6 said:
There is a reason for that. One fraction SBRT @ Cleveland Clinic pays out about $75,000 whereas I have to argue with a senile Internist from EvilCore to convince them to pay me $19,000 for five fraction SBRT.

If you paid me $75,000 per treatment course regardless of modality or fractionation I would be absolutely delighted to take a salary.
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This issue is so important! Number of “editorials” in red journal recently about 8Gy x 1 or 5 fraction beast, prostate, rectal treatments by centers that are charging so much more than everyone else. (certainly more than conventional fractionation at community center!)
 
Sometimes I think this forum really goes off the rails. Yes places like Cleveland clinic get reimbursed much higher than freestanding centers and there ought to be some reform in that. But to imply study design has anything to do with financial gain is just disingenuous. Everyone always complains about the quality of rad onc studies, but magically thinks it’s going to get better by having less rad oncs doing research or by telling smart med students not to enter the field.
 
radiation said:
Sometimes I think this forum really goes off the rails. Yes places like Cleveland clinic get reimbursed much higher than freestanding centers and there ought to be some reform in that. But to imply study design has anything to do with financial gain is just disingenuous. Everyone always complains about the quality of rad onc studies, but magically thinks it’s going to get better by having less rad oncs doing research or by telling smart med students not to enter the field.
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This Study did not have anything to do with financial gain. Maybe Cleveland clinic does have a lot of out of town pts that they want to treat expeditiously (but at a much higher price than they would have gotten back home). Regarding medstudents/residents and less research- less the better, if so much of our research is on eliminating footprint of xrt in cancer!
I
 
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radiation said:
Sometimes I think this forum really goes off the rails. Yes places like Cleveland clinic get reimbursed much higher than freestanding centers and there ought to be some reform in that. But to imply study design has anything to do with financial gain is just disingenuous. Everyone always complains about the quality of rad onc studies, but magically thinks it’s going to get better by having less rad oncs doing research or by telling smart med students not to enter the field.
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No one said that. .. Why should salaried docs do the work for more fractions when their pay doesn't change? Plus as Ricky alludes to, this just makes it easier to steal more patients from community centers and subject them to fewer fractions but more financial toxicity at an NCI one
 
In case
medgator said:
No one said that. .. Why should salaried docs do the work for more fractions when their pay doesn't change? Plus as Ricky alludes to, this just makes it easier to steal more patients from community centers and subject them to fewer fractions but more financial toxicity at an NCI one
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Study probably born out of strong incentive to be called to machine less! I hate being called for sbrt- takes me away from sdn, slickdeals, Meditation etc.
In all seriousness, maybe at the Cleveland clinic Videtic is being called to linac 10+ times a day, sometimes while he is taking a crap.
 
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radiation said:
Sometimes I think this forum really goes off the rails. Yes places like Cleveland clinic get reimbursed much higher than freestanding centers and there ought to be some reform in that. But to imply study design has anything to do with financial gain is just disingenuous. Everyone always complains about the quality of rad onc studies, but magically thinks it’s going to get better by having less rad oncs doing research or by telling smart med students not to enter the field.
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Let's be real - what has the siren song of Radiation Oncology been for the last 20 years?

Great money.

Great lifestyle.

That's what made it competitive.

Obviously, a lot of people went into it for a lot more than that. But there's many people who look amazing on paper who feel like they "made it" and just rest on laurels thereafter. It's really no mystery as to why the quality of RadOnc studies seems inversely correlated with the quality of the CV of its practitioners. It's no mystery why expansion went unchecked while reimbursements were great. If we're honest with ourselves, nothing that has happened has been surprising.

Now RadOnc got punched in the mouth. Students can do basic math and see that there are way too many people coming out of the pipeline and the government has turned its glare on everything we do.

Yes, we need less research quantity - we need better research quality.

Yes, we need fewer "smart" med students looking for a payday - we need more "smart" med students who have something to prove.

To imply that studies do not have anything to do with financial gain is equally disingenuous.
 
medgator said:
No one said that. .. Why should salaried docs do the work for more fractions when their pay doesn't change? Plus as Ricky alludes to, this just makes it easier to steal more patients from community centers and subject them to fewer fractions but more financial toxicity at an NCI one
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The outrageous reimbursement that academic health centers and large hospital systems command is simply one facet of the problem. A lot of patients will opt to pay out of pocket and travel to these centers, get one fraction of SBRT for "convenience" and then happily return home.

A few months later the subacute/late toxicity hits - radiation pneumonitis, vertebral body fracture, esophageal/duodenal perforation, etc.

Do you think the patient will fly back to Cleveland Clinic or wherever to get it managed? No - it will be an emergency so they will roll into their local ER. The local EM physicians and Oncologists have no freaking clue what the "ivory tower" did, no records, and nary a communication. Patient has expensive, painful hospitalization that adds to their financial toxicity and the net human suffering in the country.
 
Everything people do in this world has some incentives, whether one is a politician or a doctor...

So, for the single-fraction SBRT study, what are the incentives? Is it:

- Humanity (medicine is humanity anyway), making things better for pts: same local control, fewer visits, and presumably fewer fractions = less $ cost.

- Cost: many hypofx studies come from the UK with the emphasis of cost cutting measures. In the US radoncs get paid by complexity and # fractions. Let's say if Cleveland Clinic gets paid less such as $1000 for single-fraction SBRT, would they do it?

- Science: proving fewer fractions can accomplish the same job (local control and toxicity the same as more # fractions).

- If your rank and tenure depends on pub (yes it does), then more pubs = better.

- Publicity: "Look ma, I can do it in a fraction", so patients in the area read the news and flock from PP to let's say Cleveland Clinic (which is private practice anyway).

Just follow the track of the dollars...
 
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RickyScott said:
We should also keep in mind that in breast cancer, 3 weeks trended towards improved local control and better side effects. Everything, else hypofractionation is about cost and convenience!
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Agree, breast is probably the only site I'm aware of where hypofx has been a real home run, and clearly superior to conventional fx.
 
RickyScott said:
In case

Study probably born out of strong incentive to be called to machine less! I hate being called for sbrt- takes me away from sdn, slickdeals, Meditation etc.
In all seriousness, maybe at the Cleveland clinic Videtic is being called to linac 10+ times a day, sometimes while he is taking a crap.
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Or maybe this helps ease future studies for oligomets - much easier to treat oligomets with single vs. multifraction
 
medgator said:
A matter of opinion, 1 vs 3 vs 5 isn't really that hard for most patients. Certainly much easier than 15-35
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it’s more about time on table. If you are doing a sbrt setup, even with a vmat plan, each iso takes 15-30 min for treatment depending on couch kicks etc. if you are treating 3 oligomets, 5 fractions vs 3 fractions vs 1 fractions ends up making a difference. Plus you can treat each oligomet on different days to minimize effect of overlap between lesions
 
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
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Do fellowships count as jobs in this argument?
 
StIGMA said:
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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Finally someone who knows that the word "data" is a plural of "datum".
 
Ray D. Ayshun said:
We still have lemmiwinks to get all up in there and scratch around.

Edit:. I now understand the symbolism of that name given what he or she is doing
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We better all go and start tweeting... creating an account asap. An anonymous one.
 
Lamount said:
It’s hard to get past the fact that the image clearly shows a locally advanced lung cancer.

From a pragmatic perspective, it’s hard to imagine that this is going to be forced on anyone. Additionally, the “safe zone” for this treatment is more restricted than treatments with more fractions. I don’t know about others, but those who would qualify for this treatment make up a small fraction of my ablative population.
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exactly what I thought. Locally advanced, and "i thought single-fraction to the 2-cm zone" was "no fly"?
 
radiation said:
Sometimes I think this forum really goes off the rails. Yes places like Cleveland clinic get reimbursed much higher than freestanding centers and there ought to be some reform in that. But to imply study design has anything to do with financial gain is just disingenuous. Everyone always complains about the quality of rad onc studies, but magically thinks it’s going to get better by having less rad oncs doing research or by telling smart med students not to enter the field.
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it is awesome to do that type of research and benefits everyone to have shorter, well tolerated courses of radiation.

it is predatory to trainees to embark on residency and fellowship expansion while continuously pruning the amount of work the field is needed to perform
 
why is it such a big scientific breakthrough anyway to reduce the number of fractions of treatment. Lifting it up on major platforms as plenary sessions, giving it major press, high impact factor pubs - but scientifically what’s impressive about it at all? Is it some triumph of alpha beta biology? Or is it just a triumph of insurers using physicians as their proxies as pharma does to med oncs with Reckless abandon
 
RickyScott said:
This issue is so important! Number of “editorials” in red journal recently about 8Gy x 1 or 5 fraction beast, prostate, rectal treatments by centers that are charging so much more than everyone else. (certainly more than conventional fractionation at community center!)
Click to expand...

This is why they simply dont care. You so a 5fx prostate at MSKCC or CC bill multiples of a 44fx IMRT prostate.
 
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