Rad Onc Twitter

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One way or another, we will produce this highly prized data demonstrating the suffering that everyone seems to be asking for. This is happening right now -- Of course, this year's experience will be immediately affixed with an asterisk due to COVID, and all of this unpleasantness will be ignored once again. Yet another year down the drain where we could have steered the titanic a little bit farther afield from the iceberg. But really it's too late, we already hit the iceberg and now all we can do is bail some of the water out. Of course, we need "data" to do this, apparently.

Personally, I have applied to 30+ jobs and have many friends that have applied to far more. Some are even looking at positions in other countries. The effort required to get serious consideration for a good job in this field is immense. It is true that the "good" jobs are for the most part not posted, and it's pure luck if you even hear about them in time. Almost all of the publicly posted jobs have some sort of "catch" associated with them -- think, "yes, we are hiring, but...". Real life examples of this include "but this is not a partnership track position", "but this is at a satellite 2 hrs away", "but we will pay you almost nothing". Throw in studying for boards, COVID, social isolation, and 10+ consults a week and you have a grand old time.
 
thecarbonionangle said:
until places like MDACC have their own in breadlines after golden handshake, satellites are simply not enough, then they will finally admit there is “data”. Until then you will see lots of winking going on. Trust me 😉
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You are correct. Exactly like what happened North of the border.

Time to plagiarize a poem and make it about "rad onc rocks"

I am Radiation Oncology, Baron of the breadlines ;
Look on my Works, ye Mighty, and despair!
Nothing beside remains. Round the decay
Of that vault's Wreck, boundless and bare
The lone and level sands stretch far away.”

1603681487764.png


Circa 2050 from the future with the last Linac being dismantled after all indications for radiation were omitted
 
Zahramar said:
You are correct. Exactly like what happened North of the border.

Time to plagiarize a poem and make it about "rad onc rocks"

I am Radiation Oncology, Baron of the breadlines ;
Look on my Works, ye Mighty, and despair!
Nothing beside remains. Round the decay
Of that vault's Wreck, boundless and bare
The lone and level sands stretch far away.”

View attachment 321358

Circa 2050 from the future with the last Linac being dismantled after all indications for radiation were omitted
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“
Sophocles long ago
Heard it on the Ægean, and it brought
Into his mind the turbid ebb and flow
Of human misery; we
Find also in the sound a thought,
Hearing it by this distant northern sea.

The Sea of Faith
Was once, too, at the full, and round earth’s shore
Lay like the folds of a bright girdle furled.
But now I only hear
Its melancholy, long, withdrawing roar,
Retreating, to the breath
Of the night-wind, down the vast edges drear
And naked shingles of the world.

Ah, love, let us be true
To one another! for the world, which seems
To lie before us like a land of dreams,
So various, so beautiful, so new,
Hath really neither joy, nor love, nor light,
Nor certitude, nor peace, nor help for pain;
And we are here as on a darkling plain
Swept with confused alarms of struggle and flight,
Where ignorant armies clash by night.”
 
I am not a regular poster here, but i have to chip in my 2 cents.

I'm in private practice in what most would consider a highly desirable metropolitan area and have been for over a decade. In my early years i may have recieved one or two random email inquiries about joining the practice. This is without any posting/indication a position was available nor were we planning to hire. I saw them as an interesting curiosity and politely complimented their impressive cv, but told them we were not hiring.

The past few years this has changed and i now receive randon inquiries regularly. It is both sad and disturbing. There are enough of them that i only briefly reply that we are not looking at adding anyone now or in the foreseeable future.

These letters have a degree of desperation oozing from them. When these people receive responses like mine, i think it is certain that this frustration trickles down being conveyed to medical students when they interact with these residents.

My point is that it is ridiculous to lay blame at the feet sdn for "scaring" medical students. When decay sets in it is evident in many ways, posts on sdn are only one.
 
Sorry Chelain it’s good of you to come here but you should put yourself in the shoes of med students, promising smart talented med students. I presume the MDACC residents who had their job offers pulled were exactly those types of med students. Should the MDACC experience not ‘scare’ med students?

“I find it stressful to see anonymous people say there are no jobs when I know that if I had been reading these comments as a 3rd or 4th year medical student they would have profoundly influenced my decision to go into radiation oncology.”

The MDACC situation this year should profoundly influence a med students decision. A simple search of the trash on the Astro job board where fellowships outnumber actual jobs should profoundly influence a med students decision. Our annecdotes, many of us who’s life’s have been forever changed Bc we can’t move where we want Or need in order to be with family while watching much less hard working and less talented classmates not having any issue should influence their decision.
 
radoncqs said:
Hi everyone - this is Chelain.

I hope you all know that I've spent a lot of time over the past 2-3 years advocating for residents, encouraging the ACGME to impose greater minimum requirements for accreditation of residency programs, conversing with leaders in the field regarding what has been happening regarding residency expansion, discussing with the ABR regarding issues to do with the qualifying examinations and the need for virtual examinations - and also amplifying the voices of those discussing the job market. We spent a lot of time collecting data for the ARRO graduating resident survey this year. We also submitted a proposal to ASTRO for a prospective workforce database/registry for graduating residents, which was well received.

I am in agreement with much of what Chirag and others have said. But, it's hard to watch people who spend a lot of time and energy working on these issues get ganged up on in a public forum. I find it stressful to see anonymous people say there are no jobs when I know that if I had been reading these comments as a 3rd or 4th year medical student they would have profoundly influenced my decision to go into radiation oncology.

I'm not saying we need "proof" the job market sucks - if such data exists it would obviously be catastrophic. But, the number of posts on twitter saying how horrible things are in response to perhaps some favorable data is also irresponsible and unfair. I'm not a gaslighter. I haven't drunk the Kool-Aid. I'm not asking for people to demonstrate "pain and misery" prior to advocating for change - I've been advocating for change for a while now. The only thing I've tried to do is present and discuss the data - that's the only thing I asked for.

Chelain
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Chelain,

Huge props to you for joining us here for debate. To a person, each and every one of us misanthropes feels this way.

We’re here on this board because, frankly, we don’t have the power to affect change within the academic institutions which control the future of our field. You will. That’s why I was hard on you, and perhaps a bit too much so- because you will truly have the chance to make a difference.

Your commitment and caring for trainees, young attendings, and medical students is self-evident. This compassion and concern, when focused through the lens of academic institutional power you will achieve, could really change our field in a very meaningful way.

I would only ask that you take what we’re saying into account along with what you hear in the halls of your venerated institution. We are by no means the sole arbiters of Truth, but I would also argue that we too deserve the principle of charity when it comes to our goals and motivations- just as you do.

It’s abundantly clear to me that you, just like us, want the best for our field, faculty, and residents moving forward. Let’s work together to get it done.
 
radoncqs said:
But, the number of posts on twitter saying how horrible things are in response to perhaps some favorable data is also irresponsible and unfair.
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Chelain you are fighting a good fight. But disagreement doesn’t equal irresponsibility. Reality ultimately wins. People, especially med student people, are generally too smart to be tricked.

Is there any favorable data at this point? I saw the 70 new rad oncs a year poster. That data is very suspect—not just my opinion here, I’m talking data too. Fellowships rising. Average treatment length down from 4.5 weeks to 3 weeks over the last 10 years (bad in a fee for service world for salaries and bad for linac utilization). Supervision abolishment was like a mini nuke when it hit. Now people spend hundreds of calories a day explaining why it doesn’t matter or really didn’t happen (the ASTRO Theorem). Resident experience in terms of cases significantly declined over last decade. Add in APM angst, when/if it arrives. All data says cancer incidence is growing about 1% a year.

This “favorable data” must be the abscopal effect’s cousin
 
radoncqs said:
Hi everyone - this is Chelain.
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Hi Chelain, I appreciate everything you've done with ACGME, ARRO, ABR, ASTRO over the years. I don't know you but I know people who know you and I'm 100% sure you’re a wonderful person and doctor, and are more selfless than 99% of us. It can get out of hand at times on an anonymous forum, and in that sense my SDN persona is no different than how I'd behave on Reddit, the AOL chat forums of the 90's, or a political campaign page.

Anyways, like @elementaryschooleconomics, much of what I post on SDN is to dissuade talented, motivated med students from pursuing radiation oncology. The "brain drain" that you're seeking to avoid, I'm seeking to promote. Why?
  • First, disregarding the job market, radiation oncology is less able to foster physician-scientists or clinical investigators than other specialties. You and your peers may be attempting to change that with advocacy work, but it's a fact that MD/PhD's and talented MD's who have traditionally been interested in rad onc have a more difficult time securing R01's, etc. than their med onc peers. Even when I was a medical student, chairs and attendings told me this, and encouraged me to consider other specialties.
  • Second, the job market is deteriorating. Compensation, location of jobs, physician-ownership, time to partnership, terms of partnership, negotiation power, etc. all of these things have been deteriorating over the years based on my job interviews, which I treated as a part-time job for months. Sure, it's just my anecdote, and you're asking for data. I may post data on SDN later, and others have posted data here before, but I can't publish data on Twitter or in peer-reviewed journals. I don't feel safe with some of our academic leaders who read or run these journals. I know you like to say "we're on the same side" but some of them are not on our side, they would love to get top tier med students into rad onc and pay them $250k/year as attendings to work 60 hour weeks with no protected time, or farm them out to a rural satellite with no opportunity for career development or practice ownership. They publicly humiliated a junior attending for speaking up in the past. I'm not up for that.
  • Third, unlike others, I have no faith that residency programs will contract significantly. If that’s the case, high achieving students deserve a better future in other fields. Other non-traditional students, IMG’s, Caribbean grads, etc., they may still be happy to make $350k/year in a small town. They’d be a better fit for the current needs of the job market. Net utility is higher than if 200 MD/PhD superstars were still applying to rad onc every year, because frankly: 1) there aren’t 200 residency slots per year that deserve an MD/PhD superstar like yourself; and 2) there aren’t 200 MDA or MDA-quality attending jobs available per year. It’s all about residency education (1) and job market (2); not just for the top 30% of the annual cohort, but for the bottom 70% as well. When I post, I’m simply communicating my N-of-1 experience on (1) and (2) to students.
I hope that helps.
 
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imhopeful432 said:
Fair - but I would argue they (Goodman, etc) are trying to push for stricter ACGME requirements, residency program shrinkage, no SOAPing, flaming programs that expand/SOAP - although yes, unfortunately, unsuccessfully, so far. But I do think they are part of the solution...despite the lack of data as she says
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I agree with you. I think Dr. Goodman is doing the right thing from her recent/current perspective on the issue.

But this is not thinking big picture. Let's consider 1 example. ASTRO is investing in significant lobbying into political matters affecting radiation (APM etc). There are specific ASTRO staff that work on this and talk with key politicians, including things that affect APM implementation, etc. Advocacy - American Society for Radiation Oncology (ASTRO) - American Society for Radiation Oncology (ASTRO)

I would point out that "anti-trust" arguments against residency contraction have never been brought to this level of "desire for change" within ASTRO. Shouldn't ASTRO be discussing residency contraction at the highest legal levels - with sustained and full-time staffing effort- if it is a critical issue for them?

Perhaps this is because having more residents and, subsequently, more ASTRO members benefits them? So while Dr. Goodman is doing admirable work... in my perspective it is providing more ammunition to keep the status quo, because those supporting her efforts know what they are doing.

You cannot capture a downward trend in a single timepoint survey. Unemployment will not occur because fellowships or other exploitative positions will continue to expand. The indicators we need to initiate residency contraction exist... and the people who would decide to do that are choosing not to do so because it is beneficial to them to keep things as they are, to the detriment of our current and future trainees.
 
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St0rm said:
One way or another, we will produce this highly prized data demonstrating the suffering that everyone seems to be asking for. This is happening right now -- Of course, this year's experience will be immediately affixed with an asterisk due to COVID, and all of this unpleasantness will be ignored once again. Yet another year down the drain where we could have steered the titanic a little bit farther afield from the iceberg. But really it's too late, we already hit the iceberg and now all we can do is bail some of the water out. Of course, we need "data" to do this, apparently.

Personally, I have applied to 30+ jobs and have many friends that have applied to far more. Some are even looking at positions in other countries. The effort required to get serious consideration for a good job in this field is immense. It is true that the "good" jobs are for the most part not posted, and it's pure luck if you even hear about them in time. Almost all of the publicly posted jobs have some sort of "catch" associated with them -- think, "yes, we are hiring, but...". Real life examples of this include "but this is not a partnership track position", "but this is at a satellite 2 hrs away", "but we will pay you almost nothing". Throw in studying for boards, COVID, social isolation, and 10+ consults a week and you have a grand old time.
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30+ job applications?

1603710957416.png


I have personally hit 45-50, one of my coresidents is at least in that ballpark but they told me last week: "I stopped keeping track after a certain point, it's too depressing".

That being said, I know of 5-10 people who have signed this year. I also know that a few of those people basically just nailed it, and signed with talking to/interviewing with less than 5 places. Those people think "everything is fine, [they] don't understand why there's so much negativity on the internet".

Great, good for you guys! I wish I didn't understand the negativity. To use my analogy from earlier, we've all heard stories of people playing the lottery once and winning millions of dollars. To those people, Megabucks seems like a sure bet.

Don't be like those people, read the room...and the data.
 
There are over 20,000 graduating allopathic medical students annually and only 100 of them feel that Rad Onc is worth taking a stab at. This is not some new phenomenon. This has been trending for the last few years. The "best and brightest" medical students are just that. They see the writing on the wall. The glory days of radiation oncology are over, ruined by the greed and hubris of those that are currently running the ship, hoping to squeeze a few more easy bucks out of the twilight of their careers. Why would anyone want to dedicate 9 years of their life to enter this dumpster fire we've created when they are all but guaranteed to be able to walk into any radiology program in the country, get a job in any city in the country, and likely make as much or more than we do. I hate to burst the bubble here, but the intellectual and emotional rewards of this field are secondary to work life balance. Med students are not martyrs, nor should they be expected to be or vilified for not being.

What is there to be optimistic about?
1) Resident expansion in combination with fewer doctors retiring has led to an oversupply issue
2) Hypofractionation, APM, changes in coverage requirements, declining reimbursements, declining indications has led to a demand issue
3) Consolidation under academic institutions has lead to a job satisfaction and a job growth issue (i.e. enjoy your entry level salary in perpetuity)
4) Despite having historically recruited the "best and brightest", the field is not much further along than we were a decade ago and it is not inconceivable that as immunotherapy improves we may become completely obsolete. Imagine if rather than sinking all this money into hypofractionation studies we actually sought to discover new treatment indications.

The field is in shambles and the pandemic, in combination with the ill timed implementation of the APM (even if it has been delayed), has only accelerated that. Our practice in a highly desirable metro area was planning to fill a vacancy at the beginning of the year and those plans are on hold for the foreseeable future. Not even Salina, KS is hiring this year. I know for a fact that many of the jobs posted on the ASTRO job board have already been taken by internal candidates and are just being posted as a formality due to institutional requirements.

The worst part about this is that it is nothing new. It has been happening for the last 5-10 years, but the gaslighting continues. You can't tell me in the same breath that our field has recruited some of the smartest people in the country over the last 10 years and yet can't figure out that we have major supply/demand problems and we can't figure out how to fix them. They know, they simply don't care. Unfortunately we have moved past preventing it from happening and are now watching the opportunity for mitigation and damage control pass us by. Fauci would be disappointed.
 
RSAOaky said:
There are over 20,000 graduating allopathic medical students annually and only 100 of them feel that Rad Onc is worth taking a stab at. This is not some new phenomenon. This has been trending for the last few years. The "best and brightest" medical students are just that. They see the writing on the wall. The glory days of radiation oncology are over, ruined by the greed and hubris of those that are currently running the ship, hoping to squeeze a few more easy bucks out of the twilight of their careers. Why would anyone want to dedicate 9 years of their life to enter this dumpster fire we've created when they are all but guaranteed to be able to walk into any radiology program in the country, get a job in any city in the country, and likely make as much or more than we do. I hate to burst the bubble here, but the intellectual and emotional rewards of this field are secondary to work life balance. Med students are not martyrs, nor should they be expected to be or vilified for not being.

What is there to be optimistic about?
1) Resident expansion in combination with fewer doctors retiring has led to an oversupply issue
2) Hypofractionation, APM, changes in coverage requirements, declining reimbursements, declining indications has led to a demand issue
3) Consolidation under academic institutions has lead to a job satisfaction and a job growth issue (i.e. enjoy your entry level salary in perpetuity)
4) Despite having historically recruited the "best and brightest", the field is not much further along than we were a decade ago and it is not inconceivable that as immunotherapy improves we may become completely obsolete. Imagine if rather than sinking all this money into hypofractionation studies we actually sought to discover new treatment indications.

The field is in shambles and the pandemic, in combination with the ill timed implementation of the APM (even if it has been delayed), has only accelerated that. Our practice in a highly desirable metro area was planning to fill a vacancy at the beginning of the year and those plans are on hold for the foreseeable future. Not even Salina, KS is hiring this year. I know for a fact that many of the jobs posted on the ASTRO job board have already been taken by internal candidates and are just being posted as a formality due to institutional requirements.

The worst part about this is that it is nothing new. It has been happening for the last 5-10 years, but the gaslighting continues. You can't tell me in the same breath that our field has recruited some of the smartest people in the country over the last 10 years and yet can't figure out that we have major supply/demand problems and we can't figure out how to fix them. They know, they simply don't care. Unfortunately we have moved past preventing it from happening and are now watching the opportunity for mitigation and damage control pass us by. Fauci would be disappointed.
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Maybe we need to start keeping a table of the jobs being posted. Once they are filled, one can assign whether they were sham postings. Could even assign a designation: "Unlikely, Possible, Probable, or Definitely" a courtesy posting.
 
DireMoose said:
Maybe we need to start keeping a table of the jobs being posted. Once they are filled, one can assign whether they were sham postings. Could even assign a designation: "Unlikely, Possible, Probable, or Definitely" a courtesy posting.
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Not hard to keep a track of the employment mill/exploitative postings either that keep popping annually or every few years
 
RSAOaky said:
There are over 20,000 graduating allopathic medical students annually and only 100 of them feel that Rad Onc is worth taking a stab at. This is not some new phenomenon. This has been trending for the last few years. The "best and brightest" medical students are just that. They see the writing on the wall. The glory days of radiation oncology are over, ruined by the greed and hubris of those that are currently running the ship, hoping to squeeze a few more easy bucks out of the twilight of their careers. Why would anyone want to dedicate 9 years of their life to enter this dumpster fire we've created when they are all but guaranteed to be able to walk into any radiology program in the country, get a job in any city in the country, and likely make as much or more than we do. I hate to burst the bubble here, but the intellectual and emotional rewards of this field are secondary to work life balance. Med students are not martyrs, nor should they be expected to be or vilified for not being.

What is there to be optimistic about?
1) Resident expansion in combination with fewer doctors retiring has led to an oversupply issue
2) Hypofractionation, APM, changes in coverage requirements, declining reimbursements, declining indications has led to a demand issue
3) Consolidation under academic institutions has lead to a job satisfaction and a job growth issue (i.e. enjoy your entry level salary in perpetuity)
4) Despite having historically recruited the "best and brightest", the field is not much further along than we were a decade ago and it is not inconceivable that as immunotherapy improves we may become completely obsolete. Imagine if rather than sinking all this money into hypofractionation studies we actually sought to discover new treatment indications.

The field is in shambles and the pandemic, in combination with the ill timed implementation of the APM (even if it has been delayed), has only accelerated that. Our practice in a highly desirable metro area was planning to fill a vacancy at the beginning of the year and those plans are on hold for the foreseeable future. Not even Salina, KS is hiring this year. I know for a fact that many of the jobs posted on the ASTRO job board have already been taken by internal candidates and are just being posted as a formality due to institutional requirements.

The worst part about this is that it is nothing new. It has been happening for the last 5-10 years, but the gaslighting continues. You can't tell me in the same breath that our field has recruited some of the smartest people in the country over the last 10 years and yet can't figure out that we have major supply/demand problems and we can't figure out how to fix them. They know, they simply don't care. Unfortunately we have moved past preventing it from happening and are now watching the opportunity for mitigation and damage control pass us by. Fauci would be disappointed.
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Good post except for that hilariously bad take about immunotherapy. What’s the response rate again?
Also, radiology is not a good substitute for rad onc. Most of us want to take care of patients. Should have just said medical oncology
 
MegaVoltagePhoton said:
Good post except for that hilariously bad take about immunotherapy. What’s the response rate again?
Also, radiology is not a good substitute for rad onc. Most of us want to take care of patients. Should have just said medical oncology
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Probably get a little bit of that if you do breast in a larger center
 
bluebubbles said:
Hi Chelain, I appreciate everything you've done with ACGME, ARRO, ABR, ASTRO over the years. I don't know you but I know people who know you and I'm 100% sure you’re a wonderful person and doctor, and are more selfless than 99% of us. It can get out of hand at times on an anonymous forum, and in that sense my SDN persona is no different than how I'd behave on Reddit, the AOL chat forums of the 90's, or a political campaign page.

Anyways, like @elementaryschooleconomics, much of what I post on SDN is to dissuade talented, motivated med students from pursuing radiation oncology. The "brain drain" that you're seeking to avoid, I'm seeking to promote. Why?
  • First, disregarding the job market, radiation oncology is less able to foster physician-scientists or clinical investigators than other specialties. You and your peers may be attempting to change that with advocacy work, but it's a fact that MD/PhD's and talented MD's who have traditionally been interested in rad onc have a more difficult time securing R01's, etc. than their med onc peers. Even when I was a medical student, chairs and attendings told me this, and encouraged me to consider other specialties.
  • Second, the job market is deteriorating. Compensation, location of jobs, physician-ownership, time to partnership, terms of partnership, negotiation power, etc. all of these things have been deteriorating over the years based on my job interviews, which I treated as a part-time job for months. Sure, it's just my anecdote, and you're asking for data. I may post data on SDN later, and others have posted data here before, but I can't publish data on Twitter or in peer-reviewed journals. I don't feel safe with some of our academic leaders who read or run these journals. I know you like to say "we're on the same side" but some of them are not on our side, they would love to get top tier med students into rad onc and pay them $250k/year as attendings to work 60 hour weeks with no protected time, or farm them out to a rural satellite with no opportunity for career development or practice ownership. They publicly humiliated a junior attending for speaking up in the past. I'm not up for that.
  • Third, unlike others, I have no faith that residency programs will contract significantly. If that’s the case, high achieving students deserve a better future in other fields. Other non-traditional students, IMG’s, Caribbean grads, etc., they may still be happy to make $350k/year in a small town. They’d be a better fit for the current needs of the job market. Net utility is higher than if 200 MD/PhD superstars were still applying to rad onc every year, because frankly: 1) there aren’t 200 residency slots per year that deserve an MD/PhD superstar like yourself; and 2) there aren’t 200 MDA or MDA-quality attending jobs available per year. It’s all about residency education (1) and job market (2); not just for the top 30% of the annual cohort, but for the bottom 70% as well. When I post, I’m simply communicating my N-of-1 experience on (1) and (2) to students.
I hope that helps.
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Hi all - Thanks for your feedback and for welcoming me to this conversation. I'm on board with a large majority (if not all) of your points. I didn't mean to imply that we need to wait for further data to decide there is a problem. I agree with Dr. Shah that "we cant wait for absolute data to make changes" - as well as with the points that many of you have made regarding both residency expansion and challenges in the job market.

I just want to clarify why I began this conversation with MROGA on twitter to begin with, because I may have gotten lost in the details as the conversation went on. Some of the comments that were being made on twitter were personal attacks against people that really do care about these issues or statements that were quite hyperbolic/inflammatory. I'm completely supportive of presenting and discussing all data; I just think personal attacks or hyperbolic claims are unhelpful and hurtful. Real data is always going to be helpful as we attempt to achieve great change - but this doesn't mean this change needs to wait. I'll continue to do what I can to help.

Thanks -
Chelain
 
There's obviously a problem. If it's here right now or some distance up ahead, reasonable minds can disagree. But we can at least acknowledge the current path has us hitting the iceberg at some point. Problem is, it's a big ship. Once a match occurs, it takes at least 5 years before it can begin to turn.

Gotta spin the wheel hard right now.

If that means educators have to actually work to "coach em' up," or I have to pay more attention to applicant quality during interviews, or God forbid University of Oklahoma doesn't have 0.8:1 coverage; well, I'm prepared for the consequences. It's not like the Gilded Era of 2 decades MD/PhDs has yielded fantastic results in this country. Name the top 5 practice changing revelations of the last 10-15 years that originated in the US with all that brain power behind it. Honestly, it's probably pretty bleak.
 
Mandelin Rain said:
It's a big ship. Once a match occurs, it takes at least 5 years before it can begin to turn.

Gotta spin the wheel hard right now.

If that means educators have to actually work to "coach em' up," or I have to pay more attention to applicant quality during interviews, or God forbid University of Oklahoma doesn't have 0.8:1 coverage; well, I'm prepared for the consequences. It's not like the Gilded Era of 2 decades MD/PhDs has yielded fantastic results in this country. Name the top 5 practice changing revelations of the last 10-15 years that originated in the US with all that brain power behind it. Honestly, it's probably pretty bleak.
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You don't need MD PhDs in Rad Onc for innovation. You need people who can justify all this technology we have. People who push the envelope, people who are not brought down by boomer chairs.
 
Zahramar said:
You don't need MD PhDs in Rad Onc for innovation. You need people who can justify all this technology we have. People who push the envelope, people who are not brought down by boomer chairs.
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Exactly. Inaction for fear of a "brain drain" is not a great prescription. Where's the DATA that MD/PhDs have pushed our specialty forward, to be held in higher regard? Or that they've been supported to do so?
 
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Mandelin Rain said:
Exactly. Inaction for fear of a "brain drain" is not a great prescription. Where's the DATA that MD/PhDs have pushed our specialty forward, to be held in higher regard?
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Someone should do a study and look at data trying to correlate the number of tweets with achievements in the field. I am a gambling man, and I bet you'll see those inversely related.
 
Zahramar said:
Someone should do a study and look at data trying to correlate the number of tweets with achievements in the field. I am a gambling man, and I bet you'll see those inversely related.
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Each Tweet is an achievement in it's own right.
 
Zahramar said:
You don't need MD PhDs in Rad Onc for innovation. You need people who can justify all this technology we have. People who push the envelope, people who are not brought down by boomer chairs.
Click to expand...

That's how I feel. I have a PhD in physics. I used to work for a Linac manufacturer. When I went out to find jobs in rad onc, or even fellowships to keep doing rad onc device development as an MD/PhD, the big name places ignored me (and still do), and the interviews I got were 100% clinical mostly at satellites. It's been a huge struggle to do anything other than the usual retrospective reviews, which I've always found very disappointing.

What seems so obvious to us is clearly not to everyone else.
 
Neuronix said:
That's how I feel. I have a PhD in physics. I used to work for a Linac manufacturer. When I went out to find jobs in rad onc, or even fellowships to keep doing rad onc device development as an MD/PhD, the big name places ignored me (and still do), and the interviews I got were 100% clinical mostly at satellites. It's been a huge struggle to do anything other than the usual retrospective reviews, which I've always found very disappointing.

What seems so obvious to us is clearly not to everyone else.
Click to expand...


What I'm seeing is that these big-name places would rather have a pure medical physicist do the device development (Jaffray at MDA for example). Didn't a Neurosurgeon at Stanford invent the cyberknife? They allowed a mistake to be repeated! They learned nothing
 
MegaVoltagePhoton said:
Good post except for that hilariously bad take about immunotherapy. What’s the response rate again?
Also, radiology is not a good substitute for rad onc. Most of us want to take care of patients. Should have just said medical oncology
Click to expand...

Hilariously bad take on immunotherapy? I'm not sure if your qualm is with me saying immunotherapy rather than "targeted therapy" which would have been a more accurate statement. This may have been a bit of hyperbole but this is not some alarmist point of view. For example, KEYNOTE-42 included both locally advanced and metastatic patients. Sure, only 10% of the patients were locally advanced, but you bet your ass I've seen medoncs use it as a justification for definitive immunotherapy in a patient population that would have potentially gotten radiation alone.

As for radiology not being a good substitute for rad onc, there really is no substitute for rad onc. I like seeing patients, I like what I do, but the thought of going through 3 years of an IM residency and another match process would be enough to turn me away from medonc. Considering the number of radoncs I've met that have no business seeing patients to begin with, I'd suspect there are others that feel the same.
 
RSAOaky said:
Hilariously bad take on immunotherapy? I'm not sure if your qualm is with me saying immunotherapy rather than "targeted therapy" which would have been a more accurate statement. This may have been a bit of hyperbole but this is not some alarmist point of view. For example, KEYNOTE-42 included both locally advanced and metastatic patients. Sure, only 10% of the patients were locally advanced, but you bet your ass I've seen medoncs use it as a justification for definitive immunotherapy in a patient population that would have potentially gotten radiation alone.

As for radiology not being a good substitute for rad onc, there really is no substitute for rad onc. I like seeing patients, I like what I do, but the thought of going through 3 years of an IM residency and another match process would be enough to turn me away from medonc. Considering the number of radoncs I've met that have no business seeing patients to begin with, I'd suspect there are others that feel the same.
Click to expand...

Just do IM. Med oncs around the country will out-source their inpatient services to hospitalists anyways with the sheer tidal wave of patients they'll be treating and those getting side effects that land them in hospital.

There you go, you can take care of cancer patients now.

I think some folks went into rad onc because of the tech, if that's the case then radiology is a good substitute until AI does it in even worse than hypofrac did this field.
 
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elementaryschooleconomics said:
The ASTRO Career Fair is ON FIRE today: :flame::flame::flame:


View attachment 321398
View attachment 321399
Click to expand...

1603740793955.png

American citizens or Green Card holders only folks. People from Canada or elsewhere need not apply.

This is a dangerous sign. The program realizes they no longer have to sponsor visas!

Run! For the love of everything what more do you want ? Why do you want any other data? This is not a radiation omission trial! This is real life and there is an impending catastrophe. You do not want or need more data.
 

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GapCalc said:
"Acting Instructor"

Yikes.
Click to expand...
Work of an instructor, pay of an actor playing a radiation oncologist in a commercial. Non-speaking role obviously.

Was "Acting Instructor" considered a "red flag" term? Maybe not, because it was just invented to making Fellowship/12 month job interview sound more palatable.
 
Mandelin Rain said:
Work of an instructor, pay of an actor playing a radiation oncologist in a commercial. Non-speaking role obviously.

Was "Acting Instructor" considered a "red flag" term? Maybe not, because it was just invented to making Fellowship/12 month job interview sound more palatable.
Click to expand...

This is definitely not a red flag. “Practoce building” is.
 
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