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Fatradman said:
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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The fact I have great admiration of you because of the bolded, when that is literally the absolute minimum an academic attending should aspire to, is disheartening, to say the least.
 
evilbooyaa said:
The fact I have great admiration of you because of the bolded, when that is literally the absolute minimum an academic attending should aspire to, is disheartening, to say the least.
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Thank you! I know some of my colleagues will just review contours on their own. Sometimes make massive alterations and give zero feedback. Sometimes they even just adjust the PTV without adjusting the rest of the volumes. Then everything looks wrong during chart rounds and the resident gets the brunt of the wrath of the old guard. It's shambolic.

If contouring is important, and it is then it should be a big part of our certification! Even if you can automate every single part of it the physician has to have the knowledge to "QA" and "sign off" on those contours. Yet, we have no objective and structured way of assessing this skill on our boards. Maybe a few scattered questions here and there.

Clinical rad onc, physics, cancer bio (very broad and only clinically relevant) and anatomy. Do it all in one written exam. Done! No more trivia

Have dedicated contouring stations or contouring sections within each station.

Wouldn't that produce safer radiation oncologists for our patients?
 
1616544562637.png


WOW what a tone deaf Tweet.

For the last time, for the people in the back:

No one is complaining about the job itself.

The complaints are about meta-issues, namely, job market, leadership, board certification process, and reimbursement/APM.

But more importantly - blocking all replies? Don't feel like actually entering the debate? Cool.
 
elementaryschooleconomics said:
View attachment 333246

WOW what a tone deaf Tweet.

For the last time, for the people in the back:

No one is complaining about the job itself.

The complaints are about meta-issues, namely, job market, leadership, board certification process, and reimbursement/APM.

But more importantly - blocking all replies? Don't feel like actually entering the debate? Cool.
Click to expand...
If Tim Chan cannot handle the heat, maybe get out of the kitchen. Go get some take out brotha!
 
Can you blame him for his tone-deaf attitude?

Some people in the field do not care in which geographical location they end up in, they do not care about how much money they make, they do not care about Quality of Life. The goal is to advance their career. They have such tunnel vision that the only thing that matters is the job. Those people scare me, I can't imagine life just being around the job.

They love the meetings, the talk of research, the doing of research by underlings and finally seeing patients!

Teaching residents? not so much

They will get far and will become part of the leadership.
 
Fatradman said:
Can you blame him for his tone-deaf attitude?

Some people in the field do not care in which geographical location they end up in, they do not care about how much money they make, they do not care about Quality of Life. The goal is to advance their career. They have such tunnel vision that the only thing that matters is the job. Those people scare me, I can't imagine life just being around the job.

They love the meetings, the talk of research, the doing of research by underlings and finally seeing patients!

Teaching residents? not so much

They will get far and will become part of the leadership.
Click to expand...
Fat Man, these people become leaders. Gomers go to ground. A radiation oncologist can't contour in a straight line from the bread line. So it is in the House of God.
 
Fatradman said:
Thank you! I know some of my colleagues will just review contours on their own. Sometimes make massive alterations and give zero feedback. Sometimes they even just adjust the PTV without adjusting the rest of the volumes. Then everything looks wrong during chart rounds and the resident gets the brunt of the wrath of the old guard. It's shambolic.

If contouring is important, and it is then it should be a big part of our certification! Even if you can automate every single part of it the physician has to have the knowledge to "QA" and "sign off" on those contours. Yet, we have no objective and structured way of assessing this skill on our boards. Maybe a few scattered questions here and there.

Clinical rad onc, physics, cancer bio (very broad and only clinically relevant) and anatomy. Do it all in one written exam. Done! No more trivia

Have dedicated contouring stations or contouring sections within each station.

Wouldn't that produce safer radiation oncologists for our patients?
Click to expand...

There was a fair amount of contouring on my oral board exam a few years back, but I agree it’s way underrepresented given how integral it is to what we do.
 
Fatradman said:
Can you blame him for his tone-deaf attitude?

Some people in the field do not care in which geographical location they end up in, they do not care about how much money they make, they do not care about Quality of Life. The goal is to advance their career. They have such tunnel vision that the only thing that matters is the job. Those people scare me, I can't imagine life just being around the job.

They love the meetings, the talk of research, the doing of research by underlings and finally seeing patients!

Teaching residents? not so much

They will get far and will become part of the leadership.
Click to expand...
Some people are winners in this field and Tim Chan is a winner. MD/PhD from Hopkins and worked with Vogelstein and Baylin. As soon as he matched radonc residency he was destined for the type of position and career most of us could only dream of.

Now, to what degree has radiation oncology been intrinsic to Dr. Chan’s success? Well, it let him avoid a medicine residency and likely provided among the most lucrative cancer research opportunities in the world.

But...almost none of his research is specific to radiation oncology. This is genomics and epigenetics and immuno-oncology in a very general sense.

If the next Tim Chan chooses medonc, there will be zero loss to society.
 
communitydoc13 said:
Some people are winners in this field and Tim Chan is a winner. MD/PhD from Hopkins and worked with Vogelstein and Baylin. As soon as he matched radonc residency he was destined for the type of position and career most of us could only dream of.

Now, to what degree has radiation oncology been intrinsic to Dr. Chan’s success? Well, it let him avoid a medicine residency and likely provided among the most lucrative cancer research opportunities in the world.

But...almost none of his research is specific to radiation oncology. This is genomics and epigenetics and immuno-oncology in a very general sense.

If the next Tim Chan chooses medonc, there will be zero loss to society.
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This cannot be emphasized enough.

Over the last decade I've worked with some of the most prolific/well-funded RadOnc bench scientists. I have specifically been told that, when pitching your work or applying for funding, you need to put a MedOnc spin on it because "radiation research won't get funded".

That advice proved true time and time again.

If Tim Chan was a Medical Oncologist, his impact on the world would be the same (and I'm actually a big fan of his work, just not this Tweet).
 
elementaryschooleconomics said:
This cannot be emphasized enough.

Over the last decade I've worked with some of the most prolific/well-funded RadOnc bench scientists. I have specifically been told that, when pitching your work or applying for funding, you need to put a MedOnc spin on it because "radiation research won't get funded".

That advice proved true time and time again.

If Tim Chan was a Medical Oncologist, his impact on the world would be the same (and I'm actually a big fan of his work, just not this Tweet).
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How often is he in clinic? Job market issues would pretty much disappear if we all started seeing patients once a week with resident coverage and a side gig.
 
This is more or less the only tweet regarding this that need exist:

Until VALOR is published, surgery is SOC, and should be done if possible and patient preference. After VALOR is published I'd bet nothing will change, but at least we'll have a better idea of the difference. Why keep finding new ways of analyzing things (rhetorical)? It's not like ET was wrong, just kinda over-stepping.
 
Ray D. Ayshun said:
This is more or less the only tweet regarding this that need exist:

Until VALOR is published, surgery is SOC, and should be done if possible and patient preference. After VALOR is published I'd bet nothing will change, but at least we'll have a better idea of the difference. Why keep finding new ways of analyzing things (rhetorical)? It's not like ET was wrong, just kinda over-stepping.
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Can't tell if Stiles is an-hole just to SBRT, an a-hole to that plus Moghanaki, an a-hole to all of RO in general, or an a-hole to all of mankind. Jury's still out!
 
evilbooyaa said:
Yikes. A personal attack (how can someone this stupid become a chair) against someone who made a mistake (even if in another field) should get ET, WHO IS STILL A RESIDENT(!), a talking to.
Click to expand...

Judging from what I've seen here I don't think ET believes he is still a resident. Or ever was.
 
Ray D. Ayshun said:
This is more or less the only tweet regarding this that need exist:

Until VALOR is published, surgery is SOC, and should be done if possible and patient preference. After VALOR is published I'd bet nothing will change, but at least we'll have a better idea of the difference. Why keep finding new ways of analyzing things (rhetorical)? It's not like ET was wrong, just kinda over-stepping.
Click to expand...

Stiles himself is making point that paper is bunk. (I'm sure he knows this.) Diverge at 3 years would be real signal. This is always the type of signal you should look for regarding local therapy and survival (exempting things like GBM), not diverge in first year or "make up early mortality difference" at 10 months. If surgery impacts late outcomes, I will be impressed. I agree it won't change much. The life expectancy of my SBRT patients is typically on the order of 5 years or less anyway.
 
evilbooyaa said:
Yikes. A personal attack (how can someone this stupid become a chair) against someone who made a mistake (even if in another field) should get ET, WHO IS STILL A RESIDENT(!), a talking to.
Click to expand...
Yet, Evan Thomas contends that people on SDN are the ones who are toxic. All of us love radiation oncology but are angry about the direction of the field so we use SDN as our platform to discuss these important issues.

We are not stupid enough like ET to publicly say the things that he does or act the way that he does. I hope that the way he acts publicly is not how he interacts with his patients and colleagues in real life.

1616597638524.png
 
SubserviantToABR said:
Yet, Evan Thomas contends that people on SDN are the ones who are toxic. All of us love radiation oncology but are angry about the direction of the field so we use SDN as our platform to discuss these important issues.

We are not stupid enough like ET to publicly say the things that he does or act the way that he does. I hope that the way he acts publicly is not how he interacts with his patients and colleagues in real life.

View attachment 333262
Click to expand...
Very righteous. This is the guy who says that “good” radiation docs/therapists know to tell pts about moving their eyes during brain simulation because the optic structures are mobile and may land in the ptv
 
metallica81788 said:
Judging from what I've seen here I don't think ET believes he is still a resident. Or ever was.
Click to expand...
He has undergone no maturing or development. Didn't need to and didn't have to. His life has been untrammeled by doubt, uncertainty, or inferiority. He emerged from the womb as the greatest radiation oncologist mankind has ever known. (Fortunately he was born with ears because without those he'd just been born a d**k.)
 
TheWallnerus said:
He has undergone no maturing or development. Didn't need to and didn't have to. His life has been untrammeled by doubt, uncertainty, or inferiority. He emerged from the womb as the greatest radiation oncologist mankind has ever known. (Fortunately he was born with ears because without those he'd just been born a d**k.)
Click to expand...

Not specifically related to Thomas, (and at the risk of being melodramatic) but I think it's REALLY hard to get a feel for all the highs and lows and humbling experiences you can have until you're an attending.

Those long term follow ups, or calls from the ER, or seeing the small bowel obstruction or bad injury...or how you go bak and check your plan it was perfect but bad stuff happened anyway....or you check your plan and you may have missed something (or been too aggressive or too wimpy).

All that stuff can and will happen as an attending...and man is it humbling.
 
BobbyHeenan said:
Not specifically related to Thomas, (and at the risk of being melodramatic) but I think it's REALLY hard to get a feel for all the highs and lows and humbling experiences you can have until you're an attending.

Those long term follow ups, or calls from the ER, or seeing the small bowel obstruction or bad injury...or how you go bak and check your plan it was perfect but bad stuff happened anyway....or you check your plan and you may have missed something (or been too aggressive or too wimpy).

All that stuff can and will happen as an attending...and man is it humbling.
Click to expand...
My biggest concern is being too aggressively wimpy with p16+ tonsil cancers.
 
elementaryschooleconomics said:
... WOW what a tone deaf Tweet.

For the last time, for the people in the back:

No one is complaining about the job itself.

The complaints are about meta-issues, namely, job market, leadership, board certification process, and reimbursement/APM.

But more importantly - blocking all replies? Don't feel like actually entering the debate? Cool.
Click to expand...


---
- First tweet from Chan was generic: "...this field is great all that blah blah blah...", so far "~59 likes".
- Second tweet: Chan took a swipe at SDN, so far "14 "likes".
Sure we can handle that swipe...

Just click on the "likes" list, it is very entertaining to look at the list of people who like either tweet.
I have no problem with the first tweet, which was generic.
The second tweet is tone-deaf...The guy sits at "Wall St" and wonders what happens on "Main St"...

I only have one advice for Chan: don't like SDN? Don't read this freaking forum.

Re tweet replies only to those he mentioned: it is a marker of arrogant people who don't have time to see reply people he didn't "invite to the party", even the great RW does not block tweet replies..lol.
 
Rubber-necking on the Google Spreadsheet, discovered this gem:

1616639859881.png


First of all, excellent use of this meme.

Second of all, you're giving SDN too much credit. SDN is a powerful force in RadOnc, without question. But, as has been said, time and time again, SDN started yelling about residency expansion YEARS before anything happened. The data finally started to catch up with the prophetic warnings, and now we're here.

SDN didn't double residency slots in the face of decreasing demand...it just told you about it.
 
If we got Tim Chan and Marcus “cheap labour” Randall eating from our hands frothing at the mouth about SDN “thugs”, we must be onto something. Hilarious that the guy cannot take the heat of a scary @ response. Very weak low energy move. Very sad stuff.

Keep up the noise loud and clear. We are winning. I actually think efforts need to ramp up. End these hellpits. Save our field!
 
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thecarbonionangle said:
If we got Tim Chan and Marcus “cheap labour” Randall eating from our hands frothing at the mouth about SDN “thugs”, we must be onto something. Hilarious that the guy cannot take the heat of a scary @ response. Very weak low energy move. Very sad stuff.

Keep up the noise loud and clear. We are winning. I actually think efforts need to ramp up. End these hellpits. Save our field!
Click to expand...
The way out is through!

The 2011 Colts figured it out, so can we.

1616668854677.png
 
Hey KO, how about the time that Paul Wallner sent sexist letters to female junior faculty about their breastfeeding and the ABR had to had an emergency meeting on how to fix the examination process? It was 'the mob' on social media who helped accelerate change. SCAROP was there, just to take credit. What did they do? Write a letter? Only after anger grew among the community.

If SCAROP had any real role, they would listen to the data and reduce the number of residency positions, re-energizing the job market. But yeah, sit on Twitter while your mid-level does all of your work, taking credit for their work.

1616777960343.png
 
SubserviantToABR said:
Hey KO, how about the time that Paul Wallner sent sexist letters to female junior faculty about their breastfeeding and the ABR had to had an emergency meeting on how to fix the examination process? It was 'the mob' on social media who helped accelerate change. SCAROP was there, just to take credit. What did they do? Write a letter? Only after anger grew among the community.

If SCAROP had any real role, they would listen to the data and reduce the number of residency positions, re-energizing the job market. But yeah, sit on Twitter while your mid-level does all of your work, taking credit for their work.

View attachment 333427
Click to expand...

Also, where was the change when half of the class of 2019 got bent over for biology and physics and all of the ABR did was blame that we were not smart enough? Remember Lisa Kachnic standing in front of ARRO at ASTRO 2018 when she was more concerned that she was being 'cyberbullied' on Twitter than actually addressing the irregularities in the exam?
 
SubserviantToABR said:
Hey KO, how about the time that Paul Wallner sent sexist letters to female junior faculty about their breastfeeding and the ABR had to had an emergency meeting on how to fix the examination process? It was 'the mob' on social media who helped accelerate change. SCAROP was there, just to take credit. What did they do? Write a letter? Only after anger grew among the community.

If SCAROP had any real role, they would listen to the data and reduce the number of residency positions, re-energizing the job market. But yeah, sit on Twitter while your mid-level does all of your work, taking credit for their work.
Click to expand...

Couldn't agree more. I can't tell if Kenneth Oliver means well and is just dense. Or understands that SDN/the mob was the real impetus for change but just can't acknowledge it in public due to the backlash he'd receive. Either way, he needs to stop giving credit to others when the we all know everyone here was sounding the alarm about multiple issues far before anyone else on Twitter, SCAROP, or even ARRO. Ultimately of course, the chairs/SCAROP have the power to effect some real positive change but at least acknowledge those who have been sounding the alarm for a long time now.

Also for the virtual exams, let's give credit to the real MVP, COVID-19. We all know that without the near world-ending pandemic, the ABR was not going to move to a virtual exam, ever.

kenneth.oliver.needs.to.contract.his.residency.if.he.actually.cares.JPG
 
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CurbYourExpectations said:
marketdesigner.blogspot.com

The market for radiation oncologists

marketdesigner.blogspot.com marketdesigner.blogspot.com
Click to expand...
"There is no legal way to reduce spots" said Ken Olivier. Don't fall for it. This is not related to that, exactly, but it shows you can't just willy-nilly get antitrust to stick.
...Third, Plaintiffs do not have standing to bring their alleged antitrust claims, because they have not suffered an antitrust injury. Plaintiffs have not alleged antitrust injury, because they have not alleged the type of harm that the antitrust laws were intended to prevent...​
...Fourth, Plaintiffs’ federal antitrust claims fail because they have not alleged facts sufficient to state a claim under Section 2 of the Sherman Act.​

And tellingly, Nobel-prize winning economist dude nonchalantly dropped this gem:
"There is a concern that a coordinated reduction in positions would invite antitrust scrutiny, although other specialties (such as gastroenterology*) have managed that."​
 
CurbYourExpectations said:
marketdesigner.blogspot.com

The market for radiation oncologists

marketdesigner.blogspot.com marketdesigner.blogspot.com
Click to expand...

Interesting to read a bit about the GI situation in the 1990s (final linked citation at bottom of the article):

"The demise of the match seems to have been set in motion in 1993-1994, when Gastroenterology subjected itself to a manpower analysis (Meyer et al 1996). Its main conclusions were that the US health care system and gastroenterologists would benefit from a reduction in gastroenterology fellowship programs. The Gastroenterology Leadership Council endorsed a goal of 25% to 50% reduction in the number of GI fellows over 5 years. Furthermore, an additional year of training was mandated: starting in the summer of 1996, three years of training were required to be board eligible, instead of two."

I would really like to know the legal challenges the GI Leadership Council faced after that recommendation. Which brings up my personal top questions to be addressed at the April 1st Existential Crisis Zoom:

1) What are the legal barriers to contracting Radiation Oncology residency positions?
2) Same as question #1, but this time, has anyone consulted a real attorney with relevant case experience?
3) If it turns out these roadblocks are as flimsy as they seem, what needs to be done so that the decrease in offered positions can commence for the 2022 Match?


My sense is that the tide is turning as leadership at least is starting to acknowledge there is an oversupply problem, but the preferred tactic is to say "Oh we get it, but even if we wanted to, just can't do it. You know, anti-trust and stuff."

If that leg of the defense can be taken out, I think we'd get a lot closer to action.

Hell, how does Dermatology do it? Anybody know the inner workings of how a new derm program gets approved or resident spots get added? Is the bar incredibly high? My uneducated guess is they are conscientious about the long term health of their field, but if they were forced to grow by 33% tomorrow the newly minted derms would have no problems finding jobs. Maybe wait times would go from 6 weeks to 4 weeks.
 
DireMoose said:
Interesting to read a bit about the GI situation in the 1990s (final linked citation at bottom of the article):

"The demise of the match seems to have been set in motion in 1993-1994, when Gastroenterology subjected itself to a manpower analysis (Meyer et al 1996). Its main conclusions were that the US health care system and gastroenterologists would benefit from a reduction in gastroenterology fellowship programs. The Gastroenterology Leadership Council endorsed a goal of 25% to 50% reduction in the number of GI fellows over 5 years. Furthermore, an additional year of training was mandated: starting in the summer of 1996, three years of training were required to be board eligible, instead of two."

I would really like to know the legal challenges the GI Leadership Council faced after that recommendation. Which brings up my personal top questions to be addressed at the April 1st Existential Crisis Zoom:

1) What are the legal barriers to contracting Radiation Oncology residency positions?
2) Same as question #1, but this time, has anyone consulted a real attorney with relevant case experience?
3) If it turns out these roadblocks are as flimsy as they seem, what needs to be done so that the decrease in offered positions can commence for the 2022 Match?


My sense is that the tide is turning as leadership at least is starting to acknowledge there is an oversupply problem, but the preferred tactic is to say "Oh we get it, but even if we wanted to, just can't do it. You know, anti-trust and stuff."

If that leg of the defense can be taken out, I think we'd get a lot closer to action.

Hell, how does Dermatology do it? Anybody know the inner workings of how a new derm program gets approved or resident spots get added? Is the bar incredibly high? My uneducated guess is they are conscientious about the long term health of their field, but if they were forced to grow by 33% tomorrow the newly minted derms would have no problems finding jobs. Maybe wait times would go from 6 weeks to 4 weeks.
Click to expand...
Ben Falit always says real attorneys have been contacted, are constantly being contacted and work for ASTRO and so forth, and these attorneys say residency slot reduction is illegal. However just look at the current “misdiagnosis” thread in this forum. Occasionally experts disagree profoundly.
 
TheWallnerus said:
Ben Falit always says real attorneys have been contacted, are constantly being contacted and work for ASTRO and so forth, and these attorneys say residency slot reduction is illegal. However just look at the current “misdiagnosis” thread in this forum. Occasionally experts disagree profoundly.
Click to expand...

Yes, I have heard that as well. To him, I would like to say: *citations needed. Case law, specifics on how it has resulted in serious consequences for other specialties or other professions. I worry, like the pitfalls of hiring outside consultants, the lawyers are giving them the answers they want to hear.
 
TheWallnerus said:
Ben Falit always says real attorneys have been contacted, are constantly being contacted and work for ASTRO and so forth, and these attorneys say residency slot reduction is illegal. However just look at the current “misdiagnosis” thread in this forum. Occasionally experts disagree profoundly.
Click to expand...
I was told Ben falit contacted some schmo in the law school not an antitrust lawyer and they just said it could be contested.
 
DireMoose said:
Interesting to read a bit about the GI situation in the 1990s (final linked citation at bottom of the article):

"The demise of the match seems to have been set in motion in 1993-1994, when Gastroenterology subjected itself to a manpower analysis (Meyer et al 1996). Its main conclusions were that the US health care system and gastroenterologists would benefit from a reduction in gastroenterology fellowship programs. The Gastroenterology Leadership Council endorsed a goal of 25% to 50% reduction in the number of GI fellows over 5 years. Furthermore, an additional year of training was mandated: starting in the summer of 1996, three years of training were required to be board eligible, instead of two."

I would really like to know the legal challenges the GI Leadership Council faced after that recommendation. Which brings up my personal top questions to be addressed at the April 1st Existential Crisis Zoom:

1) What are the legal barriers to contracting Radiation Oncology residency positions?
2) Same as question #1, but this time, has anyone consulted a real attorney with relevant case experience?
3) If it turns out these roadblocks are as flimsy as they seem, what needs to be done so that the decrease in offered positions can commence for the 2022 Match?


My sense is that the tide is turning as leadership at least is starting to acknowledge there is an oversupply problem, but the preferred tactic is to say "Oh we get it, but even if we wanted to, just can't do it. You know, anti-trust and stuff."

If that leg of the defense can be taken out, I think we'd get a lot closer to action.

Hell, how does Dermatology do it? Anybody know the inner workings of how a new derm program gets approved or resident spots get added? Is the bar incredibly high? My uneducated guess is they are conscientious about the long term health of their field, but if they were forced to grow by 33% tomorrow the newly minted derms would have no problems finding jobs. Maybe wait times would go from 6 weeks to 4 weeks.
Click to expand...
Dermatology spots have expanded by a lot...it’s just that there was such a shortage of general dermatologists that there’s slack to maintain a good job market. Mohs however is saturated and good jobs are harder to come by.
 
RickyScott said:
I was told Ben falit contacted some schmo in the law school not an antitrust lawyer and they just said it could be contested.
Click to expand...
Without any inside knowledge, I assume this is exactly what happened with 99.9% certainty.
 
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