Rad Onc Twitter

[RadOncG]

Very few in the field more destructive than Lisa Kachnic (maybe father time Paul Wallner but he won't come on here because he writes on stone tablets)

1. She was co-author on debunked residents getting dumber hit piece
2. She stood in front of residents and defended ABR failing everyone saying small programs are bad. One year later-whoopsies small programs did no different than big programs
3. She openly mocks job market concerns and then expands her trash program at Columbia

Hopefully the program goes the way of Silvia Formenti's esteemed Cornell. If you are that tone deaf then you don't deserve residents.

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[Radonc90]

I partially agree with @David Grew above, but to say "anonymous would never work..."...hmmm...
Just think about presidential election last November, the vote was anonymous as is the case.
Only my spouse (and some election officials) knew who I voted for.
This is the way to get rid of the dictator and send him back to Mar-a-Lago, Florida...

- Displaying your real name/profile has its pros and cons.
- Anonymous username has its own pros and cons. When anonymous, people are more free to talk about stuff they don't feel comfortable talking in person. I believe in democracy and freedom of speeches, which are very important to me. Anonymous is fine with me...

 

[Baws]

What is the story with the new mentoring thing on Twitter? What does #jc mean?

 

[brushbeamscanning]

I think it means journal club

 

[elementaryschooleconomics]

What is the story with the new mentoring thing on Twitter? What does #jc mean?

I think it means journal club

Yeah, there's a "Twitter RadOnc Journal Club" that happens at least once a month I think? Maybe more. It actually gets super annoying because I pretty much only follow RadOnc/Medicine people, and when "journal club" happens it ABSOLUTELY BLOWS UP my Twitter feed and I don't get to see anything else.

 

[communitydoc13]

Anonymous is fine with me...

Anonymity has huge benefits. This forum is predicated on anonymity. To some degree, true meritocracy is only possible in the anonymous setting. Regarding the multiple threads relating to crap publications, anonymizing authors for review would have taken care of all of that.

For someone whose identity is associated with status, anonymity is a sacrifice and will lead to a skewing away from positive response. For someone who is vulnerable (which in our profession is anyone who will seek another job in the future) anonymity is freedom. (This includes the freedom to be a total ass.)

I think its great that prominent figures are engaging on this board. And for them, at least in terms of their messaging, their identity is important.

But, it's also important to realize that this engagement is due to the power of this board and the public's (medical students, regular docs) sense that wisdom is to some degree decentralized and present in the community. (Skepticism of the central planners).

There have been many times where the criticism of presentations/abstracts/papers has been more pointed and meaningful here than on any non-anonymous forum.

 

[evilbooyaa]

Not just Columbia. She expanded Vanderbilt's number of spots as well. No offense to Vanderbilt but it is not a program that should have 13 residents (and growing). And let's not even start on Columbia's rad onc program -- an embarrassingly bad program that is now taking 8 residents? God help those poor students and residents.

I was blown away by the bolded number and so double checked your numbers - Vandy has 10 currently enrolled (3 PGY-5s, 3 PGY-4s, 1 PGY-3, 3 PGY-2s), an additional 3 are currently PGY-1s and will be starting in July 2021. Weird 'breakdown' of 10 residents, but 10 residents in a program is more reasonable for their # of attendings (12 as per their faculty website) than 13 (the magical 1:1 ratio we've espoused on this site multiple times).

There have been many times where the criticism of presentations/abstracts/papers has been more pointed and meaningful here than on any non-anonymous forum.

Fully agree with this - I have had more nuanced discussions of trials/research studies on SDN than nearly any other resource. I asked a lot of questions as a medical student and an early year resident. I contributed heavily to discussions as an older resident and was taken seriously in my discussion because of the anonymity and lack of hierarchy - everyone on even ground means that one does not just 'take someone's word' for something.

I feel that clinical discussions on SDN (a small fraction of the threads now, yes, but was a higher percentage of discussions even 2-4 years ago) has made me a better radiation oncologist to get a true sense of how Rad Onc is done across multiple institutions which is otherwise near impossible to achieve in one's career. Obviously I'm biased as I was asked to be mod at some point, but my 2 cents.

 

[elementaryschooleconomics]

I feel that clinical discussions on SDN (a small fraction of the threads now, yes, but was a higher percentage of discussions even 2-4 years ago) has made me a better radiation oncologist to get a true sense of how Rad Onc is done across multiple institutions which is otherwise near impossible to achieve in one's career. Obviously I'm biased as I was asked to be mod at some point, but my 2 cents.

Agreed. As I've said elsewhere, I will casually drop things I learned on SDN into my clinical discussions in real life for my own reputational benefit. I don't have the heart to tell my attendings I'm not actually that smart.

Another huge benefit to this forum is learning about the economics of medicine in general and RadOnc in particular. Talking about APM or various other non-clinical topics from SDN on the job trail earned me a lot of excited conversations from many folks.

Thanks, random internet forum! You've been great for me.

 

[OTN]

"Taking personal accountability comes with risk but also provides enormous leverage in a way anonymous work never could."

[citation needed]

 

[thecarbonionangle]

Anonymity has huge benefits. This forum is predicated on anonymity. To some degree, true meritocracy is only possible in the anonymous setting. Regarding the multiple threads relating to crap publications, anonymizing authors for review would have taken care of all of that.

For someone whose identity is associated with status, anonymity is a sacrifice and will lead to a skewing away from positive response. For someone who is vulnerable (which in our profession is anyone who will seek another job in the future) anonymity is freedom. (This includes the freedom to be a total ass.)

I think its great that prominent figures are engaging on this board. And for them, at least in terms of their messaging, their identity is important.

But, it's also important to realize that this engagement is due to the power of this board and the public's (medical students, regular docs) sense that wisdom is to some degree decentralized and present in the community. (Skepticism of the central planners).

There have been many times where the criticism of presentations/abstracts/papers has been more pointed and meaningful here than on any non-anonymous forum.

Academics must come kiss the SDN Ganesh pinky ring.

 

[Radonc90]

BREAKING News: Steinberg and Wallner are considered "leaders" lmao...

 

[Ray D. Ayshun]

BREAKING News: Steinberg and Wallner are considered "leaders" lmao...

Wondering? It's the economy, stupid!

 

[udrag14]

BREAKING News: Steinberg and Wallner are considered "leaders" lmao...

Studies like these grind my gears. How is a 15 percent response rate acceptable?

 

[fiji128]

"The limited presence of RO in medical school curricula has previously been identified as a problem and remains a challenge for the specialty." OK, Boomers!

 

[elementaryschooleconomics]

Drew just needs to pander to his new boss.

 

[GapCalc]

For anyone not on Twitter, UCLA is paying students to rotate, up to $25k.

Medical Student Preceptorship Program

www.uclahealth.org

Please note, this opportunity is only for US applicants. Apparently UCLA doesn’t appreciate the increasingly diverse FMG applicant pool. For shame!

Desperate times, desperate measures.

 

[OTN]

S C H O L A R S H I P

 

[fiji128]

I guess UCLA is willing to try just about anything other then cutting their 12 residency spots.

 

[TheWallnerus]

For anyone not on Twitter, UCLA is paying students to rotate, up to $25k.

Medical Student Preceptorship Program

www.uclahealth.org

Please note, this opportunity is only for US applicants. Apparently UCLA doesn’t appreciate the increasingly diverse FMG applicant pool. For shame!

Desperate times, desperate measures.

Kinda bribe-y

 

[Neuronix]

"The limited presence of RO in medical school curricula has previously been identified as a problem and remains a challenge for the specialty." OK, Boomers!

This is the same nonsense they have been saying for decades--even during peak rad onc competitiveness. At 200 rad onc residents a year, you don't need very many of the 16,000+ pre-allo students to stumble into us and get the word out if it's actually a great opportunity for them.

Steinberg and company just want to ignore reality and use their circle of friends to publish these heavily biased papers with poor response rate. Hey @sueyom why is the red journal continuing to publish surveys with such poor response rates? This is not science. That's an opinion piece.

In case anyone needs me to spell it out for them, the bias is easy to find. What's a UCLA satellite rad onc job paying these days? That is if you can even get one at all if you wanted one.

 

[RickyScott]

We need educational outreach to medical students in foreign universities, Dan Golden needs to take his recruiting efforts to the Caribbean?

 

[GapCalc]

We need educational outreach to medical students in foreign universities, Dan Golden needs to take his recruiting efforts to the Caribbean?

don't give them any ideas

 

[medgator]

 

[StIGMA]

It's frustrating that the most obvious things must be stated like this in order to incite any change. Everyone in a leadership position knows this and chooses to act in defiance of these trends out of their own self-interest. Hopefully enough general field interest will develop to make continued expansion the unpopular choice.

 

[medgator]

 

[StIGMA]

"I have a great job and make sure all my best resident trainees have jobs- how bad can the job prospects really be?"

 

[Radonc90]

Couple of thoughts...

1. Med school curriculum.
It is good to have a basic course in radonc, the idea is not so much for attracting students, but the idea is to introduce some radonc concepts into future non-radonc docs (such as surgery, PCP, ENT etc.).
For example, I had a course in neurology, pediatrics in med school, and I am not a neurologist or a pediatrician.
Knowledge is knowledge... it is power.
The more PCPs know about radonc, it is good for us.

2. Attracting med students to radonc ---> Quality vs Quantity:
* Quality: of course we need to attract high-quality people (both lab scientists and clinicians) into the field.
My basic guess is 10% MD-PhD for lab + clinical and about 90% for clinical.
* Quantity: as I mentioned previously, in the 1990s: 120/yr, now almost 180-190/yr.
We don't need 180-190, we need about 80/yr but high-quality people (for both labs and clinical).

3. Someone above is correct, automation requires fewer workers.
Some of the older Boeing aircraft such as older version of 747-100 or 747-200 series had a 3-man crew (2 pilots and 1 flight engineer in the cockpit), but newer 747-400 version is down to 2-man crew (pilot and co-pilot).
You guess it right, automation and improved computer systems ---> the plane is probably more reliable, and getting rid of the flight engineer saves some pocket change too...

PS: Google "Boeing 747 flight engineer" and click in images to see...their job is to sit down on the "third seat" and look at all the gauges for hours and hours lol...

 

[RickyScott]

Couple of thoughts...

1. Med school curriculum.
It is good to have a basic course in radonc, the idea is not so much for attracting students, but the idea is to introduce some radonc concepts into future non-radonc docs (such as surgery, PCP, ENT etc.).
For example, I had a course in neurology, pediatrics in med school, and I am not a neurologist or a pediatrician.
Knowledge is knowledge... it is power.
The more PCPs know about radonc, it is good for us.

2. Attracting med students to radonc ---> Quality vs Quantity:
* Quality: of course we need to attract high-quality people (both lab scientists and clinicians) into the field.
My basic guess is 10% MD-PhD for lab + clinical and about 90% for clinical.
* Quantity: as I mentioned previously, in the 1990s: 120/yr, now almost 180-190/yr.
We don't need 180-190, we need about 80/yr but high-quality people (for both labs and clinical).

3. Someone above is correct, automation requires fewer workers.
Some of the older Boeing aircraft such as older version of 747-100 or 747-200 series had a 3-man crew (2 pilots and 1 flight engineer in the cockpit), but newer 747-400 version is down to 2-man crew (pilot and co-pilot).
You guess it right, automation and improved computer systems ---> the plane is probably more reliable, and getting rid of the flight engineer saves some pocket change too...

PS: Google "Boeing 747 flight engineer" and click in images to see...their job is to sit down on the "third seat" and look at all the gauges for hours and hours lol...

Medical school is a zero sum game-curriculum is full. What would you throw out of the curriculum to make way for radonc? There was nothing in my curriculum about nutrition or obesity. Aren’t those more worthy topics than radonc?

 

[RadOncG]

1. Med school curriculum.
It is good to have a basic course in radonc, the idea is not so much for attracting students, but the idea is to introduce some radonc concepts into future non-radonc docs (such as surgery, PCP, ENT etc.).

It's just really not as useful to other docs as you think or hope.

Quality: of course we need to attract high-quality people (both lab scientists and clinicians) into the field.

What are the lab scientists for? Who will pay them?

 

[StIGMA]

What are the lab scientists for? Who will pay them?

They are necessary for NCI/Cancer center designation (centers get dinged on Cancer Center application if not enough physician scientists)- there remains a national interest in basic discovery and improving outcomes in cancer, so they are hired by those entities.

 

[The Angle Lock]

Medical school is a zero sum game-curriculum is full. What would you throw out of the curriculum to make way for radonc? There was nothing in my curriculum about nutrition or obesity. Aren’t those more worthy topics than radonc?

Tons of useless basic science stuff?

 

[RadOncG]

They are necessary for NCI/Cancer center designation (centers get dinged on Cancer Center application if not enough physician scientists)- there remains a national interest in basic discovery and improving outcomes in cancer, so they are hired by those entities.

Right I'm just wondering what radiation oncologists do in the lab such that it so obvious to everyone that our specialty needs them around and should continue to subsidize their salaries.

Now that I'm thinking about it I am genuinely curious what a lab radiation oncologist does. They walk into work, take off their jacket, then what do they do?

 

[RickyScott]

Tons of useless basic science stuff?

But also tons of more salient clinical subjects that Trump xrt that are not part of the curriculum: geriatrics/gerontology ,nutrition,obesity, sexual health, rehab, exercise and physical etc.

 

[StIGMA]

Right I'm just wondering what radiation oncologists do in the lab such that it so obvious to everyone that our specialty needs them around and should continue to subsidize their salaries.

Now that I'm thinking about it I am genuinely curious what a lab radiation oncologist does. They walk into work, take off their jacket, then what do they do?

There's a ton of variety- mostly is that of managing a research team, securing funding, mentorship, clinical care, etc etc etc... I would pose a separate question- why should we be the only specialty that does not warrant research investment (including by the NIH)?

 

[RadOncG]

I would pose a separate question- why should we be the only specialty that does not warrant research investment (including by the NIH)?

We shouldn't be excluded but the taxpayers may want a return for their research investment.

I think it's more that I'm a little slow. I just don't know what radiation oncology innovations have come from the lab.

 

[RickyScott]

Right I'm just wondering what radiation oncologists do in the lab such that it so obvious to everyone that our specialty needs them around and should continue to subsidize their salaries.

Now that I'm thinking about it I am genuinely curious what a lab radiation oncologist does. They walk into work, take off their jacket, then what do they do?

Whatever they are doing in the lab most likely could be done via another specialty (like medonc) which would probably be much better for career and as a back up if lab does not work out.

 

[evilbooyaa]

BREAKING News: Steinberg and Wallner are considered "leaders" lmao...

The opinion of the new VA attending at UCLA (or at minimum, some place within the UCLA network, although I'll genuinely be sad if he's leaving the VA network) about his chairman and his chariman's buddy are positive.

Color. Me. Shocked.

Drew, even if he puts his foot in his mouth by virtue of being an older white male, is certainly good at playing the politics game.

 

[fiji128]

He's no longer at Emory but the West Los Angeles VA center? I was wonder why he would care about this low/no impact Advanced in Radiation Oncology paper, lol.

 

[Neuronix]

Matthew Katz's points here are the salient ones.

The vast majority of medical students thinking about rad onc are turned off by the job market.

The authors basically ignore that. Instead they focus on the unchanged reality that most med students hadn't considered us. This is reasonable. Most med students will go into IM, FP, surgery, etc. Rad onc is a tiny little niche.

So what's the goal here? If you make more med students interested in rad onc you'll have more students who will overlook the job market and take a gamble that there will be a job for them?

Why don't you... I dunno... Make an honest attempt at fixing the job market?

Also good point by Matthew Katz. Radiologists also have radbio and physics boards. Doesn't seem to stop anyone from doing radiology?

 

[thecarbonionangle]

I guess UCLA is willing to try just about anything other then cutting their 12 residency spots.

Thought experiment: imagine how much money they make off resident warm bodies that it is a worthwhile business expense to drop 25k, FMGS need not apply, MAGA agenda. It is like when JP Morgan launders money and makes BILLIONS and pays a “fine” of a few million as “cost of doing business”. Yes, our field is similar to legalized criminal enterprises. Congrats “leaders”!

Drew has a new master holding his leash. Who will be better, Steinberg or the feds? Your guess!!!!

 

[thecarbonionangle]

Matthew Katz's points here are the salient ones.

The vast majority of medical students thinking about rad onc are turned off by the job market.

The authors basically ignore that. Instead they focus on the unchanged reality that most med students hadn't considered us. This is reasonable. Most med students will go into IM, FP, surgery, etc. Rad onc is a tiny little niche.

So what's the goal here? If you make more med students interested in rad onc you'll have more students who will overlook the job market and take a gamble that there will be a job for them?

Why don't you... I dunno... Make an honest attempt at fixing the job market?

Also good point by Matthew Katz. Radiologists also have radbio and physics boards. Doesn't seem to stop anyone from doing radiology?

I thought radiology eliminated the separate exams and combined it all into one?

 

[w00tz]

Matthew Katz's points here are the salient ones.

The vast majority of medical students thinking about rad onc are turned off by the job market.

The authors basically ignore that. Instead they focus on the unchanged reality that most med students hadn't considered us. This is reasonable. Most med students will go into IM, FP, surgery, etc. Rad onc is a tiny little niche.

So what's the goal here? If you make more med students interested in rad onc you'll have more students who will overlook the job market and take a gamble that there will be a job for them?

Why don't you... I dunno... Make an honest attempt at fixing the job market?

Also good point by Matthew Katz. Radiologists also have radbio and physics boards. Doesn't seem to stop anyone from doing radiology?

Yup, physics and boards was a concern when I applied to rad onc. Also, the need to do a bunch of research was another issue. But I can suffer anything for 5ish years in exchange for an awesome job and a good lifestyle. Already suffered through undergrad and med school!
It's going to be a much tougher pill to swallow (research, boards/physics), if at the end you can't find a decent job! Rad onc would be a hard pass if I was a med student now.

EDIT: The 3 board exams and all the research is what I equate to hazing before joining the a prestigious sorority/fraternity. Except now, rad onc isn't prestigious now, so who wants to put up with that **** anymore.

 

[goodkerma]

Step 1.) Ask obvious question
Step 2.) Annoy ppl to get answers to question
Step 3.) Realize your results are garbage and lack statistical power- but hey it's an obvious question
Step 4.) Pay $$$ to advances to get it published
Step 5.) Become a "LEADER" in radonc while other people just wonder what is happening

 

[goodkerma]

Oh and don't forget the most important Step 6.) Tweet, Retweet and @yourchair

 

[drewdog1973]

Someone wants to fight, eh?

 

[OTN]

Someone wants to fight, eh?

I’d love to see a single rational solution to the mess they got us in. Intentionally.

 

[Radonc90]

Now,

This guy Moghanaki needs his wrist slapped...
What "mob"?
Maybe he refers to this SDN crowd, idk?
If he refers to the SDN crowd as "mob", then I have issues with him, we are NOT the same mob that attacked the US Capitol on Jan 6.
We are a whole bunch of educated people with real concerns that are ignored by academic.

And yes, I am in academic, but I listen to my constituents: the medstudents and the radonc residents...
And I have been around the blocks...a few times...
And I am genuinely concerned about the status of the field, which I love very much...

 

[RadOncMegatron]

Wondering? It's the economy, stupid!

I’d love to see a single rational solution to the mess they got us in. Intentionally.

WHY is it so difficult to say "RADIATION ONCOLOGY IS AN AWESOME FIELD BUT THERE AREN'T MANY JOBS OUT THERE"?

Just say it already and for goodness sake don't tempt all these otherwise great med students who probably want to be surgeons or med oncs with $. Can't we make our field attractive without bribes? Has it come to this!?!?

 

[Radonc90]

I also want to say that I absolutely agree with what @sueyom said above: "I believe residency should be a high quality experience."

The idea of cheap residency labor should be frowned upon.

 

[thecarbonionangle]

I also want to say that I absolutely agree with what sueyom said above: "I believe residency should be a high quality experience."

The idea of cheap residency labor should be frowned upon.

Not just frown upon but shamed and castigated. These places should be shut down. Everyone knows who they are.