Rad Onc Twitter

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Mandelin Rain said:
Ok. You invited a fox to the white hen house on the farm 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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yup. No eggs. No butter. Just bread. So only bread lines. If it was not for the foxes,it would be egg sandwiches. Well at least the foxes had their fill.
 
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.
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Well, so, guy who is REALLY in the know today says in APM protons will be exempt and brachy will be exempt. Now, if the person who I think should be supremely in the know is wrong I will have the sense of fairness that protons didn't get exempted, but on the other hand it really wouldn't bode well were he to be wrong. (But every single discussion with a major academic always leads at least in part to them spouting some really, uh, wacky ideas billing-wise that seem to only fly in the academic world so we will see.)
 
scarbrtj said:
Well, so, guy who is REALLY in the know today says in APM protons will be exempt and brachy will be exempt. Now, if the person who I think should be supremely in the know is wrong I will have the sense of fairness that protons didn't get exempted, but on the other hand it really wouldn't bode well were he to be wrong. (But every single discussion with a major academic always leads at least in part to them spouting some really, uh, wacky ideas billing-wise that seem to only fly in the academic world so we will see.)
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What? Who says protons and brachy will be exempt? This doesn't make any sense.
 
scarbrtj said:
Well, so, guy who is REALLY in the know today says in APM protons will be exempt and brachy will be exempt. Now, if the person who I think should be supremely in the know is wrong I will have the sense of fairness that protons didn't get exempted, but on the other hand it really wouldn't bode well were he to be wrong. (But every single discussion with a major academic always leads at least in part to them spouting some really, uh, wacky ideas billing-wise that seem to only fly in the academic world so we will see.)
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I don't know many "in the know" on this, but the one that does tend to know these things (used to do some DC advocacy/lobbying) was absolutely shocked about lack of proton exemption. Nothing else in APM was surprising but that floored him. He too thinks it’s still not concrete that protons will be included and there will be heavy push to change it to exempt.
 
How exactly will the govt decide if this is successful or not? It seems from the outset a forgone conclusion. It will save them money because they don’t pay out as much. Utilization? What exactly?

It just seems it will be successful from CMS perspective regardless of what happens.
 
RadsWFA1900 said:
How exactly will the govt decide if this is successful or not? It seems from the outset a forgone conclusion. It will save them money because they don’t pay out as much. Utilization? What exactly?

It just seems it will be successful from CMS perspective regardless of what happens.
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I agree with this.

Some other APM programs though (?ortho maybe?) were rolled out then pulled back after they were tried. I just don't see how this doesn't reduce payments and radiation usage - but with no real metrics to track if it harms patients so of course it will be "successful" for CMS.

I'm shooting from the hip though, I don't know the full details of how they're going to measure things.
 
BobbyHeenan said:
I don't know many "in the know" on this, but the one that does tend to know these things (used to do some DC advocacy/lobbying) was absolutely shocked about lack of proton exemption. Nothing else in APM was surprising but that floored him. He too thinks it’s still not concrete that protons will be included and there will be heavy push to change it to exempt.
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My shop is considering protons but I looked up our zip code and we are in the program so I Guess that’ll be put on hold it indefinitely if no exemption is made.

Honestly if protons get an exemption I could see them pressuring us to “upsell” the potential benefits of protons. On the other hand if they don’t, I could see them handing me a pink slip or a huge paycut in the next 2 years.
 
BobbyHeenan said:
I agree with this.

Some other APM programs though (?ortho maybe?) were rolled out then pulled back after they were tried. I just don't see how this doesn't reduce payments and radiation usage - but with no real metrics to track if it harms patients so of course it will be "successful" for CMS.

I'm shooting from the hip though, I don't know the full details of how they're going to measure things.
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Exactly what harm? Wait time? Survival - if it’s survival we are totally screwed. Patient satisfaction?

Under what circumstances would the program be considered a failure?

It’s not clear at all probably because their aren’t many circumstances.
 
RadsWFA1900 said:
Exactly what harm? Wait time? Survival - if it’s survival we are totally screwed. Patient satisfaction?

Under what circumstances would the program be considered a failure?

It’s not clear at all probably because their aren’t many circumstances.
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Look at 1) how many Medicare patients were/are treated before and after implementation, 2) how many seek treatment at FFS institutions within 90 day window of treatment at an APM institution, 3) QALY in APM vs. FFS
 
1601498606776.png


This is amazing.
 
elementaryschooleconomics said:
View attachment 319451

This is amazing.
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I am surprised they went public with this instead of just internally distributing this among all of Harvard Med School students and no one else. Look at their resident selections. Take your own med students much? Elitist much? If I were a non-Harvard med student I wouldn't touch this program with a 10 foot pole because their program will probably shame and demoralize you throughout the 4 years of rad onc residency for not going to Harvard Med School.
 
elementaryschooleconomics said:
View attachment 319451

This is amazing.
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I mean even MSKCC and MDA are doing it. My mindset is shifting from "lol scrub programs can't find a warm body" to "well nobody can do away rotations this year b/c of COVID so this is the 'crash course'"

At least for the programs that don't have to worry about going unmatched I suppose.
 
Ray D. Ayshun said:
It's a double hit. Not only is the job market tough for this year's residents, they also have to be the face of the program on Twitter.
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I just got a shiver thinking about how annoyed and bitter I would be if I were a resident now and was pressured into recruiting med students on twitter.
 
Lamount said:
I just got a shiver thinking about how annoyed and bitter I would be if I were a resident now and was pressured into recruiting med students on twitter.
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I can personally assure you that trying to recruit medical students right now because the faculty demand it is excruciating.
 
Lamount said:
I just got a shiver thinking about how annoyed and bitter I would be if I were a resident now and was pressured into recruiting med students on twitter.
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Think it's bad enough for disgruntled residents at bad programs to put on a happy face 2-3x a year for interviews?

Now try that same demoralizing faculty essentially forcing you to sell your soul on social media with lies and further reduce your future job prospects. Rock meet hard place.
 
metallica81788 said:
Think it's bad enough for disgruntled residents at bad programs to put on a happy face 2-3x a year for interviews?

Now try that same demoralizing faculty essentially forcing you to sell your soul on social media with lies and further reduce your future job prospects. Rock meet hard place.
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... or becoming faculty and being forced to do the same happy face on Twitter to recruit medical students.
 
StIGMA said:
... or becoming faculty and being forced to do the same happy face on Twitter to recruit medical students.
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If people could be honest with each other, perhaps departments would find the bulk of residents and faculty think they shouldn't be doing what they're "forced" to be doing?

Now I'm really enjoying the mental image of a resident and attending at an academic program both pretending to be happy for a medical student because they think the other one expects it of them.

Classic.
 
elementaryschooleconomics said:
If people could be honest with each other, perhaps departments would find the bulk of residents and faculty think they shouldn't be doing what they're "forced" to be doing?

Now I'm really enjoying the mental image of a resident and attending at an academic program both pretending to be happy for a medical student because they think the other one expects it of them.

Classic.
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I think the wise thing to do as a resident is talk up the most socially inept and incompetent applicants. You know, the unemployable ones. Push for them to be ranked highly...
 
elementaryschooleconomics said:
If people could be honest with each other, perhaps departments would find the bulk of residents and faculty think they shouldn't be doing what they're "forced" to be doing?

Now I'm really enjoying the mental image of a resident and attending at an academic program both pretending to be happy for a medical student because they think the other one expects it of them.

Classic.
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Or the Nash Equilibrium: a game where two or more players in which each player is assumed to know the equilibrium strategies of the other players, and no player has anything to gain by changing only their own strategy.

If each player has chosen a strategy—an action plan choosing its own action based on what it has seen happen so far in the game—and no player can increase its own expected payoff by changing its strategy while the other players keep theirs unchanged, then the current set of strategy choices constitutes a Nash equilibrium.
 
thecarbonionangle said:
This guy really wants you to know he wears a mask. Guys did you know he wears a mask? Lots of virtue in this guy. We’ll now you know. You’re welcome, sir.
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Jeff "Don't Shake My Hand" White
Jeff "Movie Theaters Can Suck It" White
Jeff "I Carry A 6ft Measuring Tape" White
Jeff "Anti-Anti-Malarial Drug" White

AKA Unpopular Twitter Quote Handles
 
Speaking of rad oncs and masks. Today my chairman had a brown stain on his dirty cloth mask. I could not stop staring at it at the research meeting. Was it worcestire sauce from eating tortured baby cow? Dried grease from biriyani ghee? Dried blood from sucking the life of residents? Poop or some other unthinkable filth? Gosh these people disgust me.
 
Lamount said:
Look at 1) how many Medicare patients were/are treated before and after implementation, 2) how many seek treatment at FFS institutions within 90 day window of treatment at an APM institution, 3) QALY in APM vs. FFS
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1. I don’t see that being all that different but could push the APM guys to treat more

2. QALY probably going to be similar or better
 
scarbrtj said:
in the news today...

IRRELEVANT OLD MAN SHAKES FIST AT COMPUTER SCREEN, YELLS
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I can't stop laughing at these Tweets: 1) Politically biased old white doctor makes biased post using Twitter account that might be run by a paid social media person, 2) Radically candid old white doctor makes ad hominem attacking counter Tweet that Doctor #1 definitely won't see.

1601663891480.png
 
elementaryschooleconomics said:
I can't stop laughing at these Tweets: 1) Politically biased old white doctor makes biased post using Twitter account that might be run by a paid social media person, 2) Radically candid old white doctor makes ad hominem attacking counter Tweet that Doctor #1 definitely won't see.

View attachment 319592
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Having Ralph yell "you don't know anything about prostate cancer!" is like... well you know what it's like.
 
elementaryschooleconomics said:
"Everything is fine! Oversupply is a lie! APM is weak! General supervision is illegal!"

View attachment 319744
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In all seriousness, the title acknowledges one problem, and the talks/objectives another. The talks are addressing the awareness problem, essentially, how do we make med students more aware of what we do? The title of the session, including the idea of "waning interest," implies that the med students are aware of our specialty, they're just not interested. Ultimately, the only way to address the interest problem through an increase in "awareness," is basically what you're saying, subterfuge. The other way to address the interest problem might be to do what the med students are asking us to do, reduce the number of trainees.
 
"A Roadmap for Recruiting Medical Students into Radiation Oncology during a Period of Waning Interest"

This is just completely embarrassing. How on earth could ASTRO approve such a panel?

An synonymous title would be-

How to Deceive Trainees that Already Know that the Future of the Field is Endangered.

As pointed out above the topics have nothing to do with the title of the session.

ASTRO has "jumped the shark".
 
Chartreuse Wombat said:
"A Roadmap for Recruiting Medical Students into Radiation Oncology during a Period of Waning Interest"

This is just completely embarrassing. How on earth could ASTRO approve such a panel?

An synonymous title would be-

How to Deceive Trainees that Already Know that the Future of the Field is Endangered.

As pointed out above the topics have nothing to do with the title of the session.

ASTRO has "jumped the shark".
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and Astro won’t take a position on residency expansion, although Paul Harari did “express concern” .
 
-Leaders increase spots ignoring all the warning signs

-Leaders attempt to capitalize on the phenomenon of medical students being smart and noticing said warning signs by deploying further subterfuge

What will the leaders of the field do next? How will the disgruntled generation of young ROs respond ?
 
elementaryschooleconomics said:
General supervision is illegal!"
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There is really a new supervision level. General supervision (the physician is available, by phone e.g., but not physically present) and direct supervision (physician is available in the building) exist still. And personal exists, which is the highest level. General covers hospital MDs per CMS but ASTRO said "no, it's still direct supervision for imaging." BUT... ASTRO has openly reversed itself on that:

"ASTRO interprets the revised definition [of no physical presence necessary] to apply to all radiation oncology services delivered in the freestanding [or hospital] setting for the duration of the PHE."
"ASTRO interprets the revised policy [of no physical presence necessary] to apply to both CT Image Guidance (CPT code 77014) and Stereoscopic X-Ray Guidance (CPT code 77421) for the duration of the PHE."

Furthermore, this "direct virtual supervision" is being extended until Dec 31, 2021:

"Direct Supervision by Interactive Telecommunications Technology: In response to the COVID-19 PHE, CMS adopted a policy revising the definition of direct supervision to include the virtual presence of the supervising physician or practitioner using interactive audio/video real-time communications technology. For CY 2021, CMS is proposing to allow direct supervision to be provided via real-time interactive audio and video technology (excludes telephone technology that does not also include video) through the end of the PHE or December 31, 2021, whichever comes later."

So, in reality, we had three levels of supervision in America that apply in rad onc, and medicine: general, direct, personal. But now there are four. "Direct virtual" or "virtual presence" is the new one. (BTW I have been calling this for a couple years.) It's "direct virtual" that applies to *ALL* (per ASTRO) radiation oncology services now, and at least until Dec 31, 2021. Up to each of you to guess whether or not the genie will be stuffed back into the bottle come 2022.
 
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RickyScott said:
and Astro won’t take a position on residency expansion, although Paul Harari did “express concern” .
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Harari threw up his hands in the air and mentioned the "antitrust" argument, which only works in one direction apparently
 
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