Rad Onc Twitter

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medgator said:
Urologists ignoring data and focusing on reimbursement is well known and studied....

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And those proton centers popping up in every city are what, for research and charity?

There are bad actors in every field. Putting down others and holding your field as superior is 1. Probably incorrect and 2. A meaningless pursuit that demeans the field of medicine from the inside when there are plenty of people on the outside telling us how to do our jobs.
 
DoctwoB said:
And those proton centers popping up in every city are what, for research and charity?

There are bad actors in every field. Putting down others and holding your field as superior is 1. Probably incorrect and 2. A meaningless pursuit that demeans the field of medicine from the inside when there are plenty of people on the outside telling us how to do our jobs.
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We call out the proton w****$ all the time here. They are just as bad, and in my neck of the woods the urologists hate them as much. I just don't see the rad Onc equivalent of hifu, cryo etc happening in upfront pca management at the same scale.

Even many in academics are anti proton, including, notably, Dr Spratt
 
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StIGMA said:
Not a good look to piss off a department chair at your own institution, especially when you own chair is new. Their twitter thread continued...
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Am I the only one who finds Shinde's comment to be totally reasonable? People here act like they want academics to grow a pair and push back on residency expansion, but god forbid they push back on hypocrites from referring specialties. If what he said is enough to be reprimanded over, academics is even more of a lost cause than we thought.

Frankly, a department chair borderline threatening a junior faculty of another department over Twitter for daring to call shots as he sees them is embarrassing. If Dr. Penson wants to be treated like a special snowflake, I'm sure he'd be welcomed at Parlor.
 
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medgator said:
We call out the proton w****$ all the time here. They are just as bad, and in the urologists hate them as much. I just don't see the rad Onc equivalent of hifu, cryo etc happening in upfront pca management at the same scale
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Fractionation shenanigans. Xrt or brachy for low risk disease (less AS adoption in radonc then urology). Focal brachy for PC. And that’s just the one disease site I know, god knows what else goes on with other sites. Once again, not criticizing because all of our fields, mine included, live in glass houses.
 
DoctwoB said:
Fractionation shenanigans. Xrt or brachy for low risk disease (less AS adoption in radonc then urology). Focal brachy for PC. And that’s just the one disease site I know, god knows what else goes on with other sites. Once again, not criticizing because all of our fields, mine included, live in glass houses.
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At least they are nccn recognized therapeutic modalities for prostate cancer. Over treatment is a real but separate issue.

Having treated dozens of hifu and cryo failures, it's not even closely analogous. Hifu esp. Until FDA approval a few years ago, unscrupulous urologists would fly patients out to Mexico or the Bahamas to offer it for thousands in cash.

About to start a hifu salvage xrt case next week, pt apparently had a bladder stricture from it which a different urologist had to cysto and deal with first.
 
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medgator said:
At least they are nccn recognized therapeutic modalities for prostate cancer. Over treatment is a real but separate issue.

Having treated dozens of hifu and cryo failures, it's not even closely analogous. Hifu esp. Until FDA approval a few years ago, unscrupulous urologists would fly patients out to Mexico or the Bahamas to offer it for thousands in cash
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No doubt. I interviewed with a urology practice that was far too cryo happy for my liking and looked elsewhere. And there are urologists infamous for the above HIFU shenanigans, which should only be done on trial, and even then the focal therapy data are quite suspect. You might be surprised, however, how many patients come in asking for it. I’d put it at over 50%, to the point where I include it in my speil if only to recommend against it. Is it worse to do an unindicated HIFU or an unindicated XRT or brachy on a low risk patient? I’ll save that one for the philosophers.
 
DoctwoB said:
Fractionation shenanigans. Xrt or brachy for low risk disease (less AS adoption in radonc then urology). Focal brachy for PC. And that’s just the one disease site I know, god knows what else goes on with other sites. Once again, not criticizing because all of our fields, mine included, live in glass houses.
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1. XRT or brachy for low risk disease: We don't refer these patients to ourselves. Those getting radiotherapy for low risk disease are a self selecting bunch who already spoke to a urologist and dont want AS or surgery and want RT.

2. I know of no one advocating for focal prostate RT outside of a clinical trial unlike widespread use of HIFU and cryotherapy in many regions.

3. I do think our specialties would be much better off if we worked together more.
 
radOresident said:
Am I the only one who finds Shinde's comment to be totally reasonable? People here act like they want academics to grow a pair and push back on residency expansion, but god forbid they push back on hypocrites from referring specialties. If what he said is enough to be reprimanded over, academics is even more of a lost cause than we thought.

Frankly, a department chair borderline threatening a junior faculty of another department over Twitter for daring to call shots as he sees them is embarrassing. If Dr. Penson wants to be treated like a special snowflake, I'm sure he'd be welcomed at Parlor.
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There is a certain amount of decorum you need to follow on a public forum. This shouldn't be surprising....
 
radoncopotamus said:
There is a certain amount of decorum you need to follow on a public forum. This shouldn't be surprising....
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I think it's obvious where the line was crossed- however if I were him and thinking just a few people (or only radoncs) would be reading it, maybe I wouldn't hesitate to post. However the wrong people saw it, and it was an unprofessional statement (read: a middle schooler or high schooler may be expected to talk like that, not a faculty member). If I were the uro chair, having read that and feeling slighted, I would be having words with the radonc chair too.
 
radoncopotamus said:
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The good ole boy culture at vanderbilt is well known. Know thy place and keep your mouth shut, if you know what is good for you. Isn’t this the place that got rid of a resident for kneeling to support BLM because some old white donor got “offended”? These people are badly afflicted by snowflakism. Similarly, the urology “chair” straight up threatens a junior colleague. Really great stuff and very representative of the entrenched mob like mentality of academic medicine. “We’ll see what your chair, my good ole buddy does to you”

urologists are hands down some of the worst surgeons and least evidence based. Anybody who is a rad onc knows this because we deal with their messes OFTEN.
 
thecarbonionangle said:
The good ole boy culture at vanderbilt is well known. Similarly, the urology “chair” straight up threatens a junior colleague. Really great stuff and very representative of the entrenched mob like mentality of academic medicine.
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Related, I was advised not to apply for Vanderbilt for faculty jobs.

edit: to be fair, there were several other programs I was also advised to avoid
 
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StIGMA said:
Related, I was advised not to apply for Vanderbilt for faculty jobs.

edit: to be fair, there were several other programs I was also advised to avoid
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They were in market for warm bodies recently at ASTRO. Switch and bait “main site” jobs but really a lot of them were trying to place you in a SLEEPY AF “academic satellite”.
 
radOresident said:
Am I the only one who finds Shinde's comment to be totally reasonable? People here act like they want academics to grow a pair and push back on residency expansion, but god forbid they push back on hypocrites from referring specialties. If what he said is enough to be reprimanded over, academics is even more of a lost cause than we thought.
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radOresident said:
Frankly, a department chair borderline threatening a junior faculty of another department over Twitter for daring to call shots as he sees them is embarrassing. If Dr. Penson wants to be treated like a special snowflake, I'm sure he'd be welcomed at Parlor.
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I agree that it seems like an overreaction to an off the cuff comment, but it is inappropriate for a professional to say in a public forum you can’t ask field X for data, basically speaking derogatorily about a whole field of medicine. it was bound to ruffle feathers.

For example. Saying “I believe we should to xrt for high risk cancer because of X” may annoy referring doctors, but is appropriate. Saying urologists don’t believe in data isn’t.

And that is also why I stay off Twitter posting. Too easy for a quick comment, even one meant as a joke or offhand comment, to have real consequences.
 
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DoctwoB said:
I agree that it seems like an overreaction to an off the cuff comment, but it is inappropriate for a professional to say in a public forum you can’t ask field X for data, basically speaking derogatorily about a whole field of medicine. it was bound to ruffle feathers.

For example. Saying “I believe we should to xrt for high risk cancer because of X” may annoy referring doctors, but is appropriate. Saying urologists don’t believe in data isn’t.

And that is also why I stay off Twitter posting. Too easy for a quick comment, even one meant as a joke or offhand comment, to have real consequences.
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Totally agree. It's easy to forget, as you sit in your pajamas, in your home, on your phone, scrolling through a small touchscreen, that anything you read and write on the BirdApp can be seen and interpreted by anyone and everyone. I have an account with my real name that I use mostly to lurk, and looking through my (scant) post history, it seems I mostly re-Tweet relatively uncontroversial things said by big names in Radiation Oncology. I probably have <10 original posts...compared to my nearly 1,000 posts here, on my anonymous account.

On Twitter, I write (or re-Tweet) as if my Chair would read it, and I ask myself if it's something I would be comfortable to say to their face. On SDN, I write with the desperate hope that my Chair does read it, and they think about my opinion and if it stands on its own merit.
 
elementaryschooleconomics said:
Totally agree. It's easy to forget, as you sit in your pajamas, in your home, on your phone, scrolling through a small touchscreen, that anything you read and write on the BirdApp can be seen and interpreted by anyone and everyone. I have an account with my real name that I use mostly to lurk, and looking through my (scant) post history, it seems I mostly re-Tweet relatively uncontroversial things said by big names in Radiation Oncology. I probably have <10 original posts...compared to my nearly 1,000 posts here, on my anonymous account.

On Twitter, I write (or re-Tweet) as if my Chair would read it, and I ask myself if it's something I would be comfortable to say to their face. On SDN, I write with the desperate hope that my Chair does read it, and they think about my opinion and if it stands on its own merit.
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Yep, at least here (for the most part), I can express my true opinion with a few posts deleted (thanks mods).

Unfortunately, those were some of my best zingers I will never get back, but most likely the ones that would have ended my career if I posted on Twitter, so maybe a good thing in the end if anyone ever was to ID me here (thanks mods).
 
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Aggressive if the urology chair to respond to a tweet like that. Twitter discourse has different flow and significance than an academic conference or even tumor board.

The confrontational turn by the chair is a good learning point for academics though. Academics is 75% politics and a network of older people in power looking out for their power and preventing others advancement to the same level. Instead of engaging and asking questions, the chair responds with righteous indignation “supposedly my colleague” and with such afront the discussion needs to go private. Please, what a power play joke.

Our chairs and SCAROP are the exact same. Why do you think so much has been posted here and only recently has the oversupply issue gotten any traction(still no action!) in non anonymous settings?
 
DebtRising said:
Our chairs and SCAROP are the exact same. Why do you think so much has been posted here and only recently has the oversupply issue gotten any traction(still no action!) in non anonymous settings?
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I was just writing a post to this effect. This is not a Vandy specific issue. This is a rad onc wide issue. With the job market in shambles and rad oncs dependent on referrals to survive, you better get used to being a "yes (wo)man" or the alternative is unemployment.
 
Totally agree. Our field is ruthless to its young. As the “bounty” of medicine decreases for all, expect more and more senior / leadership attitudes as shown here.
 
DebtRising said:
Aggressive if the urology chair to respond to a tweet like that. Twitter discourse has different flow and significance than an academic conference or even tumor board.

The confrontational turn by the chair is a good learning point for academics though. Academics is 75% politics and a network of older people in power looking out for their power and preventing others advancement to the same level. Instead of engaging and asking questions, the chair responds with righteous indignation “supposedly my colleague” and with such afront the discussion needs to go private. Please, what a power play joke.

Our chairs and SCAROP are the exact same. Why do you think so much has been posted here and only recently has the oversupply issue gotten any traction(still no action!) in non anonymous settings?
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I have only been junior faculty a short while, but in my limited experience, this sort of thing was more a issue with urologists than politics. Urologists are the specialty with whom I have debated the most ... and I don’t even treat prostate/GU. The tone got nasty quickly in these few instances, especially when the word “data” is mentioned, just like the above example. If the urology chair had an evidence-based methodology for which HR patients get RP, why discuss it “offline”? The threats are for public consumption but the data are secret?
 
Lamount said:
I have only been junior faculty a short while, but in my limited experience, this sort of thing was more a issue with urologists than politics. Urologists are the specialty with whom I have debated the most ... and I don’t even treat prostate/GU. The tone got nasty quickly in these few instances, especially when the word “data” is mentioned, just like the above example. If the urology chair had an evidence-based methodology for which HR patients get RP, why discuss it “offline”? The threats are for public consumption but the data are secret?
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There's no other specialty equivalent to hifu or cryo, except maybe the unscrupulous IRs I've come across who try to steer patients referred for biopsies to lung and liver RFA without appropriate multi-D consultations
 
LOL,

I read through this whole tweet...
Shinde deleted his tweet since.

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-----
Couple of comments:

- Shinde's tweet was correct in terms of data and "humanity" but politically incorrect to the Urology world, which is a shady world as we all know when it comes to prostate cancer. I am fortunate to work with a great Urologist who does not believe in RP and refer to me most pts with prostate ca for RT! He has done tons of RPs over the yrs and sees how his pts suffer from side effects of RP and he recommends against RP. Go figure.

- As to the comment above: "Do not question the hands that feed you"...It is a difficult situation I agree if your bread/fish comes from the hands of the Urologists. However, when it is ethically bad, you need to question it from an ethical standpoint. Where do you raise the issues? Twitter, RedJ, NEJM...? The only reason Urologists get away with RP is that: the generation that they currently deal with grew up with no internet, some of these pts don't even own a computer, they trust their docs like God. These pts don't even use Google. Fifty (50) yrs from now, the current gen (which is in their 20's now)...you cannot fool them with the Urology BS, so fifty (50) yrs from now, RP is a thing of the past bc the millennium gen is very smart.

- Dr Penson's comment probably referred to "Hey, we have good collaboration with radonc, you can verify this with your chair".
But this depends on the academic level, Shinde is junior in radonc, Penson is the chair in Uro at the same institution. Penson should have been more forgiving (a Chair should be forgiving) and ignored the tweet. Instead, Penson chose to respond, which is in itself stupid for him to do.
One thing I have learned over the yrs: Urology people are very insecure themselves.
 
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Forget the power dynamics, the fact they are at same institution, and Shinde’s lack of experience.

Right or not, why say that all of one specialty is a data free zone?

“Owning the urologists” is all fun and games on Twitter, but risky business career-wise.

I don’t think he’s completely right or completely wrong. What he is showing is bad judgment. Despite his feelings, would he say that in a tumor board to their face? I’d guess probably not.

Either he realized his error, feared a smack down coming from his department, or just quickly learned that conflicts with other specialists isn’t worth it, despite being “right”.
 
drewdog1973 said:
Forget the power dynamics, the fact they are at same institution, and Shinde’s lack of experience.

Right or not, why say that all of one specialty is a data free zone?

“Owning the urologists” is all fun and games on Twitter, but risky business career-wise.

I don’t think he’s completely right or completely wrong. What he is showing is bad judgment. Despite his feelings, would he say that in a tumor board to their face? I’d guess probably not.

Either he realized his error, feared a smack down coming from his department, or just quickly learned that conflicts with other specialists isn’t worth it, despite being “right”.
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Shinde is a good guy trying to fight the good fight. but didnt he literally just get out of training? Like only been out on his own for a few months. I know that shouldn't undermine the validity of his statements but come on...does he not realize that at the end of the day we are bottom feeders and the EBM standard is unevenly applied especially when it comes to your referrings. Ive seen his stuff on mednet and twitter he writes like hes been practicing for 20 years when in reality it just sounds like something he ripped his opinions from the attendings that trained him or his current colleagues.

They used to tell me just be the smartest guy in the room and your referrings will respect and send patients to you: Wrong. If its a choice between me taking food out of their mouths or the other way around, It really doesn't matter how well versed you are in the literature.

Ive had an ENT at a TORs program of course literally threaten to stop sending patients to us if we continued to offer post-op RT for p16+ OPX patients for patient with high risk features. He is a scumbag and continues to practice to this day. could we get away with this? What do we have to threaten an ENT with? Refuse to do RT? What? Report them?
 
RadsWFA1900 said:
Shinde is a good guy trying to fight the good fight. but didnt he literally just get out of training? Like only been out on his own for a few months. I know that shouldn't undermine the validity of his statements but come on...does he not realize that at the end of the day we are bottom feeders and the EBM standard is unevenly applied especially when it comes to your referrings. Ive seen his stuff on mednet and twitter he writes like hes been practicing for 20 years when in reality it just sounds like something he ripped his opinions from the attendings that trained him or his current colleagues.
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Yup... Definitely can't start trash talking other physicians you work with until at least 3-4 years in. In mid career practice, i feel quite comfortable talking $h!/ when warranted. Shinde needs to simmer down until he gets a bit more seasoned into his practice
 
medgator said:
Yup... Definitely can't start trash talking other physicians you work with until at least 3-4 years in. In mid career practice, i feel quite comfortable talking $h!/ when warranted. Shinde needs to simmer down until he gets a bit more seasoned into his practice
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This is unfortunately so true. Makes for some tough judgment calls in those 3-4 years. Obviously there are lines that should not be crossed, but a whole lotta gray in there too. I have enough clout at this point where I can throw down if needed and the reaction is "oh, that reasonable guy who works all my patients in immediately disagrees? maybe I should listen." Sometimes you have to lose a few battles to win the war.
 
RadsWFA1900 said:
Shinde is a good guy trying to fight the good fight. but didnt he literally just get out of training? Like only been out on his own for a few months. I know that shouldn't undermine the validity of his statements but come on...does he not realize that at the end of the day we are bottom feeders and the EBM standard is unevenly applied especially when it comes to your referrings. Ive seen his stuff on mednet and twitter he writes like hes been practicing for 20 years when in reality it just sounds like something he ripped his opinions from the attendings that trained him or his current colleagues.

They used to tell me just be the smartest guy in the room and your referrings will respect and send patients to you: Wrong. If its a choice between me taking food out of their mouths or the other way around, It really doesn't matter how well versed you are in the literature.

Ive had an ENT at a TORs program of course literally threaten to stop sending patients to us if we continued to offer post-op RT for p16+ OPX patients for patient with high risk features. He is a scumbag and continues to practice to this day. could we get away with this? What do we have to threaten an ENT with? Refuse to do RT? What? Report them?
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This is one thing that really sucks about rad onc because we are at the end of the referral chain. This really puts us in a bad spot strategically. Being part of a big hospital chain and tumor boards help, but at the end of the day we do not have much power. ENT and urology don't beg rad onc for consults that's fo dang sho.
 
Kinda on the same lines but how do you break into a new market where there already long established referral bases and really no incentives for the docs to refer to someone new? From my experience, the best approach is to be around and available for everyone but you have to have a lot of patience. Another option is to give money under the table, I haven’t seen that approach yet but it may be the fastest way.
 
RadOncDoc21 said:
Kinda on the same lines but how do you break into a new market where there already long established referral bases and really no incentives for the docs to refer to someone new? From my experience, the best approach is to be around and available for everyone but you have to have a lot of patience. Another option is to give money under the table, I haven’t seen that approach yet but it may be the fastest way.
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What are your favourite ways to slip “money under table”? Do you give a bit extra to greedy sticky fingered urologists?
 
thecarbonionangle said:
What are your favourite ways to slip “money under table”? Do you give a bit extra to greedy sticky fingered urologists?
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That’s the hardest part to figure out. It’s almost like buying drugs on the street, you have to know somebody first. They made it hard these days so I just can’t hand them a money bag like I was planning to do.
 
RadOncDoc21 said:
That’s the hardest part to figure out. It’s almost like buying drugs on the street, you have to know somebody first. They made it hard these days so I just can’t hand them a money bag like I was planning to do.
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I just fold a check and palm it, then shake their hand when I introduce myself with a sly wink.
 
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medgator said:
Amazon e- gift cards always make it easy
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1606834892931.png
 
I think I have told this story before but I was in Korea giving a talk many moons ago. Different docs sponsored by different vendors speaking. Varian is very by the book and, honestly, stingy with speaking fees. There was another doc there speaking on Tomotherapy. After the talks, later at the restaurant get together for everyone, I saw this discrete exchange take place between the attractive Asian Tomo rep and the well known US professor where she literally handed him a big wad of cash, maybe 5K. File this under stories like when 21st Century used to fly interviewees to Florida by private jet.

Rad onc will do well to have ANY cash to hand anybody, under or over the table, in the future!
 
elementaryschooleconomics said:
Basically any story I hear about Radiation Oncology from ~2001 to ~2011 I'm like, "ah yes, I understand where all of our problems in 2020 came from".
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Supposedly ASTRO used to have barely clothed women walking around giving you drinks and hors d’oeuvres. The chairs loved it, heavily attended by them. Anybody shocked? How times change!
 
scarbrtj said:
I think I have told this story before but I was in Korea giving a talk many moons ago. Different docs sponsored by different vendors speaking. Varian is very by the book and, honestly, stingy with speaking fees. There was another doc there speaking on Tomotherapy. After the talks, later at the restaurant get together for everyone, I saw this discrete exchange take place between the attractive Asian Tomo rep and the well known US professor where she literally handed him a big wad of cash, maybe 5K. File this under stories like when 21st Century used to fly interviewees to Florida by private jet.

Rad onc will do well to have ANY cash to hand anybody, under or over the table, in the future!
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There is a cultural aspect to this. I have had invited talks at overseas conferences (no vendor involvement); and I remember the surprise I had the first time in Korea where I received several thousand dollars in cash for my plane ticket and honorarium from the institution that asked me to speak. Same thing happened in the Middle East and South America. So, not necessarily nefarious; I was told that it was often the only way they were allowed to reimburse in dollars.
 
GI_RadOnc said:
There is a cultural aspect to this. I have had invited talks at overseas conferences (no vendor involvement); and I remember the surprise I had the first time in Korea where I received several thousand dollars in cash for my plane ticket and honorarium from the institution that asked me to speak. Same thing happened in the Middle East and South America. So, not necessarily nefarious; I was told that it was often the only way they were allowed to reimburse in dollars.
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I have the same experience. Fifteen years ago invited to conference in Turkey. At the reception prior to the meeting attended by international faculty envelopes full of Benjamins handed out. Not quite pallets of cash...
 
GI_RadOnc said:
There is a cultural aspect to this. I have had invited talks at overseas conferences (no vendor involvement); and I remember the surprise I had the first time in Korea where I received several thousand dollars in cash for my plane ticket and honorarium from the institution that asked me to speak. Same thing happened in the Middle East and South America. So, not necessarily nefarious; I was told that it was often the only way they were allowed to reimburse in dollars.
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Comped overseas trip and wads of cash? Where do i sign up?
 
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Radonc90 said:
The guy is back:

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I'm not gonna lie - I have a secret hope that all these "outreach" programs do, in fact, educate medical students about RadOnc, they then decide to not pursue it as a specialty because of all the problems, but it's kept on their radar as a place to refer patients to.

I can dream, right?
 
Radonc90 said:
The guy is back:

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you can't spell UCLA Radiation Oncology Medical Student Preceptorship without PALM. I clicked the link, and it said "Application Accepted."
 
And then Dr. Gillespie hawking a funded year at Sloan for students. $27k stipend. So, you may be able to live in a shared studio. I think you fill out surveys to make some scratch to pay for an occasional meal.

Or, you can just match at a top program and get on with your life a year earlier. Pushing a “gap” year to match into RO is just not nice...
 
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