Rad Onc Twitter

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RadOncMegatron said:
I don't personally know Spratt, but as far as consistency and research goes, he is definitely on point. Sharp guy no doubt who I think has the right view of RCTs and Stats.
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Nothing phony about him. Just an upfront arrogant and smart guy. But, there is a parody aspect to his act. The bro talk about lifting, that cinder block gym he made, and then this “caliber” bit. I feel like he plays the character of “Daniel Spratt” like “Neil Patrick Harris” in the White Castle movies.
 
RadOncMegatron said:
I don't personally know Spratt, but as far as consistency and research goes, he is definitely on point. Sharp guy no doubt who I think has the right view of RCTs and Stats.
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The right view of stats? Forget about knowing Bayesian methodology, are you talking about the same guy that boasted at ASTRO that his post hoc analysis of 9601 was infallible based on an arbitrary PSA threshold with which he went p-value-fishing? These and such dubious views have been mentioned many times on SDN, regardless of the fact that I agree with him on protons for prostate. Dude couldn't argue with the proton esophageal randomized trial at ASTRO so he spent his tweets attacking the discussant instead. Bravo, Dan.
 
rtog 9601 p value fishing is right. everything we know about chemical and physical castration is pretty much that all animals live longer. He could have checked with his vet.
Hypothesis that castration is life lengthening at young age but life shortening at old age is very sketchy, but seems to be popular in radonc.
 
FrostyHammer said:
The right view of stats? Forget about knowing Bayesian methodology, are you talking about the same guy that boasted at ASTRO that his post hoc analysis of 9601 was infallible based on an arbitrary PSA threshold with which he went p-value-fishing? These and such dubious views have been mentioned many times on SDN, regardless of the fact that I agree with him on protons for prostate. Dude couldn't argue with the proton esophageal randomized trial at ASTRO so he spent his tweets attacking the discussant instead. Bravo, Dan.
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Yes, this one was a major drop (I swear I was going to mention this and the arbitrary PSA 0.6 cutoff). I completely agree Spratt was wrong on this. Post-hoc p hacking is correct. But overall he is not too bad. Just like Ioannidis’ miss on COVID, I generally tend to agree with Spratt.

He did get skewered on Twitter for this and agree with Andrew Vickers.
 
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Well at least this stuff is openly talked about in Radiology.
 
I think it’s being talked about openly in most places, no?

My friends in residency still are talking about it openly with faculty

It’s a known thing across all fields
 
At least the rad onc residents are prepared lol

Those poor dermatology kids gonna be so shaken!
 
PhotonBomb said:
This is about COVID

every field will be HIT hard

Feel really sorry for anyone graduating residency in 2021
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thecarbonionangle said:
Gonna be a very bad year folks!!
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This is more than COVID. We on SDN have constantly talked about the risk the field is taking due to saturation. This would include unpredictable risks and so yes, all those not worried about expansion should be eating their humble pie right now. Why do we save for rainy days? Why do we prepare for emergencies? We know unexpected things happen and need to be prepared, whether it be hypofractionation, elimination of XRT all together, drastic health policy changes, or global pandemic. The constant expansion was an obvious thing that made us fragile and susceptible to these things but folks keep SOAPing and expanding... Shameful. Really, needs to stop NOW.
 
RadOncMegatron said:
This is more than COVID. We on SDN have constantly talked about the risk the field is taking due to saturation. This would include unpredictable risks and so yes, all those not worried about expansion should be eating their humble pie right now. Why do we save for rainy days? Why do we prepare for emergencies? We know unexpected things happen and need to be prepared, whether it be hypofractionation, elimination of XRT all together, drastic health policy changes, or global pandemic. The constant expansion was an obvious thing that made us fragile and susceptible to these things but folks keep SOAPing and expanding... Shameful. Really, needs to stop NOW.
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Exactly the expansion put us in a devastatingly vulnerable position. Now combine that with supervision changes, hypofract, apm etc, and throw in covid and we are in the perfect storm.
 
PhotonBomb said:
At least the rad onc residents are prepared lol

Those poor dermatology kids gonna be so shaken!
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Most ‘derm kids’ have had super charmed paths, they won’t understand this struggle, will be hard for them.

I have some derm friends who are REALLY hurting right now in the private world, but at least they have jobs
 
Mandelin Rain said:
I have long said that the breadlines would form if there was an economic downturn where boomers lost their savings. I didn’t predict a pandemic as the cause but really a recession for any reason would have done it with the position we were in (completely avoidable and self-inflicted).
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This is actually worse than a garden variety recession, as COVID-19 is accelerating things like hypofx and tele-supervision, all of which drives down the need for RO labor. A black swan event for the stock market and RO, apparently.
 
In the grand scheme of medical specialties... I think others are in a far weaker position. Covid isn’t going away any time soon and we are still generating revenue. No distribution problems, minimal PPE, and cancer still has a far worse prognosis. We are a rare group of doctors who are still doing our jobs and aren’t working in an ED, ICU or on a floor. That being said, I can’t imagine too many places are expanding.
 
I disagree, specialities with more access to primary diagnoses will do better than RadOnc (or SurgOnc, HemOnc, Rheum for that matter)
 
Lamount said:
In the grand scheme of medical specialties... I think others are in a far weaker position. Covid isn’t going away any time soon and we are still generating revenue. No distribution problems, minimal PPE, and cancer still has a far worse prognosis. We are a rare group of doctors who are still doing our jobs and aren’t working in an ED, ICU or on a floor. That being said, I can’t imagine too many places are expanding.
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This is true. Although my numbers are low, we’re still in business and considered “essential.” I’m just going to maintain and count my blessings (for now).
 
Lamount said:
In the grand scheme of medical specialties... I think others are in a far weaker position. Covid isn’t going away any time soon and we are still generating revenue. No distribution problems, minimal PPE, and cancer still has a far worse prognosis. We are a rare group of doctors who are still doing our jobs and aren’t working in an ED, ICU or on a floor. That being said, I can’t imagine too many places are expanding.
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Yeah I agree. Have some friends in private practice in other specialties like optho and derm who are sitting at home getting paid $0. Sucks.

Meanwhile the referrals keep flowing for our practice. Volumes are down but we’ve been at all time highs for 2-3 years now.


Sent from my iPhone using SDN
 
frijoles said:
Yeah I agree. Have some friends in private practice in other specialties like optho and derm who are sitting at home getting paid $0. Sucks.

Meanwhile the referrals keep flowing for our practice. Volumes are down but we’ve been at all time highs for 2-3 years now.


Sent from my iPhone using SDN
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Specialties like ortho, pts will come back eventually. So will ours, but we will have diff fractionation and supervisory requirements and an apm on horizon
 


As much as l loathe much of what has come out from the current administration, healthcare price transparency is a big deal and something they've been working on and something that is opposed by hospitals, insurers and, going out on a limb, probably ASTRO

www.healthcarefinancenews.com

Pricing disparities an issue as Trump's executive order on healthcare price transparency takes hold

The national disparity between gross charges for each procedure is significant with a 297% difference between the lowest and highest gross charge.
www.healthcarefinancenews.com www.healthcarefinancenews.com
 
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Agree that price transparency is a good thing, but the idea of people being able to ‘shop around’ is laughable. That just doesn’t happen, that’s not how people do health care, and it never will be. The fact that price transparency is even a thing is an indictment of the system.

There is zero role for the free market in healthcare.
 
Wow.

radoncgrad2019 said:
Agree that price transparency is a good thing, but the idea of people being able to ‘shop around’ is laughable. That just doesn’t happen, that’s not how people do health care, and it never will be. The fact that price transparency is even a thing is an indictment of the system.

There is zero role for the free market in healthcare.
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ROFallingDown said:
Wow.
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So it says in the article that trump favors price transparency so that people can ‘shop around’. This is what the right wing is always talking about but I don’t see any evidence that’s how people use healthcare. No - either they have an emergency or they go where their insurance sends them.

It’s a hot garbage right wing talking point.
 
radoncgrad2019 said:
There is zero role for the free market in healthcare.
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I mean, thanks for coming right out and saying it. Most are aware of how absurd the socialist principles sound and try to sugarcoat it somehow.

So we will be like the fire department. Is that what you want? An essential service supported by taxpayer dollars. You have one choice in fire departments. Hope you like their service!

Hope you like getting paid like a firefighter too.

Not all of us sacrificed our 20s and early 30s to forego significant earnings in other careers to end up as a rank and file government employee with no autonomy.
 
How can you shop around now when there are no prices?

There are imaging centers with price transparency, there is a surgery center in Oklahoma that is completely transparent, and offers excellent value. LASIK is another example of the market improving cost and quality. There are so many examples, but when you have a completely closed mind you’ll put your finger in your ears rather than try to learn something new.

The only dumber comment than “There is no role for the free market in health car is there is no role for the government in health care”. Actually, both terribly and equally dumb.

radoncgrad2019 said:
So it says in the article that trump favors price transparency so that people can ‘shop around’. This is what the right wing is always talking about but I don’t see any evidence that’s how people use healthcare. No - either they have an emergency or they go where their insurance sends them.

It’s a hot garbage right wing talking point.
Click to expand...
 
radoncgrad2019 said:
Agree that price transparency is a good thing, but the idea of people being able to ‘shop around’ is laughable. That just doesn’t happen, that’s not how people do health care, and it never will be. The fact that price transparency is even a thing is an indictment of the system.

There is zero role for the free market in healthcare.
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Patently false. Maybe get out and about in the real world a bit when you have/see an insurance plan that requires you to pay a % co-insurance. Price shopping absolutely makes sense and should be happening in the non-emergent healthcare setting. A great example is radiation or imaging. Most pet scans, MRI etc pricing I've seen is at least a 2-3x fold difference favoring the freestanding centers vs getting it done at a hospital

Some of the stuff you say is just straight up mind boggling at times
 
medgator said:
Patently false. Maybe get out and about in the real world a bit when you have/see an insurance plan that requires you to pay a % co-insurance. Price shopping absolutely makes sense and should be happening in the non-emergent healthcare setting. A great example is radiation or imaging. Most pet scans, MRI etc pricing I've seen is at least a 2-3x fold difference favoring the freestanding centers vs getting it done at a hospital

Some of the stuff you say is just straight up mind boggling at times
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Dude I genuinely think you struggle with reading comprehension. Nowhere did I say that prices weren’t different between different places. My comment was on how health care is consumed in this country. People don’t get in a car accident and then choose to shop around. Or when their PCP gets them an MRI for the headaches that reveal brain mets, they don’t (nor should they be in the position where they have to do this) call up different centers to figure out where they should get a scan.
 
Prior to 2010 ACA, people used to say all sorts of scare tactic things about the things we take for granted now like preexisting condition rules or making sure that insurance companies spent a certain proportion off their revenue on actually paying for healthcare....

Radoncgrad2019 - I agree that in some years time some of this stuff will seem silly as hell. Of course everyone needs affordable healthcare available to them that isn’t tied to employment (how INSANE is that concept) and doesn’t require trying to bounce from place to place trying to navigate the health care market yourself like you’re going to shop for a mother trucking Buick. It’s insane to me that people think this makes sense in the big picture (exceptions like cosmetic procedures and LASIK etc are the exceptions Not the rule on how the majority of health care dollars are spent in this country)

Some people will once again be on the wrong side of history lol
 
PhotonBomb said:
trying to navigate the health care market yourself like you’re going to shop for a mother trucking Buick

Some people will once again be on the wrong side of history lol
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Don't be that person, PB. Biggest problem is prices, not fractions or technique, when it comes to RO. Like anything else

www.wbur.org

Why Are U.S. Health Costs The World's Highest? Study Affirms 'It's The Prices, Stupid'

The overriding reason for our out-of-whack costs is the exorbitant price tag attached to everything from doctors' time to prostatectomies to brand-name drugs, the Harvard study finds -- not extra or wasted care.
www.wbur.org www.wbur.org

First step to solving the absurd disparity and high cost in healthcare pricing (including some of the absurd pricing itself like mid 5-figure SBRT at Mayo) is pricing transparency, period
 
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ROFallingDown said:
Response to this:

<finger in ears> “I CANT HEAR YOU I CANT HEAR YOU YOURE OLDER THAN ME SO I KNOW EVERYTHING”
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Seriously. I mean saying that is so completely ignorant. My parents call around to see where procedures are cheapest. They will ask for cash discounts. Hell, I check GoodRx and compare to my insurance cost if I need a script for myself.
 
Mandelin Rain said:
People absolutely do call around to find the cheapest imaging.
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some people. There is disparity though. Most of my prostate cancer patients come with mountains of research. My cervical cancer patients barely have a pcp. Not everyone has the luxury to shop around.

(not meant to be a sjw post, just real talk)
 
I mean, I take Medicaid patients. Not every place does, so that limits those folks. Most everyone takes Medicare though. If you’re a patient on the hook for 20%, the price matters. Quite a bit.
 
MegaVoltagePhoton said:
some people. There is disparity though. Most of my prostate cancer patients come with mountains of research. My cervical cancer patients barely have a pcp. Not everyone has the luxury to shop around.

(not meant to be a sjw post, just real talk)
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There is nothing sjw about saving $$$ and being financially smart. Hate to be preachy, but i shop around before i buy a TV, why not for when i need a scan?
 
MegaVoltagePhoton said:
it’s not that you shouldn’t. Some people don’t have the time or medical literacy to do it.

i was calling myself the sjw for saying there is a disparity.
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Not only can some people not shop around, most people do not. Perhaps with increased transparency where you can easily look things up online, they will have an easier time doing so. But again, that is just not how people consume health care in large quantities. If your PCP sends you to a GI for your colonoscopy, most go to that one!! You have people like medgator who I am sure understand the importance of referrals in community medicine, and yet he or she is going to ask like
This doesn’t matter.

That’s not the point though. A system where someone with cancer needs to shop around to find the best place to get imaged is no system at all. Some of you are the ones keeping your fingers in your ears, but that’s okay. Wrong side of history and all.
 
medgator said:
There is nothing sjw about saving $$$ and being financially smart. Hate to be preachy, but i shop around before i buy a TV, why not for when i need a scan?
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LOL that’s what you thought he meant??
 
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