Rad Onc Twitter

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RadsWFA1900 said:

ClinicalTrials.gov

www.clinicaltrials.gov www.clinicaltrials.gov

Can’t wait for this gem to hit the guidelines
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A Rad Onc P.I. actively looking to make 0 fx standard of care for the largest chuck of our business. Right or wrong from the patient's perspective, this would pretty much be the nail in the coffin for many RT centers. Yesterday's 35 on treatment is now today's 20 will be tomorrow's 10. Us BE/BC docs can only watch this slow motion disaster play out. Med students this is what the plane flying into the mountain looks like for our specialty. Do not believe the gas lighters on twitter and the various professional organizations trying to fish for a few more residency applicants. Do not bet your future on something that looks like this.
 
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RadsWFA1900 said:

ClinicalTrials.gov

www.clinicaltrials.gov www.clinicaltrials.gov

Can’t wait for this gem to hit the guidelines
Click to expand...

And yet still we wait for the 5 fraction versus AI trial for these patients. Can somebody who actually wants to give radiation write that trial? Caputure QoL, total costs, fractures, usage of bisphosphonates, usage of other meds (SSRI) to chase side effects of AI, etc and show that a 5 fraction APBI is way better than anything for your 70 year old stage I ER+ breast cancer patient?
 
RadOncMegatron said:
ASTRO is one step away from announcing academics are better than everyone else and thus we get to charge more see my NCDB/SEER study! I think that "one step" will be taking away these reimbursements and then they may be tempted to come out and just flat out say "C'mon, ya'll know academics are better. You need to pay extra for our expertise when giving radiation for low risk prostate cancer."

I hope I am dead wrong, but I've seen reluctance of main centers to refer even to their own satellites, let alone another hospital.
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I actually do think that academics can charge slightly (10-20%?) more because of training and research mission. The issue is that some of these centers are charging 3-5X more in terms of negotiated rates! Anecdotally, many docs dont believe me, and that is why we need price transparency mandate. Would love to start confronting ASTRO "choose wisely" and some of those thought leaders who are fraction shaming but are face of negotiated astronomical rates.



www.marketwatch.com

This woman was charged $143,396.66 for a breast biopsy — here are the people working to improve medical billing transparency

A doctor’s prescription to save patients money, grief and sticker shock.
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medgator said:
Hopefully those urorads folks have a backup plan....

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I predict that those who poo-pooed the results of RTOG 9413 will suddenly appreciate the "value" of treating pelvic lymph nodes.
 
BobbyHeenan said:
And yet still we wait for the 5 fraction versus AI trial for these patients. Can somebody who actually wants to give radiation write that trial? Caputure QoL, total costs, fractures, usage of bisphosphonates, usage of other meds (SSRI) to chase side effects of AI, etc and show that a 5 fraction APBI is way better than anything for your 70 year old stage I ER+ breast cancer patient?
Click to expand...

Probably too hard to find med oncs willing to attach their name and enroll patient's into something may decrease a substantial amount of their business.
 
fiji128 said:
Probably too hard to find med oncs willing to attach their name and enroll patient's into something may decrease a substantial amount of their business.
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Prob not a good pharma model:
1) R&D a drug
2) Clinical trial drug to show superiority
3) Market drug
4) Perform trials to show drug not needed

You could skip every step and wind up with same result. Role of radiation oncology becoming teleological: the purpose of radiotherapy in oncology is to show radiation should have never been given.
 
scarbrtj said:
Prob not a good pharma model:
1) R&D a drug
2) Clinical trial drug to show superiority
3) Market drug
4) Perform trials to show drug not needed

You could skip every step and wind up with same result. Role of radiation oncology becoming teleological: the purpose of radiotherapy in oncology is to show radiation should have never been given.
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Maybe Varian needs to have a pow-wow with some of these "woke" academics
 
Someone needs to tell dan golden to STFU

Guy writes all these papers like hes a real academic doc while in reality he is an underpaid private practice guy (drank the kool aid with satellite UChicago)

 
radoncdoc16 said:
Someone needs to tell dan golden to STFU

Guy writes all these papers like hes a real academic doc while in reality he is an underpaid private practice guy (drank the kool aid with satellite UChicago)

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Found this when I had to look him up:

"Dr. Golden's practice is based at the University of Chicago Medicine Comprehensive Cancer Center at Silver Cross Hospital in New Lenox, Ill., where patients receive the expertise and investigational therapies of the University of Chicago Medicine in a convenient community setting."

I wonder if convenient means charging lower rates than the mothership? (SPOILER: It does not)
 
radoncdoc16 said:
Someone needs to tell dan golden to STFU

Guy writes all these papers like hes a real academic doc while in reality he is an underpaid private practice guy (drank the kool aid with satellite UChicago)

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These people just totally miss the point. It's possible for a single person to believe all of the following:

1) RadOnc is the greatest specialty of all time
2) The day-to-day work is amazing, the patients are amazing
3) Decreasing fractions, increasing surveillance, and any/all cost/toxicity reduction is amazing for patients and should be intensely researched and implemented
4) Medical students should not touch this field for 10-20 years because of a 127% increase in residents in light of point #3

Woke Twitterati love to invoke this "if you tell students to avoid RadOnc because of hypofrac you hate patients" strawman, WHICH IS RIDICULOUS.

Walking and chewing gum...look it up, guys.
 
radoncdoc16 said:
Same with erin gillespie. wtf is she talking about... This thread is actually great with the pushback

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1595524621427.png

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There's fractionated radiotherapy.
And hypofractionated radiotherapy.
And then there's afractional radiotherapy; like fraction times i or something.

If we don't give radiotherapy, there's literally no need for our specialty. Any analogy that doesn't allude to this, e.g. "Pulmonologists encourage everyone to quit smoking," is not an apt analogy.
 
scarbrtj said:
There's fractionated radiotherapy.
And hypofractionated radiotherapy.
And then there's afractional radiotherapy; like fraction times i or something.

If we don't give radiotherapy, there's literally no need for our specialty. Any analogy that doesn't allude to this, e.g. "Pulmonologists encourage everyone to quit smoking," is not an apt analogy.
Click to expand...

The true analogy would be "phase 3 study shows RN-placed nasal cannula equally effective as intubation".

Or something like that. Maybe asthma is actually a psychiatric disease, bronchodilators no better than placebo?
 
scarbrtj said:
There's fractionated radiotherapy.
And hypofractionated radiotherapy.
And then there's afractional radiotherapy; like fraction times i or something.

If we don't give radiotherapy, there's literally no need for our specialty. Any analogy that doesn't allude to this, e.g. "Pulmonologists encourage everyone to quit smoking," is not an apt analogy.
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But don't worry everyone, oligomets!!!

VOMIT
 
radoncdoc16 said:
But don't worry everyone, oligomets!!!

VOMIT
Click to expand...
Yup. This (and to a lesser extent cardiac ablations) has become the rallying cry of those desperate for applicants.

Pinning the hope of the future of your field on oligomets is a sad spot to be. Even if it works out, in two years Pharma will be like, "Nope. All your patient are belong to us."
 
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Mandelin Rain said:
Yup. This (and to a lesser extent cardiac ablations) has become the rallying cry of those desperate for applicants.
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And with no sense of irony whatsoever that looking to do non-oncology things in a specialty entitled "radiation oncology" signals existential problems. (And with no understanding of the way the world actually works that if cardiac ablation really takes off, cardiologists will be marketed to by equipment manufacturers and they will take over cardiac irradiation just like derms have taken over skin irradiation. A ZAP-X for the heart doctor's office. Cardiologists would be stupid to let rad oncs do cardiac irradiation, and they're not stupid. Even in the coronary brachy days, cardiologists could become AUs after lots of preceptoring. Yet unlike radioactive sources, X-ray'ing doesn't require AU'ing though.)
 
scarbrtj said:
And with no sense of irony whatsoever that looking to do non-oncology things in a specialty entitled "radiation oncology" signals existential problems. (And with no understanding of the way the world actually works that if cardiac ablation really takes off, cardiologists will be marketed to by equipment manufacturers and they will take over cardiac irradiation just like derms have taken over skin irradiation. A ZAP-X for the heart doctor's office. Cardiologists would be stupid to let rad oncs do cardiac irradiation, and they're not stupid. Even in the coronary brachy days, cardiologists could become AUs after lots of preceptoring. Yet unlike radioactive sources, X-ray'ing doesn't require AU'ing though.)
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Channeling my inner KHE - here's a great example of "super woke Twitter":

1595592001830.png


For those who don't visit the cesspool of Twitter, a vascular surgery journal published a paper on "unprofessionalism in social media" and TWITTER CAUGHT FIRE.

Granted, I totally agree the paper was trash and inappropriate.

But so many people just exploded to dunk on this paper and the authors, dozens of female (and male) docs started posting pics in swimwear etc - it's still going on this morning.

Fortunately, Simul's tweets brought some additional #RaRaRadOnc folks into the fray yesterday...to tell him how wrong he was but still, at least they engaged?
 
When your profession is dying (like vascular surgery, largely) you come up with complete nonsense to publish. Unrelated (probably)... did you guys get another survey emailed to you about your perception of marijuana use.....?
 
RO28 said:
Or maybe this is a grand scheme by palliative care to get all rad oncs to do a palliative care fellowship so we can make ourselves actually useful 😵

Shh...don't take my back up plan.
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I think something lost in the consideration of how great hypofx is for the patient, is how I ungreat it is for us, and I don't mean financially. An initial attraction for me to this specialty was not only the cool tech, but the potential to get to know people and be with them through hard times. Otherwise, I would have just gone into rads or something. It's becoming that to an extent, with less and less meaningful patient contact. Figuring a way to double board in hpm would allow for that, and residency is already 12 months, minimum, longer than it needs to be.
 
Ray D. Ayshun said:
I think something lost in the consideration of how great hypofx is for the patient, is how I ungreat it is for us, and I don't mean financially. An initial attraction for me to this specialty was not only the cool tech, but the potential to get to know people and be with them through hard times. Otherwise, I would have just gone into rads or something. It's becoming that to an extent, with less and less meaningful patient contact. Figuring a way to double board in hpm would allow for that, and residency is already 12 months, minimum, longer than it needs to be.
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Yup. This is something no one on Twitter has addressed. I loved spending 8-9 weeks getting to know guys or 6 weeks chatting up old ladies. They usually were doing well and broke up the day with some positive vibes. Additionally, sometimes you got them to quit smoking or start exercising at the YMCA or get on BP meds or whatever. It felt good.

Now, I feel like a glorified IR doc. Get em in. Get em out.

Not as satisfying professionally at all.

"See spot, treat spot" is the death of our field. Anyone can do that. Literally. Which is why banking hopes on oligomets seems crazy to me.
 
Mandelin Rain said:
Yup. This is something no one on Twitter has addressed. I loved spending 8-9 weeks getting to know guys or 6 weeks chatting up old ladies. They usually were doing well and broke up the day with some positive vibes. Additionally, sometimes you got them to quit smoking or start exercising at the YMCA or get on BP meds or whatever. It felt good.

Now, I feel like a glorified IR doc. Get em in. Get em out.

Not as satisfying professionally at all.

"See spot, treat spot" is the death of our field. Anyone can do that. Literally. Which is why banking hopes on oligomets seems crazy to me.
Click to expand...
Right. It doesn't seem unreasonable to argue this is ungreat for the patients as well.
 
Ray D. Ayshun said:
Right. It doesn't seem unreasonable to argue this is ungreat for the patients as well.
Click to expand...
And the impacts on the field where small practices close due to financial pressure, consolidation of care into ever larger nameless, faceless entities, people not being able to be treated in their hometowns... but yes, we do what is “best” for patients. Many rad oncs wear a t-shirt that says “I know what is best for everyone” on the front.
 
Mandelin Rain said:
Yup. This is something no one on Twitter has addressed. I loved spending 8-9 weeks getting to know guys or 6 weeks chatting up old ladies. They usually were doing well and broke up the day with some positive vibes. Additionally, sometimes you got them to quit smoking or start exercising at the YMCA or get on BP meds or whatever. It felt good.

Now, I feel like a glorified IR doc. Get em in. Get em out.

Not as satisfying professionally at all.

"See spot, treat spot" is the death of our field. Anyone can do that. Literally. Which is why banking hopes on oligomets seems crazy to me.
Click to expand...

This was what clinched the field for me. I was interested in several specialties (like, to the point of doing rotations and talking to PDs etc). In the end, it was the time the RadOncs I worked with spent with patients that did it for me. Literally weeks of intensely working with and getting to know people during what was usually the most vulnerable point in their lives. Seeing patients in follow-up that were treated years ago.

Hypofrac, SBRT, punting follow-up to MedOnc or SurgOnc...I should have just done IR like I wanted to.
 
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scarbrtj said:
And the impacts on the field where small practices close due to financial pressure, consolidation of care into ever larger nameless, faceless entities, people not being able to be treated in their hometowns... but yes, we do what is “best” for patients. Many rad oncs wear a t-shirt that says “I know what is best for everyone” on the front.
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And doing “what’s best” certainly involves charging/negotiated rates 3x as much at large monopolistic/academic/regional price gouging centers. Of course, they will argue that must separate cost from the convenience of hypofract and that these are 2 completely separate issues when it comes to “choose wisely”
 
scarbrtj said:
And the impacts on the field where small practices close due to financial pressure, consolidation of care into ever larger nameless, faceless entities, people not being able to be treated in their hometowns... but yes, we do what is “best” for patients. Many rad oncs wear a t-shirt that says “I know what is best for everyone” on the front.
Click to expand...

Losing smaller more local centers will lead to less personal care and worse outcomes. A lot of people that live in those areas simply can't or won't travel to the Ivory Towers for care. I was very big advocate for local radiation in residency much to the dismay of my attendings and still feel that way. We can't claim to be a patient-centered field by offering them the same treatment hours from their home and charge them more for it. I don't see a day where I won't look up where every new patient lives because that is important to my practice.
 
elementaryschooleconomics said:
Channeling my inner KHE - here's a great example of "super woke Twitter":

View attachment 313791

For those who don't visit the cesspool of Twitter, a vascular surgery journal published a paper on "unprofessionalism in social media" and TWITTER CAUGHT FIRE.

Granted, I totally agree the paper was trash and inappropriate.

But so many people just exploded to dunk on this paper and the authors, dozens of female (and male) docs started posting pics in swimwear etc - it's still going on this morning.

Fortunately, Simul's tweets brought some additional #RaRaRadOnc folks into the fray yesterday...to tell him how wrong he was but still, at least they engaged?
Click to expand...

The activity on this is intense!!!!

I'm with you the study was trash.

Wish more ppl defended Simul 🙁

Once I get a job I'll start a twitter instead of just lurking but until that day my well wishes are all with Parikh!
 
radoncdoc16 said:
The activity on this is intense!!!!

I'm with you the study was trash.

Wish more ppl defended Simul 🙁

Once I get a job I'll start a twitter instead of just lurking but until that day my well wishes are all with Parikh!
Click to expand...

Probably best to wait until you're done with the hoops of the board certification process too! Don't need The Wallner sending you a cease and desist from his personal lawyers...
 
elementaryschooleconomics said:
Channeling my inner KHE - here's a great example of "super woke Twitter":

View attachment 313791

For those who don't visit the cesspool of Twitter, a vascular surgery journal published a paper on "unprofessionalism in social media" and TWITTER CAUGHT FIRE.

Granted, I totally agree the paper was trash and inappropriate.

But so many people just exploded to dunk on this paper and the authors, dozens of female (and male) docs started posting pics in swimwear etc - it's still going on this morning.

Fortunately, Simul's tweets brought some additional #RaRaRadOnc folks into the fray yesterday...to tell him how wrong he was but still, at least they engaged?
Click to expand...

The dumpster fire is exploding :flame: on this thread. I can hardly read it hahaha




Let's heed Dr. Evan's words here. *Don't judge ya'll

*Unless of course you disagree with something on social media then you can publish that in NEJM or JCO.

This paper though, why they thought it was a good idea ... (Yea I didn't read it so, but why would I? lol)
 
1595701098631.png


Ralph is literally pouring acid in a wound right now.

Many of us (myself included) are struggling to even find a place that's hiring, let alone being offered jobs.

Dr Boomer Weichselbaum is out here after making bank for decades saying we're all overpaid.

Thanks bud. Really helping the field. Love what you did in the 90s.
 
elementaryschooleconomics said:
View attachment 313891

Ralph is literally pouring acid in a wound right now.

Many of us (myself included) are struggling to even find a place that's hiring, let alone being offered jobs.

Dr Boomer Weichselbaum is out here after making bank for decades saying we're all overpaid.

Thanks bud. Really helping the field. Love what you did in the 90s.
Click to expand...

Wow WTH? What a hypocrite. It’s like he’s taunting them.
 
elementaryschooleconomics said:
View attachment 313891

Ralph is literally pouring acid in a wound right now.

Many of us (myself included) are struggling to even find a place that's hiring, let alone being offered jobs.

Dr Boomer Weichselbaum is out here after making bank for decades saying we're all overpaid.

Thanks bud. Really helping the field. Love what you did in the 90s.
Click to expand...
look up adz in the dictionary and you'll see a pic of Ralph
 
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