Rad Onc Twitter

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thecarbonionangle said:
still misrepresents some things clearly though. Always implies he can’t find ANYTHING when you know there are things out there, clearly not as open...

also, there are many BAD no good programs. Some of them still fill year to year. As the ranking approaches if you are thinking about ranking a place pretty high, feel free to message any of us in the know and we can tell you what we think. I do not want anybody to end up in any of these places
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Something is up with the guy, that much we all know. Your guess is as good as mine. He struggles. There’s more to the story
 
theradiator said:
Academics used to say that their mission was to put ourselves out of business. This is clearly the opposite. NL cannot say that $$$$$ is not a factor when her job title and thus some unspecified portion of her compensation package is linked to the existence of this $300,000,000 monstrosity/white elephant.
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That dumb line about putting us out of bussiness was a gimmick with nothing but the most selfish intent.

Academic rad oncs and their handlers are the most disingenuous and dangerous people in oncology today.

If there was ever an argument to remove the exemptions these institutions and their people from site neutrality and bundling it’s this.

They are no better than the rad onc treating bone Mets in 20fx.

They can write as many papers as they like and have the most impeccable pedigree but at the end of the day they are scum
 
RadsWFA1900 said:
Academic rad oncs and their handlers are the most disingenuous and dangerous people in oncology today.

They can write as many papers as they like and have the most impeccable pedigree but at the end of the day they are scum
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Love you too bro

Show me on the doll where the bad academic rad onc from Twitter touched you.
 
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‘Academic rad oncs and their handlers are the most disingenuous and dangerous people in oncology today.‘

Yep this is a totally sane person here, nothing to see folks!
 
Neuronix said:
Love you too bro

Show me on the doll where the bad academic rad onc from Twitter touched you.
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Have to admit ASTRO brought it upon themselves allowing shameless residency expansion to occur, freestanding/pp rad onc to take the brunt of the cuts while attacking urorads (essentially presiding over the reduction/extinction of pp rad onc), and telling everyone to "choose wisely" while offering protons for everything under the sun and getting paid more for everything compared to regular hospital or freestanding rad onc.

RadsWFA1900 said:
They are no better than the rad onc treating bone Mets in 20fx.
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Probably worse, financially.

I'm sure someone has that link/source showing bone met sbrt bringing in 5 figures at NCI designated RO centers. It was floating around on here for years
 
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Neuronix said:
Don't hate the player hate the game. Sure I'm in academics, but I'm trying to do research not whatever else you guys are mad at.
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Agree, just like many of those of us out in practice do refer out when appropriate and offer 0/3-4 weeks of breast XRT when appropriate.

Anger should be directed to the specialty leadership that's allowed this to occur and to thoughtless "thought leaders" like Nancy Lee and their blatant hypocrisy
 
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medgator said:
Have to admit ASTRO brought it upon themselves allowing shameless residency expansion to occur, freestanding/pp rad onc to take the brunt of the cuts while attacking urorads (essentially presiding over the reduction/extinction of pp rad onc), and telling everyone to "choose wisely" while offering protons for everything under the sun and getting paid more for everything compared to regular hospital or freestanding rad onc.



Probably worse, financially.

I'm sure someone has that link/source showing bone met sbrt bringing in 5 figures at NCI designated RO centers. It was floating around on here for years
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There are only certain designated sites in this country designed to bilk insurances. If you aren’t in on the game, you are SOL
 
medgator said:
Agree, just like many of those of us out in practice do refer out when appropriate and offer 0/3-4 weeks of breast XRT when appropriate
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I'd never post that private practice docs are scum or academics are scum. Always a range of people doing different things for different reasons.
 
Neuronix said:
I'd never post that private practice docs are scum or academics are scum. Always a range of people doing different things for different reasons.
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academia is not going to waste its time making distinctions between the good PP docs and the bad ones. He good community places and the bad ones.

Glad you paint with such a fine brush...unfortunately the people in power do not.
 
RadsWFA1900 said:
They can write as many papers as they like and have the most impeccable pedigree but at the end of the day they are scum
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Never expect someone to show you more respect than you are willing to show them.

edit: removed quote from medgator that was accidentally included.
 
Lamount said:
Never expect someone to show you more respect than you are willing to show them.

edit: removed quote from medgator that was accidentally included.
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Lamount said:
Never expect someone to show you more respect than you are willing to show them.
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To be fair, I haven't seen a lot of academics rail against expansion outside a few that have come around in the last year.... Vapiwala, Tendulkar etc. And they are the ones that created this mess after all....
 
medgator said:
To be fair, I haven't seen a lot of academics rail against expansion outside a few that have come around in the last year.... Vapiwala, Tendulkar etc. And they are the ones that created this mess after all....
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To be fair, he called academics “scum”. I have little interest in debating anyone who has such a mindset.
 
Obama recently made some comments about leadership very pertinent to our burning manure field. Basically if you look at the world and so many of the problems, it most often is old men who just cannot get out of the way. One of the saddest things is to see people in our field who cannot get out of the stage, basically holding on to power, half senile, basically will die on the job. We have a good amount of these people in our leadership. They must retire, but how does the field force their hand? Do they all have to basically be walked out by security before they let go of the mouse?
 
thecarbonionangle said:
Obama recently made some comments about leadership very pertinent to our burning manure field. Basically if you look at the world and so many of the problems, it most often is old men who just cannot get out of the way. One of the saddest things is to see people in our field who cannot get out of the stage, basically holding on to power, half senile, basically will die on the job. We have a good amount of these people in our leadership. They must retire, but how does the field force their hand? Do they all have to basically be walked out by security before they let go of the mouse?
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the backwards way of this is increased peer review and increased oversight requiring forms etc that came from PPs being bought out by bigger practices or academic centers. the only benefit of this expansion by academic centers has been to force old people out
 
thecarbonionangle said:
Obama recently made some comments about leadership very pertinent to our burning manure field. Basically if you look at the world and so many of the problems, it most often is old men who just cannot get out of the way. One of the saddest things is to see people in our field who cannot get out of the stage, basically holding on to power, half senile, basically will die on the job. We have a good amount of these people in our leadership. They must retire, but how does the field force their hand? Do they all have to basically be walked out by security before they let go of the mouse?
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This is basically what Jagsi basically proposed - term limits
 
RadsWFA1900 said:
academia is not going to waste its time making distinctions between the good PP docs and the bad ones. He good community places and the bad ones.

Glad you paint with such a fine brush...unfortunately the people in power do not.
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If you think this is simply "academics" vs "private", I disagree with you. If only things were so black and white. Unfortunately, financial motives have created some negative factors in medicine and they can affect anything, everywhere. I've seen good and bad both on the private and academic sides, so sure I paint with a fine brush.

I'm not at a major academic center, and patients have told us numerous times how our center has been bad mouthed by big name academic places. Meanwhile, For every underpaid and unhappy academic satellite doc there is also a churned and burned private practice doc.

The most important thing is that we're all physicians. Once we start talking about how one side is inherently better than other, we're just creating divisions in our tiny little specialty.
 
Neuronix said:
If you think this is simply "academics" vs "private", I disagree with you. If only things were so black and white. Unfortunately, financial motives have created some negative factors in medicine and they can affect anything, everywhere. I've seen good and bad both on the private and academic sides, so sure I paint with a fine brush.

I'm not at a major academic center, and patients have told us numerous times how our center has been bad mouthed by big name academic places. Meanwhile, For every underpaid and unhappy academic satellite doc there is also a churned and burned private practice doc.

The most important thing is that we're all physicians. Once we start talking about how one side is inherently better than other, we're just creating divisions in our tiny little specialty.
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In my neck of the woods the lies all come from one direction: Told by the academic practices about the private practices.
 
CaesarRO said:
I think it's pretty obvious this was a slide in a talk in which she is highlighting the "crisis of protons" as Mimi Knoll emphasizes in subsequent replies.

Nancy Lee is highlighting the fact that with the capital investment that goes into building proton centers, if proton trials are negative then many centers would be hard pressed to give up their centers and just close up shop. Thus, many centers will treat regardless if results are negative. *She's highlighting this scenario as a crisis.* I take the "we" to mean we radiation oncologists.

I didn't see the talk, so not sure if she presented solutions.

Also, from what I know, the problem with randomizing photons vs protons is that pts still need insurance auth to get protons, so thats a prerequisite to enroll on trial. For many pts, if they are enrolled on trial and get randomized to photons, they will withdraw from trial and all for the protons since they've already got approval. Many _patients_ don't have equipoise when it comes to photons vs protons.

Sent from my Pixel 2 XL using Tapatalk
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This is directly BECAUSE of the marketing drive behind photons and the associated physicians who have overstated the benefits of protons.
xrthopeful said:
haha there is no doubt in my mind that this DukeNukem

I feel bad for him, I truly hope he fixes whatever the issue is and finds a better job soon.

one quote here - 'We have a hard time filling our residency program, so fortunately the medical school has forced them to stop expanding, at least for now. ' - I think this is important to underline what medical students already know, but this is proof of concept, DON'T GO TO A BAD PROGRAM, even if you think the location is good for you, or you got tricked on interview day blah blah, just don't do it. Duke went to a bad program, and it set him up for a bad job.
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I read that to mean the residency program at the place he works at, since we know that he works at an academic satellite.... I don't know that it speaks to any amount in regards to the program that HE went to (which is likely NOT the same one that he works for) and the fact that you continue insinuating that his crap situation is all his fault is really victim blaming and not helping the situation whatsoever.
 
RadsWFA1900 said:
That dumb line about putting us out of bussiness was a gimmick with nothing but the most selfish intent.

Academic rad oncs and their handlers are the most disingenuous and dangerous people in oncology today.

If there was ever an argument to remove the exemptions these institutions and their people from site neutrality and bundling it’s this.

They are no better than the rad onc treating bone Mets in 20fx.

They can write as many papers as they like and have the most impeccable pedigree but at the end of the day they are scum
Click to expand...

Another person on the hyperbole train. Ridiculously opinionated and comes off as completely ignorant. Kudos.
 
One time I locumed as a dosimetrist make extra cash. My plans were pure garbage but the docs were old and trained in the 90s and didnt know any better.

It was a win win!
 
medgator said:
NCI designated center a few hours away says that about us, with zero evidence. I personally have never trashed said center
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It's a mixed bag.

We have one NCI designated center nearby that sends pts to us and assures them they will receive excellent care.

We have another academic center nearby who tells pts they absolutely must have their treatment at their facility and no where else.

Such is life.
 
Exactly. Where I trained some docs would routinely assist patients to be treated closer to home. Where I work, we have some docs who probably are against the community and others who are fine with it.

I've seen all sorts of kooky stuff from private around here. 28 fraction bone mets, inappropriate modalities used, etc. But that's not all the private groups, and when patients live far away I try to send out to the people I think do reasonable things.
 
Neuronix said:
Exactly. Where I trained some docs would routinely assist patients to be treated closer to home. Where I work, we have some docs who probably are against the community and others who are fine with it.

I've seen all sorts of kooky stuff from private around here. 28 fraction bone mets, inappropriate modalities used, etc. But that's not all the private groups, and when patients live far away I try to send out to the people I think do reasonable things.
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Almost like you should judge a person based on their abilities, not whether they are in academics or private practice. #shocker
 
Neuronix said:
Exactly. Where I trained some docs would routinely assist patients to be treated closer to home. Where I work, we have some docs who probably are against the community and others who are fine with it.

I've seen all sorts of kooky stuff from private around here. 28 fraction bone mets, inappropriate modalities used, etc. But that's not all the private groups, and when patients live far away I try to send out to the people I think do reasonable things.
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Just had pt treated for calvarial mets at MSKCC who was told they couldnt possibly do good job with mask at home. Made them stay for a week in nyc. I am sure they were just trying to limit financial toxicity...
 
RickyScott said:
Just had pt treated for calvarial mets at MSKCC who was told they couldnt possibly do good job with mask at home. Made them stay for a week in nyc. I am sure they were just trying to limit financial toxicity...
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Forcing patients to stay away from home for a palliative treatment is by far the worst thing. Any palliation that does not involve re-RT I always offer the patient a facility closer to home if applicable.

How'd they treat the mets? 3D or IMRT?
 
evilbooyaa said:
Forcing patients to stay away from home for a palliative treatment is by far the worst thing. Any palliation that does not involve re-RT I always offer the patient a facility closer to home if applicable.

How'd they treat the mets? 3D or IMRT?
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How would you truly know. They can write 3D in their note but even then you wouldn't really know unless you could see the TPS. (And some payors will reimburse 3D if they won't let you bill IMRT, even though the tx is actually IMRT, etc.) But a calvarium met, depending on size and chosen "palliative" dose, you can make a reasonable argument for IMRT. IMRT shouldn't never be used for palliation.
RickyScott said:
Just had pt treated for calvarial mets at MSKCC who was told they couldnt possibly do good job with mask at home. Made them stay for a week in nyc. I am sure they were just trying to limit financial toxicity...
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Or make sure his/her heart was in rhythm.
 
Neuronix said:
Exactly. Where I trained some docs would routinely assist patients to be treated closer to home. Where I work, we have some docs who probably are against the community and others who are fine with it.

I've seen all sorts of kooky stuff from private around here. 28 fraction bone mets, inappropriate modalities used, etc. But that's not all the private groups, and when patients live far away I try to send out to the people I think do reasonable things.
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well this can happen, the vast majority of community practice in my experience is SOC especially anywhere near a major metero.
 
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RickyScott said:
Just had pt treated for calvarial mets at MSKCC who was told they couldnt possibly do good job with mask at home. Made them stay for a week in nyc. I am sure they were just trying to limit financial toxicity...
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This. This is the kind of crap that causes the massive wedge between academia and private practice. It's not "people on both sides" who are causing the problem.
 
OTN said:
This. This is the kind of crap that causes the massive wedge between academia and private practice. It's not "people on both sides" who are causing the problem.
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Yeah. Could you even imagine if private practice docs launched derogatory insults at academic docs with whom they have never even worked? Wait, no need to imagine, just scroll up.

...perhaps the greatest wedge of all is the intellectual laziness of assuming “if I’ve met one, I’ve met them all”. The world is a bigger place than your “neck of the woods”.
 
Lamount said:
Yeah. Could you even imagine if private practice docs launched derogatory insults at academic docs with whom they have never even worked? Wait, no need to imagine, just scroll up.

...perhaps the greatest wedge of all is the intellectual laziness of assuming “if I’ve met one, I’ve met them all”. The world is a bigger place than your “neck of the woods”.
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Are you equating a Rad onc physician in academics telling a patient that a board certified physician in private practice cannot do simple palliative treatments to somebody saying something mean about academics (and getting appropriately called out on it by about 3-5 posters) on the internet?

There are certain things academics do well, like brachy, peds, complicated re-irradiation cases, rare diagnoses for a region, etc. But to call out an academic facility for doing a simple palliative treatment because that can't be done closer to their home is honestly fine.

The PP guys near me, some of them I'd feel comfortable referring out a H&N. Some of them (having personally spoken to them on the phone) I wouldn't trust with a L-sided breast. Having seen how some of them treat Gyn Pelvis for example I wouldn't send out willingly to some fraction of them. Sometimes it's just seeing how the patients are treated and knowing that's not what you would want.

Regardless, all of them I would trust with palliation and R-sided breast, for example.
 
scarbrtj said:
How would you truly know. They can write 3D in their note but even then you wouldn't really know unless you could see the TPS. (And some payors will reimburse 3D if they won't let you bill IMRT, even though the tx is actually IMRT, etc.) But a calvarium met, depending on size and chosen "palliative" dose, you can make a reasonable argument for IMRT. IMRT shouldn't never be used for palliation.
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More for my curiosity than anything. I'm just saying that if the MSKCC doc (reality, resident or dosimetrist) slapped on tangents or did an electron plan for calvarial mets and sold it as "the PP can't do this" then that's kinda nonsense, but if you did say whole skull RT with IMRT while minimizing brain/skin dose that may be something more complicated that maybe I can see the justification. And that's not to say that a good PP doc couldn't do the same thing.
 
Lamount said:
Yeah. Could you even imagine if private practice docs launched derogatory insults at academic docs with whom they have never even worked? Wait, no need to imagine, just scroll up.

...perhaps the greatest wedge of all is the intellectual laziness of assuming “if I’ve met one, I’ve met them all”. The world is a bigger place than your “neck of the woods”.
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I have never -EVER- talked trash about a radonc I've never met or their ability to treat a certain disease. I've had it happen to me several times over by multiple academicians. This has been my experience, and I will not be shamed into silence. THEY should be ashamed about the lies they tell their patients to try to get them to needlessly stay away from home, financial toxicity be damned.
 
evilbooyaa said:
Are you equating a Rad onc physician in academics telling a patient that a board certified physician in private practice cannot do simple palliative treatments to somebody saying something mean about academics (and getting appropriately called out on it by about 3-5 posters) on the internet?
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Quite frankly, your juxtaposition is confusing. Of course they are not the same thing. If the MSKCC doctor acted cravenly, greedily, condescendingly etc..., it was wrong (and we don't even know that to be the case). It wouldn't mean that all academics are "scum" (appreciate you calling this out), nor would it mean that all academics are "driving a wedge" into our field. It would mean that a nameless doctor at MSKCC was wrong.

The idea that everyone who works in an NCI cancer center somehow bears responsibility for that one doc who reportedly said a bad thing that one time is, frankly, silly.
 
Lamount said:
Quite frankly, your juxtaposition is confusing. Of course they are not the same thing. If the MSKCC doctor acted cravenly, greedily, condescendingly etc..., it was wrong (and we don't even know that to be the case). It wouldn't mean that all academics are "scum" (appreciate you calling this out), nor would it mean that all academics are "driving a wedge" into our field. It would mean that a nameless doctor at MSKCC was wrong.

The idea that everyone who works in an NCI cancer center somehow bears responsibility for that one doc who reportedly said a bad thing that one time is, frankly, silly.
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A fair amount of trust and deference has been afforded by patients and society at large to academic and NCI designated cancer centers. Some of our experiences show that's been misplaced.
 
Lamount said:
Quite frankly, your juxtaposition is confusing. Of course they are not the same thing. If the MSKCC doctor acted cravenly, greedily, condescendingly etc..., it was wrong (and we don't even know that to be the case). It wouldn't mean that all academics are "scum" (appreciate you calling this out), nor would it mean that all academics are "driving a wedge" into our field. It would mean that a nameless doctor at MSKCC was wrong.

The idea that everyone who works in an NCI cancer center somehow bears responsibility for that one doc who reportedly said a bad thing that one time is, frankly, silly.
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I will agree with you on the bolded. Individual actors.
 
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