Rad Onc Twitter

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It is pretty ridiculous that “leaders” think having our heads on a platter, our skin on their boots will automatically fix all!
Its all SDN fault!!
 
I think McFarlane is absolutely correct...

- Just think WW II...Hitler's time, why did the French resistance exist?
Because the French were upset...

- In politics, bad leaders hate dissent. Xi Jinping (China president) wants his dissidents jailed.
Putin poisoned his opponents.

- In the USA, people expect some decency and democracy, which are the foundational principles of the USA. But the people in this radonc field did not feel the so-called leaders" care about that.
So they went "underground"...

- In fact, Twitter, SDN, reddit are the worst nightmare of these co-called radonc leaders.
Imagine right now if it were the 1980s, and early 1990s when the internet did not exist? All these issues would have been swept under the rug...There would be no Twitter, SDN, reddit to discuss issues as it happens.

- As to being "anonymous"...just to digress a bit, I used to have a Honda Odyssey van with sliding door problem, guess what? The dealer (the "leader") was worthless, only the Honda forum members (~ 98% people in Honda forum are "anonymous") helped me solve my problem. And yes, 98% of them are anonymous...I told my adult kids "It is OK to talk to strangers, sometimes, or very often, they help you. There are more good people than bad people on this earth..."

Just think positive...

- Back to "my coal mine"...I told the medstudents and residents to bring up issues so we can talk. We have fun debating stuff. When they talk, I keep my mouth shut so I can learn from them. I teach my trainees to be humble, you will never know everything and you will always learn new stuff.
 
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Palex80 said:
Personally, when people tweet too many irrelevant stuff for me that shows up on my feed, I tend to unfollow.
I once followed Matthew Katz for instance, but he keeps retweeting his patients "survivor" tweets, every other day.
"I beat breast cancer 2 years ago" blablabla... It gets frustrating at some point...
:nod:
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I had to mute Katz for that reason.

The way I curate my Twitter feed: I basically try to follow every Radiation Oncologist on Twitter that I find. Most of them are lurkers and almost never Tweet. There are a core group that Tweet or re-Tweet somewhat regularly, and that's the content that makes up my feed.

Then, there are the people who go bananas and I mute them. Katz is one, Dave Fuller is another. It's absolutely not personal, and it's often that I don't even disagree with them, it's just that there are some power users that will DOMINATE my feed if I don't do something about it.

While a few of the goofy Twitterati are often teased on this thread, there are definitely a bunch of folks on Twitter that I enjoy hearing from, whether it's about trials or stupid jokes or whatever.

To be honest, even the ones I disagree with about certain topics will often post things I find interesting. Erin Gillespie is a good example of that - I disagree with what I perceive to be her opinion about the job market, but she Tweets a lot of other studies/papers that I wouldn't see otherwise, and she has a reasonable output so she's not all I see. I will never unfollow or mute her for those reasons, unless something changes.
 
Re Twitter...

Most of us here are radonc's, so we tend to gravitate toward radonc's contents on Twitter.
But I like to see the human side of people too.

So, if a radonc posted a pic of him/herself giving the vaccine into people's arm, I enjoy it.
Or if a radonc built a tree-house (have not seen that yet), I think it is fun to see too.
Something that makes us a better human being...

After all, we are human beings too.
 
Radonc90 said:
Re Twitter...

Most of us here are radonc's, so we tend to gravitate toward radonc's contents on Twitter.
But I like to see the human side of people too.

So, if a radonc posted a pic of him/herself giving the vaccine into people's arm, I enjoy it.
Or if a radonc built a tree-house (have not seen that yet), I think it is fun to see too.
Something that makes us a better human being...

After all, we are human beings too.
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Yeah! I like seeing people do regular non-medicine stuff. Medicine will consume your soul if you don't actively fight it.
 
Dumb question from me: what is the point of muting someone on Twitter?
When I see someone "not worth it", I simply "unfollow" and I am done with that person.
What is the advantage of keeping someone but mute that person (I follow that person but he/she does NOT follow me back)?
 
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TheWallnerus said:
It still seems almost impossible that the U.S. is producing 200 new RO jobs per year, or that it could produce ~1000 RO jobs over the next 5 years. We could factor in the steady rate of RO retirement (who knows what that rate really is) which helps to produce RO jobs. But practicing ROs instead of retiring occasionally like to look for new jobs too.
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We need a survey, paper, or whatever, to figure out how many of these people are going to retire in the next 5 years. It won't save the job situation but an accurate estimate will go a long way.

Of course my current extended practice had somebody working well into his 80s so I am not optimistic at all.
 
metallica81788 said:
We need a survey, paper, or whatever, to figure out how many of these people are going to retire in the next 5 years. It won't save the job situation but an accurate estimate will go a long way.

Of course my current extended practice had somebody working well into his 80s so I am not optimistic at all.
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Our practice of 7 physicians have decided that when the next one retires in the next 5 years, he will not be replaced. When the next one does ~5-10 years following him, she also will not be replaced. We anticipated increased patient per doc throughput due to increasing hypofractionation and increasing volumes to maintain income in the face of decreasing reimbursement/APM.
 
OTN said:
Our practice of 7 physicians have decided that when the next one retires in the next 5 years, he will not be replaced. When the next one does ~5-10 years following him, she also will not be replaced. We anticipated increased patient per doc throughput due to increasing hypofractionation and increasing volumes to maintain income in the face of decreasing reimbursement/APM.
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This! Same here, our management has decided that since we do a significant amount of hypofractionation (average number of fractions is now 14), that the number on treatment is unacceptable and underutilized. As a result, we are being viewed by management as having a surplus of FTEs in our entire group, and either we increase our office visit volume or we start cutting the fat. Our number of consults/new patient starts has been steady over the past year (fortunate despite COVID), but they demand us to be busier because our machines are finishing earlier. In addition, like you said @OTN, we also anticipate decreasing reimbursement once RO-APM rolls around.
 
SubserviantToABR said:
This! Same here, our management has decided that since we do a significant amount of hypofractionation (average number of fractions is now 14), that the number on treatment is unacceptable and underutilized. As a result, we are being viewed by management as having a surplus of FTEs in our entire group, and either we increase our office visit volume or we start cutting the fat. Our number of consults/new patient starts has been steady over the past year (fortunate despite COVID), but they demand us to be busier because our machines are finishing earlier. In addition, like you said @OTN, we also anticipate decreasing reimbursement once RO-APM rolls around.
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Totally unexpected outcome there re: the less fractions equating to less machine time/use.
 
TheWallnerus said:
Totally unexpected outcome there re: the less fractions equating to less machine time/use.
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Hahaha. It is very nice! I like!

We have a pretty robust oligomet, pancreas SBRT, and HCC SBRT program, but there is not an amount of new indications at this time (sorry Ralphie!) that can replace the breast, prostate, and rectal (mostly all 5 fractions now) volume. It's great for patient convenience and cost-effectiveness, but from a business perspective, it really sucks. With decreased screening identified breast and prostate (especially with COVID), increased prostate active surveillance, lung and H&N with decreased smoking, and potential decrease in HPV-related cancers with (hopefully) increased HPV vaccine uptake, I can't imagine a route to increase the number of patients seen and treated and keep the bean counters and hospital overlords happy.
 
OTN said:
Our practice of 7 physicians have decided that when the next one retires in the next 5 years, he will not be replaced. When the next one does ~5-10 years following him, she also will not be replaced. We anticipated increased patient per doc throughput due to increasing hypofractionation and increasing volumes to maintain income in the face of decreasing reimbursement/APM.
Click to expand...
When our next senior partner retires in 6 years or so.... We are reviewing the idea of not replacing them. I REALLY hate to say that... especially as a new grad who just suffered through the current environment... but once 5 fraction regimens are standard of care for most sites we just simply won't have room anymore.
 
RSAOaky said:
Derm seems to have no problem being highly competitive and attracting a large proportion of women, I’m not sure that the back handed misogynistic silver lining of “now that we’re less competitive we can be more inclusive” holds much weight.

People in power recruit those that they connect with, I.e. people who look and act like them. People being recruited gravitate to places that they fit in, I.e. places that match their demographic.

As someone whose made the unfortunate mistake of bringing his wife to an ASTRO event, I can attest that there’s no bigger turnoff to a woman than being hit on by a bunch of drooly mouth breathers. It’s a bit of a self fulfilling prophecy but I’d imagine when many underrepresented potential Med students consider radonc and see a bunch of old white men who stare at them like they’re some newly discovered Inca tribe, they think “hmm, this probably isn’t the place for me.”
Click to expand...

I’m a dermatologist just stumbled on this thread..... and can’t stop reading it. Like watching a train wreck in slow motion hitting a flaming dumpster!

Seriously, I had no idea the field became such a disaster- graduated 16 yrs ago and radonc was equally difficult to match into as derm.

I guess the 1 or 2 radonc friends I know don’t talk about this because they are mid to late career like me (and established and don’t care?).
 
doctalaughs said:
I’m a dermatologist just stumbled on this thread..... and can’t stop reading it. Like watching a train wreck in slow motion hitting a flaming dumpster!

Seriously, I had no idea the field became such a disaster- graduated 16 yrs ago and radonc was equally difficult to match into as derm.

I guess the 1 or 2 radonc friends I know don’t talk about this because they are mid to late career like me (and established and don’t care?).
Click to expand...
It has structural labor supply/demand issues, but it’s still an amazingly fulfilling specialty that I would choose any day over prescribing steroid and acne creams.
 
Krukenberg said:
It has structural labor supply/demand issues, but it’s still an amazingly fulfilling specialty that I would choose any day over prescribing steroid and acne creams.
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Yeah since dermatologists don't treat cancer 🙄 according to @scarbrtj they may even be treating more cases than us
 
Krukenberg said:
It has structural labor supply/demand issues, but it’s still an amazingly fulfilling specialty that I would choose any day over prescribing steroid and acne creams.
Click to expand...
No need to harsh on dermatologists. It’s a good field with whom we should work closely. They have their own issues with private equity, unfortunately.
 
OTN said:
Our practice of 7 physicians have decided that when the next one retires in the next 5 years, he will not be replaced. When the next one does ~5-10 years following him, she also will not be replaced. We anticipated increased patient per doc throughput due to increasing hypofractionation and increasing volumes to maintain income in the face of decreasing reimbursement/APM.
Click to expand...
THIS is the kind of "data" that needs to be discussed in the open. On Twitter, published letters etc.

Why are academics not anticipating these changes? It's not like academics are immune shifting patterns in utilization & reimbursement. We all know "non-profit" hospitals are entirely dependent on RVU, fee-for-service revenue. Many faculty have RVU targets & bonus etc. With decreasing reimbursement, eventually hospital admins are going to pick up the lost revenue...
 
Oh, they're anticipating them and know exactly how to maintain their income in the face of the challenges we all face.

For example, here we have a tweet from Dr. Kenneth Olivier. I will take the liberty of translating from Twitter English to Real English: "Instead of hiring another doc, which is what one used to do when "demand for consults exceeded supply", we used a physician extender in order to increase throughput in my department, and thus increase the profitability of our practice. This was easy for us to do, based on the exploitative billing on the technical side Mayo is able to extract from cancer patients and their payors. At the same time, pay no attention to the 'misanthropes' on SDN who have been saying that this exact process that I am currently bragging about on Twitter is one of many which will lead to significant problems for future radoncs."

 
frijoles said:
THIS is the kind of "data" that needs to be discussed in the open. On Twitter, published letters etc.

Why are academics not anticipating these changes? It's not like academics are immune shifting patterns in utilization & reimbursement. We all know "non-profit" hospitals are entirely dependent on RVU, fee-for-service revenue. Many faculty have RVU targets & bonus etc. With decreasing reimbursement, eventually hospital admins are going to pick up the lost revenue...
Click to expand...
A lot department chairs don’t really care if faculty meet rvu targets- would just hire someone else. It is a setup for overutilization. When someone retires, they will just replace them and let the faculty battle it out.
 
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RickyScott said:
A lot department chairs don’t really care if faculty meet rvu targets- would just hire someone else. It is a setup for overutilization. When someone retires, they will just replace them and let the faculty battle it out.
Click to expand...
Having too many rad oncs in the US is the BEST way to over-utilize RT.
 
OTN said:
Oh, they're anticipating them and know exactly how to maintain their income in the face of the challenges we all face.

For example, here we have a tweet from Dr. Kenneth Olivier. I will take the liberty of translating from Twitter English to Real English: "Instead of hiring another doc, which is what one used to do when "demand for consults exceeded supply", we used a physician extender in order to increase throughput in my department, and thus increase the profitability of our practice. This was easy for us to do, based on the exploitative billing on the technical side Mayo is able to extract from cancer patients and their payors. At the same time, pay no attention to the 'misanthropes' on SDN who have been saying that this exact process that I am currently bragging about on Twitter is one of many which will lead to significant problems for future radoncs."

Click to expand...


The fact that this is openly admitted by an academic RO of PAs doing consults (and with how much 'supervision' are they doing them) should be disconcerting to anyone looking for a job.
The majority of your patient-facing work (initially follow-ups only, now doing consults as well) is doable by a PA with zero residency training according to this academic RO. Back into the 'technician camp' we go.
 
OTN said:
Oh, they're anticipating them and know exactly how to maintain their income in the face of the challenges we all face.

For example, here we have a tweet from Dr. Kenneth Olivier. I will take the liberty of translating from Twitter English to Real English: "Instead of hiring another doc, which is what one used to do when "demand for consults exceeded supply", we used a physician extender in order to increase throughput in my department, and thus increase the profitability of our practice. This was easy for us to do, based on the exploitative billing on the technical side Mayo is able to extract from cancer patients and their payors. At the same time, pay no attention to the 'misanthropes' on SDN who have been saying that this exact process that I am currently bragging about on Twitter is one of many which will lead to significant problems for future radoncs."

Click to expand...


KO benefits from all the issues that are plaguing the field. He pretends otherwise on Twitter. In real life it's a lot more difficult to get him to say anything that isn't ambivalent

I don't know if you're reading this KO but here it is : to have a PA do a RO consult is foolish but to admit it in a public forum is just criminal. If you need a PA then why not shut down your residency program?
 
evilbooyaa said:
The fact that this is openly admitted by an academic RO of PAs doing consults (and with how much 'supervision' are they doing them) should be disconcerting to anyone looking for a job.
The majority of your patient-facing work (initially follow-ups only, now doing consults as well) is doable by a PA with zero residency training according to this academic RO. Back into the 'technician camp' we go.
Click to expand...

Loathe to defend KO here since I still think it's a terrible trend for the field, but I didn't read his remarks as they are having PA/NPs do RadOnc consults at Mayo. I read it as: in order for existing physicians to take on more consults, *instead of hiring more physicians (this is the bad part)*, they are offloading follow up clinic almost entirely to APPs, which is a fairly common trend many places.
Then you just see consult, treat 5 fractions, never see them again. Completely different than truly getting to know and follow your patients.
 
I can't seem to follow KO's Twitter posts. He is all over the place and not making much sense. One minute he sympathizes with the current job situation, the other he is promoting the use of APPs, the other he's talking about some bizarre Halloween pictures. I think people need to put their Twitter accounts away and just focus on their jobs...

I remember meeting him as a medical student at ASTRO during a med student function, where he was surrounded by other medical students asking for advice. He boasted about how competitive radiation oncology was and how great Mayo Clinic is. He can keep echoing nonsense like that but off of Twitter, please...
 
DireMoose said:
Loathe to defend KO here since I still think it's a terrible trend for the field, but I didn't read his remarks as they are having PA/NPs do RadOnc consults at Mayo. I read it as: in order for existing physicians to take on more consults, *instead of hiring more physicians (this is the bad part)*, they are offloading follow up clinic almost entirely to APPs, which is a fairly common trend many places.
Then you just see consult, treat 5 fractions, never see them again. Completely different than truly getting to know and follow your patients.
Click to expand...

And... I stand corrected. What garbage.

 
RadOncDoc21 said:
This guy needs a person to monitor his tweeting.
Click to expand...
I agree! maybe take away his twitter when he's at work

He admitted that the PA allows him to have time for tweeting at work! His words, not mine!

I'm flabbergasted, incoming residents please take note. A PD and senior attending who could very well be the chair of the Mayo Clinic Department of Radiation Oncology in the future needs a PA so he can tweet at work.
 
DireMoose said:
And... I stand corrected. What garbage.

Click to expand...

I would argue that "prepping the consult" is tied for the single most important thing that we do - that and contours. The patient's entire course and treatment is based off that initial information gathering and consolidation for their plan.

If we as radiation oncologists begin fully outsourcing that to APPs, it's over. Take note that is different then obtaining dispo for an inpatient consult.
 
Grubbe-a-dub-dub said:
I can't seem to follow KO's Twitter posts. He is all over the place and not making much sense. One minute he sympathizes with the current job situation, the other he is promoting the use of APPs, the other he's talking about some bizarre Halloween pictures. I think people need to put their Twitter accounts away and just focus on their jobs...

I remember meeting him as a medical student at ASTRO during a med student function, where he was surrounded by other medical students asking for advice. He boasted about how competitive radiation oncology was and how great Mayo Clinic is. He can keep echoing nonsense like that but off of Twitter, please...
Click to expand...

Maybe he wouldn't need an APP if he spent more time in clinic and less on twitter?
 
DireMoose said:
And... I stand corrected. What garbage.

Click to expand...

FWIW the clinical oncologist (aka the rad onc in American vernacular) in the UK doesn’t generally contour (or plan)... this task is left to dosimetry. Even GTV and CTV contouring. So if the RO isn’t seeing consults, then we could foresee a time where the RO is just an APP and dosimetry overseer. But in essence isn’t this what a lot of academic ROs (KO included) are already doing; just substitute “dosimetry” with “resident and dosimetry.” Total garbage.
 
I wasn’t sure where to post this, but worth sharing

“NCAA case involving anti-trust going to be heard by Supreme Court”

This is referring to the BILLIONS of dollars on college players likeness etc

I may be a simpleton, but I really don’t think contracting a few rad onc residency spots is going to make a dent in legal world

www.espn.com

Emmert to meet protesting players after tourney

NCAA president Mark Emmert has informed a group of players who started a social media campaign to protest inequities in college sports that he will meet with them after the NCAA tournament.
www.espn.com www.espn.com
 
metallica81788 said:
I would argue that "prepping the consult" is tied for the single most important thing that we do - that and contours. The patient's entire course and treatment is based off that initial information gathering and consolidation for their plan.

If we as radiation oncologists begin fully outsourcing that to APPs, it's over. Take note that is different then obtaining dispo for an inpatient consult.
Click to expand...
First of all, his time is better spent tweeting than seeing consults? So he can chill when he gets home?? Wtf?!! If this isn’t evidence of a massive leadership problem in our field then I don’t know what else can be said.

I would love to online shop and gym tan and laundry while I’m at work too so that I can chill after 4 pm too. Where do I sign up for a chairman job?

He’s not the only one using APMs for this, however. I have been told on record that NPs/PAs are completing head and neck contouring at MSK for attendings (who may or may not have lost resident coverage due to behavioral issues). So not only are patients not receiving care from board certified rad oncs, but they’re receiving care from non-physicians at 5-6x the rate charged by community facilities nearby. This is one of the biggest hippocracies in our corrupt field.
 
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heavyluva said:
First of all, his time is better spent tweeting than seeing consults? So he can chill when he gets home?? Wtf?!! If this isn’t evidence of a massive leadership problem in our field then I don’t know what else can be said.

I would love to online shop and gym tan and laundry while I’m at work too so that I can chill after 4 pm too. Where do I sign up for a chairman job?

He’s not the only one using APMs for this, however. I have been told on record that NPs/PAs are completing head and neck contouring at MSK for attendings (who may or may not have lost resident coverage due to behavioral issues). So not only are patients not receiving care from board certified rad oncs, but they’re receiving care from non-physicians at 5-6x the rate charged by community facilities nearby. This is one of the biggest hippocracies in our corrupt field.
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No way. Tell me this ain’t so
 
heavyluva said:
So not only are patients not receiving care from board certified rad oncs, but they’re receiving care from non-physicians at 5-6x the rate charged by community facilities nearby. This is one of the biggest hippocracies in our corrupt field.
Click to expand...
Btw 5-6x cms rates would be on the low end of my estimates.
 
RadOncMegatron said:
No way. Tell me this ain’t so
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Yes way! There are plenty of places where dosimetry does all the normals. There are a few places where NPs/PAs do all the contours, normals and targets! In fact, I know of a place that has a foreign trained radiologist doing skull base contours! (Normals and targets). Can you guess which place that is? It's not a hellpit program and it's not MSKCC.

For what it's worth I have a few "tricks" that speed up contouring with our treatment planning system. I never teach them to the residents unless they've rotated with me long enough and I know they know how to contour. Even then it's only good for normals. I would never automate target contouring for GTV. Maybe CTV expansions (shaved off normal structures!) and automating PTV generation.
 
Fatradman said:
Yes way! There are plenty of places where dosimetry does all the normals. There are a few places where NPs/PAs do all the contours, normals and targets! In fact, I know of a place that has a foreign trained radiologist doing skull base contours! (Normals and targets). Can you guess which place that is? It's not a hellpit program and it's not MSKCC.

For what it's worth I have a few "tricks" that speed up contouring with our treatment planning system. I never teach them to the residents unless they've rotated with me long enough and I know they know how to contour. Even then it's only good for normals. I would never automate target contouring for GTV. Maybe CTV expansions (shaved off normal structures!) and automating PTV generation.
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I actually enjoy contouring. It is the heart of what we do. Would never allow a non physician to contour gtv/ctv especially in head and neck.
 
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RickyScott said:
I actually enjoy contouring. It is the heart of what we do. Would never allow a non physician to contour gtv/CT’s especially in head and neck.
Click to expand...

I enjoy it too, it's calming. But I must speed it up because of time constraints. And I agree, I wouldn't let non physicians do them. I'd rather automate things then patch it up. Or review resident contours (when I have the privilege of having one), patch them up if they need any alterations and give feedback.
 
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