Rad Onc Twitter

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SubserviantToABR said:
So much more to unpack on that thread (screenshot for posterity):
View attachment 332670

This is the problem with leadership. For the past decade, we have had the highest percentage of MD/PhDs and research inclined folks out of any specialty, mostly all of them lured into the field under the guise of rich research environments, and idiots like Ralph Weichselbaum pissed it all down the drain, with no real research opportunities, all of which are held by the old guard (like at NRG/RTOG at the trial level), or forced into purely clinical positions (private or academic) without any opportunities for scientific pursuits. I am an MD/PhD, and I do not know anyone in my year who have a legitimate research position (clinical or lab-based) that came out of my cohort, once we realized what a scam this field is with the talents at their hands.
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Yup this was my experience as well. As a trainee, it's very difficult to succeed in research (either clinical or bench) without strong institutional/mentor support which is generally available at only a handful of institutions. I feel like this is a classic Boomer argument of "those darn Millennials and their participation trophies!" not realizing that THEY'RE the ones who handed out the trophies and drove things into the ground.
 
Cool so people who didn't have a home program, did months of away rotations away from their own bed, spent thousands of dollars to apply to get A SPOT, and busted a$$ for years to make their application what the leaders wanted it to be were just in pursuit of the ivory tower of misery and lifestyle. Too bad we're not artisan enough.
 
The lack of competitiveness today is strictly a function of decisions by these leaders over the past 15 years. These leaders viewed residents as resources and not as professional progeny. The math is simple and others have summed it up beautifully, They could have kept resident numbers at ~120/year and everything would have been fine. Competitiveness would not have cooled and the our radonc needs would have been met just the same.

I'm a little sympathetic to KO here. Excess competition does very little to help a field and in some circumstances provides perverse incentives (see insane publication volume vs publication quality). There is very little correlation IMO between metrics like board scores and actual creative intellectual ability. Board scores should mean something to but not very much. (I would be concerned about a low score because passing your boards should be the easy part of residency.) I'm on board with KO messaging that the new group of residents can get the job done. I'm not on board with the implication that the peak residents were somehow deficient.

Regarding RWs comment? Fine. Where is the great work on metastases, the link between local control and metastatic progression, developing an understanding of what stage really means in the setting of ever increasing imaging sensitivity? I would think that RW of all people would know that profound scientific narrative takes decades to develop.

Just prior to publication of the grab-bag Nivolumab trials (~2010?) many academic medoncs were still denigrating immunotherapy as an unfortunate initiative that had taken decades of resources. Might work in Melanoma but not much else! James Allison is not an MD. He is a PhD who spent 30 years building a scientific narrative without competing clinical responsibilities. This is how great science is done. Radonc can give joint appointments to people like James Allison and help fund them. They don't need an army of MD/PhDs with 10 patients on treatment, collecting clinician pay and trying to survive from one funding cycle to the next in an already saturated professional space.
 
SubserviantToABR said:
So much more to unpack on that thread (screenshot for posterity):
View attachment 332670

This is the problem with leadership. For the past decade, we have had the highest percentage of MD/PhDs and research inclined folks out of any specialty, mostly all of them lured into the field under the guise of rich research environments, and idiots like Ralph Weichselbaum pissed it all down the drain, with no real research opportunities, all of which are held by the old guard (like at NRG/RTOG at the trial level), or forced into purely clinical positions (private or academic) without any opportunities for scientific pursuits. I am an MD/PhD, and I do not know anyone in my year who have a legitimate research position (clinical or lab-based) that came out of my cohort, once we realized what a scam this field is with the talents at their hands.
Click to expand...
Unfortunately I think your use of the word “scam” here in regards to research is wholly appropriate. Not only do many MD/PhDs not have legit research positions (much less labs and funding and protected non clinical time etc), many have been cast from the mothership to the community boonies staffing satellites. Not that there’s anything wrong with the boonies or communities... I just don’t think that’s what people got a PhD/MD for.
 
The combination of more people that aren't anonymous on social media putting real faces to the concerns of the job market and people providing data backing it all up seems to be making headway with some of the people who have been lucky enough to get dream jobs take notice. Hope it continues.

Even if there are only 80 residency spots needed to supply the nation with cancer care, diversity is important and those diverse people deserve to be happy. Over supply only harms RadOncs, no matter the race or gender.
 
CurbYourExpectations said:
The combination of more people that aren't anonymous on social media putting real faces to the concerns of the job market and people providing data backing it all up seems to be making headway with some of the people who have been lucky enough to get dream jobs take notice. Hope it continues.

Even if there are only 80 residency spots needed to supply the nation with cancer care, diversity is important and those diverse people deserve to be happy. Over supply only harms RadOncs, no matter the race or gender.
Click to expand...
Agree, but the fact that people are trying to use the oversupply to target "diversity" and URMs when their same institutions couldn't care less a decade ago is nothing short of disgusting... A warm body is a warm body and if they can match under the guise of finally being "woke", they will certainly take it
 
CurbYourExpectations said:
The combination of more people that aren't anonymous on social media putting real faces to the concerns of the job market and people providing data backing it all up seems to be making headway with some of the people who have been lucky enough to get dream jobs take notice. Hope it continues.

Even if there are only 80 residency spots needed to supply the nation with cancer care, diversity is important and those diverse people deserve to be happy. Over supply only harms RadOncs, no matter the race or gender.
Click to expand...
Agreed. I think this is just the beginning. I expect more people will speak up non-anonymously as the winds continue to change and people don't feel like they're the lone squeaky wheel.
 
In response to KO:

1615941368943.png

1615941388967.png


Hmm, how do you summarize this? Ah, yes:

1615941469585.png
 
CurbYourExpectations said:
I like KO. Seems like a nice guy. Wish he would be more of an advocate for “fix the job market and keep diversity going!”
Click to expand...


Simul needs to be honest and call a spade a spade, i understand why he can't but no need to give KO a free pass here. This is the same PD that called us a bunch of anonymous misanthropes with no idea about anything a couple years ago
 
medgator said:


Simul needs to be honest and call a spade a spade, i understand why he can't but no need to give KO a free pass here. This is the same PD that called us a bunch of anonymous misanthropes with no idea about anything a couple years ago
Click to expand...

And Simul is y'all's hero? 🤣🤣🤣🤣
 
CurbYourExpectations said:
I still think he’s a good guy and probably does do things to advocate for the young docs. I think he just doesn’t really understand how far behind the 8 ball we are and how fast things need to change.

“It's hard to get out of bed in the morning to go for a run when you're sleeping in silk sheets.” -RIP Marvin Hagler.

Back then how could he know? Now there is no excuse not to know. (Thanks scarb, mudit, simul, etc.)

I agree I wish they were all more upfront with everyone about their true intentions so we didn’t have to guess.
Click to expand...
Marvelous Marvin RIP
 
thecarbonionangle said:
Let’s be honest, the field has mostly never cared about racial diversity. It was only when quality dropped that they said it
Click to expand...
I don't think that's true - ASTRO launched their minority summer fellowship in 2010 and there has been an increasing emphasis on bringing more diverse minds to our field (that is a good thing and will bring new ideas to our field). I have no problem with that and support it.

The problem is when people talk about the problems with the rad onc match/job market and talk about increasing minority/women as somehow linked to that or talk about "increasing exposure to rad onc" as some kind of novel 2021 solution. That's denigrating to the hard working people from those background who are in rad onc and is ignoring the problem.
 
imhopeful432 said:
I don't think that's true - ASTRO launched their minority summer fellowship in 2010 and there has been an increasing emphasis on bringing more diverse minds to our field (that is a good thing and will bring new ideas to our field). I have no problem with that and support it.

The problem is when people talk about the problems with the rad onc match/job market and talk about increasing minority/women as somehow linked to that or talk about "increasing exposure to rad onc" as some kind of novel 2021 solution. That's denigrating to the hard working people from those background who are in rad onc and is ignoring the problem
Click to expand...
The tweet above is not a unique sentiment, i assure you. Gender diversity was a consideration but rarely race. Tricking minorities into a dead end field is immoral. Where were these woke PDs then?
 
I'm a wannabe physician-scientist who has seriously struggled to make it work. Ralph is delusional. A lot of these older guys are. They established themselves back in the days when rad onc training was 3 years long and NCI R01 funding rates were like 40th percentile. The mentality back then was like his--if you build more research buildings and hire more smart people, you can milk more money out of the NIH. They felt that anyone could be a physician-scientist if they were willing to put in the effort and had a good idea. That's what it was like in the 90s and 00s when I first started on a physician-scientist pathway.

Nowadays the opportunities for a physician-scientist career are there for a very small, dedicated, and lucky few. More physician-scientists in the specialty is not going to change the limited opportunities. It will only push a higher percentage of them clinical. NCI R01 funding rates are 11th-16th percentile (established vs. new investigator), and you have to have a lot invested both personally and from the institution to even get to the point of submitting a competitive R01. Good luck.
 
fiji128 said:
View attachment 332721If we could just get more really awesome individuals into the speciality the whole thing might just fix itself.
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when we are all retiring in 40 years, making “good living” below peds salaries, RW will still be chair with most of his body replaced by electronics. some screws missing in head.
 
Making a career as a newly-graduated Rad Onc physician scientist in the modern job market is difficult, if not flat out impossible.

I can think of maybe two or three people over the past few years I have known who had any success with it. For the already uphill battle of a job search, the path to physician scientist Rad Onc is even more steep. The vast majority of MD/PhDs will pursue private practice or clinical academic positions without any sort of basic lab component attached.

There was an article in the RJ some time ago that showed that MD/PhD Rad Onc residents were some of the least likely to publish "copiously" during residency. Probably a mixture of burn out of publications from pre-residency training, recognition of uselessness of filler publications, and sobering realization of the limited end game prospects. The fact that the same % of MD/PhD Rad Onc residents go into pp as regular MDs speaks volumes.
 
fiji128 said:
If we could just get more really awesome individuals into the specialty the whole thing might just fix itself.
Click to expand...

Nothing's good enough for this wacko. Get the most MD-PhDs in medical fields, the best of the best, for a decade? Not good enough. Need more better people. Then things will improve.

All the sand he's inhaled from having his head stuck in it for decades has moved into his brain.

FWIW, I remember amazing MD/PhD applicants from my year and when I was in residency ultimately taking clinical jobs because there was nothing there for them. It actually bothered me because they were invading into my clinical non-academic job track.
 
What kind of start up packages is UC offering for heavily protected physician scientists currently? Honest question. This is literally putting money where your mouth is. I assume there's several, unfilled, just waiting for "really awesome, highly-skilled individuals".
 
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Mandelin Rain said:
What kind of start up packages is UC offering for heavily protected physician scientists currently? Honest question. This is literally putting money where your mouth is. I assume there's several, unfilled, just waiting for "really awesome, highly-skilled individuals".
Click to expand...

We all eagerly await his reply

1615995433808.png
 
Paid consultant: "What do you want to hear?"

ASTRO: "Well... we want a thorough, evidenced based analysis..."

Paid consultant: "I'm going to stop you right there. Time is money. What do you want to hear?"

ASTRO: "That we aren't training enough residents. We need the dues."

Paid consultant: "Got it. We accept cash upfront."
 
I think the idea of an outside consultant is interesting. Sort of like a special counsel. You have to take it off the hands of “leaders” and create an independent comisson to oversee it, with sexual orientation, gender and racial diversity, academics, pp equally represented. The environment is too bitter now to trust leaders not to bury it or spin it.
 
I think an outside consultant is a lousy idea. As I implied, their findings are most likely to represent the interest of the agency paying them. Additionally it abdicates the authority of our "leaders" to lead, which is presumably what they're there for and paid for. The issue is obvious to anyone with a working knowledge of elementary math. More in + less out = too much eventually. We're there. They know it. They've known it. There are just a series of perverse incentives to not address the issue.

Obfuscating overtraining (bad) with diversity (good) is so transparent, disingenuous, and potentially harmful that it speaks to the depths they'll sink to avoid acting in the best interest of the specialty at large.
 
Watch some incredibly frustrating op-eds come out in the next 5-7 years as the "leaders" retire and express opinions that they knew about the oversupply but couldn't fix it and throw pity upon the current state of RadOnc as they sit on their throne of cash. Heads will explode.
 
At this point I feel those “leaders” who think nothing is wrong need to PROVE it more than we do

In 5 yrs, if they are right then no harm done to individuals or society as there is not a “total under supply in US”

In 5 yrs, if they are wrong then graduates will be left in financial disaster. Those same leaders aren’t going to dip into their personal finances to help them

I tried to emphasize on Twitter yesterday, hopefully someone will see sense
 
radonc17 said:
At this point I feel those “leaders” who think nothing is wrong need to PROVE it more than we do

In 5 yrs, if they are right then no harm done to individuals or society as there is not a “total under supply in US”

In 5 yrs, if they are wrong then graduates will be left in financial disaster. Those same leaders aren’t going to dip into their personal finances to help them

I tried to emphasize on Twitter yesterday, hopefully someone will see sense
Click to expand...
Absolutely, the “ burden of proof” falls on those who thought it was a good idea to double resident numbers with no indication of doubling in demand.
 
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