Rad Onc Twitter

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radiaterMike said:
I think he is saying that FLASH can deliver treatment in such a rapid manner that the only benefit is to minimize intrafraction organ motion- but otherwise it won't prove to have any benefit. I wonder if Twitter offers a RRW translation feature ?
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Ralph is pontificating three steps into the future...how about we learn to crawl before critiquing the running shoe choice for the 100m dash, eh Ralph?
 
elementaryschooleconomics said:
When I first heard about RadOncReview, I thought it would be like First Aid.

Then I saw RadOncReview, and realized they're using the word "review" as in, "Cochrane Review".

It's a tremendous source of information, and I have the utmost respect for the authors. But ain't nobody got time for that.
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Haha this is so great! If you choose to use it, use it like rad onc wiki or be blinded to most info except for the summary boxes. Ultimately, Control + F and learning per patient is the way to go.
 
scarbrtj said:
On radonc review dot org I saw where they have 115 single spaced, small fonted pages on "breast." It's beautiful and fantastically organized and intimidating and a testament to its creators. I don't think any ordinary human has hope of REALLY knowing even half this data, in detail, over the span of even a 40y career. If a tree falls in the forest and no one is around, does it make a sound? If 5-5-5 is most of what we do in rad onc, does stuff like knowing the minutiae of "TEXT-SOFT [Pagani NEJM '14, JCO '19]: Adjuvant tamox vs. exemestane + ovarian suppression in early br ca" (directly copied/pasted) help make one a better/worse rad onc?
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The brief answer is it doesn't matter for us! Haha. But it is on a quite few questions on radoncquestions.com so it made it in there.

TL;DR ovarian suppression for premeno is annoying for med oncs bc it requires FSH or LH testing or some crap like that (who cares, we're RadOnc so TMI), so reserve AIs + ovarian suppression for younger patients at high risk who may benefit from extra DFS benefit. The key is there is a DFS DETRIMENT with premenos on AI who *aren't* suppressed vs tamoxifen (regardless of suppression). Med oncs fear this DFS detriment vs tamox alone so they don't Rx unless they're cool checking additional labs to make sure they're suppressed. Tamoxifen = autopilot, don't need to test for suppression

TBL you nailed it, who cares
 
evilbooyaa said:
I like the concept of rad onc review but will never read it start to finish. Maybe treat it more like the old rad onc wiki as a resource to go look up summaries of things for a quick reference.

I would not expect Rad Oncs to be able to know RadOncReview cold in prep for oral boards.
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☝☝☝ This! Yes, please treat it as rad onc wiki and for the love of God please don't read it all the way through. Maybe just read sections of interest for a particular patient or stick to the summary boxes when starting out. There are a lot of great resources out there, just find what works best for you!

For oral boards prep I'll be helping to tweak rad onc table's oral boards prep sheet (Chris Estes and I are buds), so I'd stick with that as a potential resource for oral boards.

RadOnc.org is more like a quick reference for tumor boards or commentary for clinical trials. It's kinda meant to be an encyclopedia.

Happy studying!
 
I've heard rumblings that some ACGME surveys were not great this year:

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elementaryschooleconomics said:
I've heard rumblings that some ACGME surveys were not great this year:

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I've made this argument here before, but: residency expansion was fueled by IMRT reimbursements. RadOnc was super competitive because of a reasonable lifestyle and huge salary. This meant that the "best of the best" med students went to programs with totally lackluster training. These bloated, unprepared residencies were kept afloat by students-turned-residents totally capable of teaching themselves. Now, with the government coming after reimbursements and the job market unbelievably tight, simply "getting into a RadOnc residency" IS NOT GOOD ENOUGH.

People are not going to be happy "just getting a seat". Additionally, "average" medical students are matching, students who are less equipped (theoretically) to just teach themselves an entire specialty by reading some textbooks. This means *gasp* residency programs will actually have to...provide a good training environment? The horror!

PROGRAMS ARE GOING TO HAVE TO STEP UP BECAUSE RESIDENTS WILL BE HONEST ON THESE SURVEYS.

ASTRO, SCAROP, ADROP - you reap what you sow. But what do you guys care? You got your careers and retirement accounts and are happy...screw the next generation!
 
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Mandelin Rain said:
All of it.

1. If your program sucks, you can't speak out or it may close.

2. If it closes, you likely have no funding.

3. Other institutions are VERY reluctant to take you without funding.

4. Breadline.
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Just a PSA to residents out there who are reluctant to answer surveys honestly because of this:

- it takes a few years of bad surveys to cause the ACGME to respond
- the ACGME will perform a site audit/visit
- depending on the findings, nothing will happen, the program could be given a violation, or if it's really serious the program could get shut down immediately (SUPER rare, think of that Arizona NSGY program)
- then what happens really depends on the program and future surveys

It's definitely not a forgone conclusion that if your program has some bad surveys you're out of a job. There's a whole process, and programs aren't just shut down without cause.

Answer honestly!

Edit: Sorry, it was New Mexico - U of New Mexico neurosurgery residency to lose accreditation in 2020: The University of New Mexico School of Medicine in Albuquerque will shut down its neurosurgery residency program on June 30, 2020, after losing accreditation, according to the Albuquerque Journal..
 
Mandelin Rain said:
All of it.

1. If your program sucks, you can't speak out or it may close.

2. If it closes, you likely have no funding.

3. Other institutions are VERY reluctant to take you without funding.

4. Breadline.
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This has been the same situation for a long time now though, was there some recent change?
 
Mandelin Rain said:
All of it.

1. If your program sucks, you can't speak out or it may close.

2. If it closes, you likely have no funding.

3. Other institutions are VERY reluctant to take you without funding.

4. Breadline.
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this is the biggest issue with the ACGME survey. The ACGME claims the only way to provide feedback and hold places accountable is to be honest. Programs remind residents that the survey may cause them to end up unemployed (low key threat),and if they do end up “unemployed” there is no guarantee they find a funded spot. So the incentive is to smile during interviews, dont say anything bad, be an asset to your bad program, and just get through it and nothing ever gets better for anybody, you are just helping more suckers get into a bad situation. We have too many people getting a terrible education in many places and nothing is being done
 
Haybrant said:
This has been the same situation for a long time now though, was there some recent change?
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No. Maybe more honesty among people struggling to "teach themselves"?????

I too would encourage everyone to be brutally honest on those things. As stated, it takes a lot to shut down a program, but a site visit may be enough to catch the dean's eye who may in turn speak with the chair. Only way to make things better is to admit there's a problem.
 
thecarbonionangle said:
this is the biggest issue with the ACGME survey. The ACGME claims the only way to provide feedback and hold places accountable is to be honest. Programs remind residents that the survey may cause them to end up unemployed (low key threat),and if they do end up “unemployed” there is no guarantee they find a funded spot. So the incentive is to smile during interviews, dont say anything bad, be an asset to your bad program, and just get through it and nothing ever gets better for anybody, you are just helping more suckers get into a bad situation. We have too many people getting a terrible education in many places and nothing is being done
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Seems like this exact board would be a good place for the old Name n' Shame.
 
Mandelin Rain said:
No. Maybe more honesty among people struggling to "teach themselves"?????

I too would encourage everyone to be brutally honest on those things. As stated, it takes a lot to shut down a program, but a site visit may be enough to catch the dean's eye who may in turn speak with the chair. Only way to make things better is to admit there's a problem.
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Honestly, as someone with a "boots on the ground" perspective - the same reasons which have helped medical students avoid the field are the same reasons residents won't just rubber stamp the surveys moving forward. The oversupply is real, the residency expansions were harmful - and the ones who are harmed the most are the people who committed themselves to this specialty for life. If you're a current resident, watching opportunities vanish for those ahead of you but unable/unwilling to bail out as you watch medical students run behind you - what is left? You can only hope to be trained as the best Radiation Oncologist you can possibly be. You should DEMAND your program give you the training to be the kind of doctor operating at the apex of your potential - nothing less than this is appropriate.

Departments which leave residents to fend for themselves should no longer be tolerated. If you're going to throw residents into the tightest job market ever seen you OWE THEM, at a bare minimum, excellent training. Note monkeys and contour puppets left to memorize RadOncQuestions on their own is NOT what it means to be a resident physician.
 
Mandelin Rain said:
No. Maybe more honesty among people struggling to "teach themselves"?????

I too would encourage everyone to be brutally honest on those things. As stated, it takes a lot to shut down a program, but a site visit may be enough to catch the dean's eye who may in turn speak with the chair. Only way to make things better is to admit there's a problem.
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What are you guys talking about this has happened a bunch in the past, more with other specialties but pretty well documented cases in Rad onc too. Other specialists always know that being truthful on this has the chance to hurt you and some programs like JHU surgery or maybe duke ortho can’t recall was lost accreditation Bc of these surverys
 
elementaryschooleconomics said:
Honestly, as someone with a "boots on the ground" perspective - the same reasons which have helped medical students avoid the field are the same reasons residents won't just rubber stamp the surveys moving forward. The oversupply is real, the residency expansions were harmful - and the ones who are harmed the most are the people who committed themselves to this specialty for life. If you're a current resident, watching opportunities vanish for those ahead of you but unable/unwilling to bail out as you watch medical students run behind you - what is left? You can only hope to be trained as the best Radiation Oncologist you can possibly be. You should DEMAND your program give you the training to be the kind of doctor operating at the apex of your potential - nothing less than this is appropriate.

Departments which leave residents to fend for themselves should no longer be tolerated. If you're going to throw residents into the tightest job market ever seen you OWE THEM, at a bare minimum, excellent training. Note monkeys and contour puppets left to memorize RadOncQuestions on their own is NOT what it means to be a resident physician.
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Residents will always be a vulnerable population. You want someone to put a decade of education and jumping through hoops on the line by bringing their program down? Keep in mind how hard current residents worked to scrape by with a spot anywhere in radiation oncology. This isn't even a radonc specific problem, residency and the contracts that go along with it are fundamentally unethical, and in medicine we allow this to continue.
 
goodkerma said:
Residents will always be a vulnerable population. You want someone to put a decade of education and jumping through hoops on the line by bringing their program down? Keep in mind how hard current residents worked to scrape by with a spot anywhere in radiation oncology. This isn't even a radonc specific problem, residency and the contracts that go along with it are fundamentally unethical, and in medicine we allow this to continue.
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It is not easy to shut an accredited program down, and if a program with poor survey scores as the inciting event can't work with the faculty and residents to rectify issues, they probably deserve to be shut down. A year or two of bad survey scores are not, by themselves, going to shut a program down and leave residents unemployed. It's just not true.

Here's the list of all programs with probationary status for 2020-2021:


A total of 15 out of thousands.

Notably...2/15 are RadOnc.
 
Unfortunately, cruelty is seen as a feature, not a bug by those in charge in America currently.

If you’re an undergrad considering medicine: don’t.

If you’re a med student considering rad onc: don’t.

If you’re a FMG considering SOAP: don’t.

The ship is a sinking.
 
Folks, please don't forget that in 2019 ASTRO said:

"The Radiation Oncology (RO) Model announced today by the Center for Medicare and Medicaid Innovation (Innovation Center) is a step forward in allowing the nation’s 4,500 radiation oncologists to participate in the transition to value-based care that improves outcomes for cancer patients."

Ok. You invited the vampire into your house and now it's sucking your blood and just generally being a vampire. Problem is, I'm a housemate and I didn't get a vote on who to let into the house! ASTRO 2019: APM's great. ASTRO 2020: Weeping and gnashing of teeth.
Not to put too fine a point on it but I am p**sed at ASTRO. They're not helpful. They're either really stupid or have some ulterior motives. You can't constantly flirt with scenarios that have negative logical conclusions and whine and complain when the logical conclusions arrive.
 
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scarbrtj said:
Folks, please don't forget that in 2019 ASTRO said:

"The Radiation Oncology (RO) Model announced today by the Center for Medicare and Medicaid Innovation (Innovation Center) is a step forward in allowing the nation’s 4,500 radiation oncologists to participate in the transition to value-based care that improves outcomes for cancer patients."

Ok. You invited the vampire into your house and now it's sucking your blood and just generally being a vampire. Problem is, I'm a housemate and I didn't get a vote on who to let into the house! ASTRO 2019: APM's great. ASTRO 2020: Weeping and gnashing of teeth.
Not to put too fine a point on it but I am p**sed at ASTRO. They're not helpful. They're either really stupid or have some ulterior motives. You can't constantly flirt with scenarios that have negative logical conclusions and whine and complain when the logical conclusions arrive.
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The only thing I want to invite into RadOnc's house:

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scarbrtj said:
Folks, please don't forget that in 2019 ASTRO said:

"The Radiation Oncology (RO) Model announced today by the Center for Medicare and Medicaid Innovation (Innovation Center) is a step forward in allowing the nation’s 4,500 radiation oncologists to participate in the transition to value-based care that improves outcomes for cancer patients."

Ok. You invited the vampire into your house and now it's sucking your blood and just generally being a vampire. Problem is, I'm a housemate and I didn't get a vote on who to let into the house! ASTRO 2019: APM's great. ASTRO 2020: Weeping and gnashing of teeth.
Not to put too fine a point on it but I am p**sed at ASTRO. They're not helpful. They're either really stupid or have some ulterior motives. You can't constantly flirt with scenarios that have negative logical conclusions and whine and complain when the logical conclusions arrive.
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I always struggle with press releases like that. How much is sincere? How much is rah-rah bull ****? How much is just grim acceptance?

Nevertheless, it would have been better had ASTRO said something like, "The Radiation Oncology (RO) Model announced today by the Center for Medicare and Medicaid Innovation (Innovation Center) is an unprecedented proposal to bundle services while dramatically decreasing the reimbursement of our member physicians and organizations. Almost assuredly, this will restrict access to health care and latest treatments for cancer patients as an unintended consequence. While we fully endorse value driven practice, we find the proposed solution unacceptable and urge all of our membership to contact their local representatives and donate to our PAC such that we can continue the fight for accessible quality health care for those impacted by cancer."


Just a highly ineffective organization.
 
Mandelin Rain said:
I always struggle with press releases like that. How much is sincere? How much is rah-rah bull ****? How much is just grim acceptance? .... Just a highly ineffective organization.
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Carbonionangle talks about the cojones a lot. Helps to have 'em. I'm much more a "rage, rage against the dying of the light" even in the face of grim odds vs a Bobby Knight approach.
 
Pharma does direct to consumer advertising. Why not ASTRO?

Show the decade long trend of iterative reimbursement decline of rad onc. Show the sky rocketing cost of oncologic drugs. Show them next to eachother in absolute terms (with drug cost more than dwarfing all of rad onc expenditures). Play some ominous music and show "former pharma president and board member of the largest pharma lobby" Alex Azar.

"And now.... Alex Azar is threatening to cut your access to high quality and high value cancer services so he can enrich the pharmaceutical companies he once, and continues to serve. Swamp drained? You decide. Vote on November 3rd and contact your local representative and tell them to protect your right to cancer care."
 
Mandelin Rain said:
Pharma does direct to consumer advertising. Why not ASTRO?

Show the decade long trend of iterative reimbursement decline of rad onc. Show the sky rocketing cost of oncologic drugs. Show them next to eachother in absolute terms (with drug cost more than dwarfing all of rad onc expenditures). Play some ominous music and show "former pharma president and board member of the largest pharma lobby" Alex Azar.

"And now.... Alex Azar is threatening to cut your access to high quality and high value cancer services so he can enrich the pharmaceutical companies he once, and continues to serve. Swamp drained? You decide. Vote on November 3rd and contact your local representative and tell them to protect your cancer care."
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That's a wonderful idea that I am absolutely sure will not come to pass, as ASTRO is incompetent beyond belief.
 
Mandelin Rain said:
I always struggle with press releases like that. How much is sincere? How much is rah-rah bull ****? How much is just grim acceptance?

Nevertheless, it would have been better had ASTRO said something like, "The Radiation Oncology (RO) Model announced today by the Center for Medicare and Medicaid Innovation (Innovation Center) is an unprecedented proposal to bundle services while dramatically decreasing the reimbursement of our member physicians and organizations. Almost assuredly, this will restrict access to health care and latest treatments for cancer patients as an unintended consequence. While we fully endorse value driven practice, we find the proposed solution unacceptable and urge all of our membership to contact their local representatives and donate to our PAC such that we can continue the fight for accessible quality health care for those impacted by cancer."


Just a highly ineffective organization.
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I think ASTRO (and academia) thought they would get a proton exemption. If APM gives them a proton/MRI/adaptive XRT exemption and shifts the rad onc world to a 5 fraction world, then enormous cancer centers "win." No more second opinion no treats, just second opinion, stay in hotel for a week, and you're done and lots of revenue on the proton/MRI side as well

I think the lack of proton/MRI exemption (off trial) and no consideration at all for gyn brachy boost implications (and pandemic issues) has thrown them for a loop.

I think there are a lot of differing agendas at play, but any time CMS comes with a "plan" to help "quality," there is pretty much no scenario where it seems beneficial to play a long nicely.
 
Mandelin Rain said:
Ok. You invited a fox to the (white) hen house and now he's invited all the other foxes over and they are eating the hens and generally doing foxy things. Only problem is, I need those eggs too and didn't vote to let the fox in.
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Even though we, for the most part, won't leave that talk with positive feelings, at least we can come away from it knowing we deserve to have our field collapse for all the awful things we've done, have thought about doing, or want to do without knowing we want to do them.
 
BobbyHeenan said:
I think ASTRO (and academia) thought they would get a proton exemption. If APM gives them a proton/MRI/adaptive XRT exemption and shifts the rad onc world to a 5 fraction world, then enormous cancer centers "win." No more second opinion no treats, just second opinion, stay in hotel for a week, and you're done and lots of revenue on the proton/MRI side as well

I think the lack of proton/MRI exemption (off trial) and no consideration at all for gyn brachy boost implications (and pandemic issues) has thrown them for a loop.

I think there are a lot of differing agendas at play, but any time CMS comes with a "plan" to help "quality," there is pretty much no scenario where it seems beneficial to play a long nicely.
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Yup. Any threat to reimbursement, your stance has to be to fight it tooth and nail. Publicly if needed.
 
BobbyHeenan said:
I think the lack of proton/MRI exemption (off trial) and no consideration at all for gyn brachy boost implications (and pandemic issues) has thrown them for a loop.

I think there are a lot of differing agendas at play, but any time CMS comes with a "plan" to help "quality," there is pretty much no scenario where it seems beneficial to play a long nicely.
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This. And this.
Mandelin Rain said:
Yup. Any threat to reimbursement, your stance has to be to fight it tooth and nail. Publicly if needed.
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As Roger Waters says there is no Us + Them. We are all RadOnc. Hurt one, we all hurt. Help one, we all benefit. Time to toss petty compartmentalizing (academics, private, proton, non-proton, UroRads) and snarky "othering" out the window. ASTRO had longstandingly preached, preached, preached a divisive sermon (present ASTRO keynote speaker: exhibit #1) instead of listening, supporting, being non-judgmental. Now they're getting preached to it's not so fun.
 
scarbrtj said:
This. And this.

As Roger Waters says there is no Us + Them. We are all RadOnc. Hurt one, we all hurt. Help one, we all benefit. Time to toss petty compartmentalizing (academics, private, proton, non-proton, UroRads) and snarky "othering" out the window. ASTRO had longstandingly preached, preached, preached a divisive sermon (present ASTRO keynote speaker: exhibit #1) instead of listening, supporting, being non-judgmental. Now they're getting preached to it's not so fun.
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The academic centers who have negotiated monopolistic prices from payers do not- and never will- see themselves as "all one" with the rest of us. I have zero doubt they've been hoping the RO-APM will be nail in their competitors' coffins.
 
OTN said:
The academic centers who have negotiated monopolistic prices from payers do not- and never will- see themselves as "all one" with the rest of us. I have zero doubt they've been hoping the RO-APM will be nail in their competitors' coffins.
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The pps exemption for the anointed NCI-designated CCs to everything, including APM afaik, continues for a reason...
 
Tigerstang said:
They have started to one better. Open up satellites to compete with said practices.
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Yep- no need to "buy out" a practice when you can use the piles of money you get by bilking the system to simply advertise your competition out of existence.
 
RickyScott said:
So shouldn’t nci centers buy out other practices since they can charge so much more?
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They are already. Multiple PPS-exempt hospitals have ballooned their satellite network over the past 10 years. Not sure what is the rate of satellite boom at NCCN-member institutions (is that the same as NCI center?) that are not PPS-Exempt.
 
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