Rad Onc Twitter

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Neuronix said:
This whole idea of getting a "job offer" in your region of interest as a measure of success is a joke.

A region is a whole large several state area encompassing both large metros and small metros.

There are plenty of rural and urban areas in both the west coast and mountain west. Those had the worst percentages. There is just no need for more radiation oncologists there, and that is about 1/3 of the entire United States.

Further, there is no control for whether the one job offer received is total garbage.

Most specialties are looking at multiple job offers within a single metro or part of a state. They look at it as a disaster if they can't find a job in one specific city (see recent article from emergency forum where someone couldn't get a job in Houston). We can't even call it a disaster if we can't find a job in an area the size of Western Europe.

All of these papers should conclude with "the job market is an absolute disaster" not the softball crap that is written in those red journal articles.
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I was able to get a job in my "region of interest", and can personally vouch for how terrible of a metric that is.

Obviously, a traditional US Census Bureau "region" is just too large to be taken seriously. For me, there's an area of the country where I have a lot of family. I made that the center of where I'd like a job, and basically cast a net for 3-4 hours (at least) in every direction (along with, obviously, looking nationwide).

I've been wondering how big of an area that was, and I just found this site:

Map Area Calculator Tool

An area calculator using a map
www.daftlogic.com

Using that site, my "region of interest" was approximately 49,500 square miles. Within that area, I was able to receive a single job offer (my only one).

By some measures, that's an objective success. But...was it really? Would most doctors in most other specialties consider one job in 50,000 square miles an acceptable return on investment? I would think not.
 
elementaryschooleconomics said:
I made that the center of where I'd like a job, and basically cast a net for 3-4 hours (at least) in every direction (along with, obviously, looking nationwide).
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As a PGY-4/5, I cold called every hospital and rad onc facility within 100 miles of the city where I wanted a job. I didn't even get an interview. I had connections there too. Simply put, only one place was hiring and they already knew who they wanted.

The city was not a top tier sort of place. It was not on Mudit's list, for example, and certainly not a city you would think of as "least opportunities".

I ended up with two academic offers in opposite parts of the country treating random disease sites that I wasn't particularly setup for.

I tell people considering this specialty to only consider it if you have no preference about the location and practice type, and are just happy to be any type of rad onc, anywhere.
 
elementaryschooleconomics said:
I was able to get a job in my "region of interest", and can personally vouch for how terrible of a metric that is.

Obviously, a traditional US Census Bureau "region" is just too large to be taken seriously. For me, there's an area of the country where I have a lot of family. I made that the center of where I'd like a job, and basically cast a net for 3-4 hours (at least) in every direction (along with, obviously, looking nationwide).

I've been wondering how big of an area that was, and I just found this site:

Map Area Calculator Tool

An area calculator using a map
www.daftlogic.com

Using that site, my "region of interest" was approximately 49,500 square miles. Within that area, I was able to receive a single job offer (my only one).

By some measures, that's an objective success. But...was it really? Would most doctors in most other specialties consider one job in 50,000 square miles an acceptable return on investment? I would think not.
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Neuronix said:
As a PGY-4/5, I cold called every hospital and rad onc facility within 100 miles of the city where I wanted a job. I didn't even get an interview. I had connections there too. Simply put, only one place was hiring and they already knew who they wanted.

The city was not a top tier sort of place. It was not on Mudit's list, for example, and certainly not a city you would think of as "least opportunities".

I ended up with two academic offers in opposite parts of the country treating random disease sites that I wasn't particularly setup for.

I tell people considering this specialty to only consider it if you have no preference about the location and practice type, and are just happy to be any type of rad onc, anywhere.
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Your stories stress me out.

I can only pray that med students matching into rad onc 2022 understand the razor thin margins between happiness and sadness, success and failure, that defines what it means to choose rad onc as a career.
 
Medical students doing rotations in radiation oncology should be offered lectures and a practicum on how to make all sorts of home cooking with corn.

Cornbread, corn on the cob, popcorn, cornmeal, creamed corn, elote, corn tortillas, corn salsa, corn fritters, candy corn, corn chowder, corn whiskey, corn ethanol

It is a great survival skill for the rural Midwest where many will be working one day.
 
yesmaster said:
Medical students doing rotations in radiation oncology should be offered lectures and a practicum on how to make all sorts of home cooking with corn.

Cornbread, corn on the cob, popcorn, cornmeal, creamed corn, elote, corn tortillas, corn salsa, corn fritters, candy corn, corn chowder, corn whiskey, corn ethanol

It is a great survival skill for the rural Midwest where many will be working one day.
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You forgot corn nuts
 
RickyScott said:
Minority medical students may need special mentoring on how to fit into MAGA country.
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By minority, you mean Black (sic).

And if ASTRO is more diverse, or not, more trained in implicit bias, or not, what would it help our specialty as a whole? For the job market problems, like the French elite in Paris in WWII when speaking of their new German "friends," ASTRO says je ne suis pas un collaborateur. It is arguable, rather, it is arguably laughable, rather, it is laughable, that ASTRO getting more diverse or promulgating diversity will affect training programs (and, downstream, our specialty) because ASTRO has said so many times they really have nothing to do with training programs. But if ASTRO can help rad onc be more diverse, surely it can help rad onc thin its numbers a bit.

4COAlx5.png


4ZNkxMO.png
 
TheWallnerus said:
By minority, you mean Black (sic).

And if ASTRO is more diverse, or not, more trained in implicit bias, or not, what would it help our specialty as a whole? For the job market problems, like the French elite in Paris in WWII when speaking of their new German "friends," ASTRO says je ne suis pas un collaborateur. It is arguable, rather, it is arguably laughable, rather, it is laughable, that ASTRO getting more diverse or promulgating diversity will affect training programs (and, downstream, our specialty) because ASTRO has said so many times they really have nothing to do with training programs. But if ASTRO can help rad onc be more diverse, surely it can help rad onc thin its numbers a bit.

4COAlx5.png


4ZNkxMO.png
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Very reasonable to view as Astro as a type of Vichy version of radonc. Heard that Eichler himself has had issues finding a permanent job?
 
StIGMA said:
Maybe we can work on other noble endeavors too, like curing cancer and ensuring good employment (and therefore continued good medical student recruitment). You know, the solid foundation is laid before the roof sort of thing. But right now we’re on sinking sand.
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Fear not, for ASTRO's white papers have heroically saved the American public from getting more than 20 fractions for breast cancer. They're doing important things, guys! They're doing it!
 
RadsWFA1900 said:
That’s a joke of a cut.
RO has been taking cuts for the last 10 years. Astro will pull its usual string size and get it to a 1/2 percent cut and call it a victory and the same **** will happen next year
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Med Onc is stressful, too. I'm sure they also wake up at night wondering if they missed...the patient's port.
 
Lamount said:
Biden is proposing a $3.5 trillion expansion to medicare. Does anyone know if this would address the CMS reimbursements?
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Nothing! there gonna go down! This is for free hearing aids and dental work. I love how people like to talk about how popular these programs are if I told you you could get any medical or dental care or ancillary med svcs bottom dollar with token copays. When would that ever be unpopular?
 
Radonc90 said:
Interesting tweet. Bentzen's reply was funny...

---
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Such a good point. The system would collapse underneath us. How much research and "policy" is tied up in "increasing the value" of radiation by dropping fractions? And yet, if overnight everyone started doing that jobs would be cut and salaries would drop and everyone would be left fighting for the same crumbs. The disconnect is that radiation oncologists as a whole ARE providing greater value, but yet the MDACCs/UPenns of the world are simultaneously pillaging the system charging exorbitant fees for low value care (i.e. expensive treatments with no proven benefits) which makes it all a zero sum game and continues to put us in the crosshairs for cuts.
 
medgator said:
Some solid advice at any stage of practice from Tendulkar. Really belongs in the sticky imo
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Advice on how to choose a job assumes that you have options. If you have one job offer, you take it. If you have no job offers, you start begging.

More practical advice for this specialty is:

Make whatever job you end up in work as best you can since you have no idea when you will find something else. Stay flexible and adapt.
 
Mandelin Rain said:
Funny stuff.

BTW, I'm not sure I'm boosting every single 5mm, PET negative node I see in the setting of anal cancer. Is everyone else boosting tiny nodes indiscriminately?
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Honestly with that kind of advice you could treat the RP nodes in many patients unnecessarily. Crane really off the mark here.

The size criteria for inguinal nodes is also larger than what you see in the neck iirc, they are naturally larger in that area
 
Hey, y’all 🙂

I think I’ve been wayward for a bit, but happy to find my way back home to SDN.

Thanks for being a welcoming place for many truly diverse voices and opinions, without cancellation and condemnation (except for our poor rural friend).

Looking forward to the conversation!
 
medgator said:
Honestly with that kind of advice you could treat the RP nodes in many patients unnecessarily. Crane really off the mark here.

The size criteria for inguinal nodes is also larger than what you see in the neck iirc, they are naturally larger in that area
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Quote/screenshot if possible please?
 
Not sure I am totally onboard here with Rahul. He implies that geographic availability has always been equally problematic and this is just not true. Much easier 10-15 years ago. Also first job not being your last etc again was true when I came out, but unlikely the case today. I think a lot of radoncs will be frozen into their first jobs for a long long time in a horrible job market.[
 
medgator said:
Honestly with that kind of advice you could treat the RP nodes in many patients unnecessarily. Crane really off the mark here.

The size criteria for inguinal nodes is also larger than what you see in the neck iirc, they are naturally larger in that area
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I find pet scan in anal and rectal cancer very useful for target delineation.
 
RealSimulD said:
Hey, y’all 🙂

I think I’ve been wayward for a bit, but happy to find my way back home to SDN.

Thanks for being a welcoming place for many truly diverse voices and opinions, without cancellation and condemnation (except for our poor rural friend).

Looking forward to the conversation!
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Lil Rad Onc!
 
pikachu said:
Quote/screenshot if possible please?
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Attached along with another response from Simul that really puts Chris crane in his place regarding financial toxicity
 

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medgator said:
Attached along with another response from Simul that really puts Chris crane in his place regarding financial toxicity
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Hard to virtue signal signal about financial toxicity when you charge 10x cms. Percy Lee was also going off about “high value care” while promoting his groundbreaking paradigm shattering approach to treating stage I nsclc in one fraction on an mri linac.
 
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Mandelin Rain said:
Funny stuff.

BTW, I'm not sure I'm boosting every single 5mm, PET negative node I see in the setting of anal cancer. Is everyone else boosting tiny nodes indiscriminately?
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Boosting 5mm nodes? Man, that's basically a coin toss on whether you're even gonna see that at sim based on where you set your scan borders.

Crane out here doing 0.625mm slices for his pelvic scans? Has he set a sim on fire yet?
 
medgator said:
Attached along with another response from Simul that really puts Chris crane in his place regarding financial toxicity
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thanks for sharing this - that's quite the hot take on no PET-CT in these cases. PET is useful not only for target delineation but response assessment too. I guess if you're going to indiscriminately boost any >5-mm node based on no evidence whatsoever maybe it doesn't change your practice (is he getting MRI for contouring guidance?????) but why bother to even post this? To make the evicore reps feel better about routinely denying PET/CT for staging in this disease?
 
pikachu said:
thanks for sharing this - that's quite the hot take on no PET-CT in these cases. PET is useful not only for target delineation but response assessment too. I guess if you're going to indiscriminately boost any >5-mm node based on no evidence whatsoever maybe it doesn't change your practice (is he getting MRI for contouring guidance?????) but why bother to even post this? To make the evicore reps feel better about routinely denying PET/CT for staging in this disease?
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Like i said crane's post was pretty much hot garbage.

Thankfully it generated multiple responses on mednet to address it
 
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medgator said:
Attached along with another response from Simul that really puts Chris crane in his place regarding financial toxicity
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"All enlarged nodes >5mm should be boosted"

Excuse me, what?

Does he suggest we should boost all groinds with lymph nodes >5mm (short axis)? That would be >90% of my patients.
 
Palex80 said:
"All enlarged nodes >5mm should be boosted"

Excuse me, what?

Does he suggest we should boost all groinds with lymph nodes >5mm (short axis)? That would be >90% of my patients.
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Agree. Think how this compares to guidelines on how to interpret Axumin PET (I know, completely different disease) but the fact is for Axumin as a prostate cancer staging tool you have to account for frequently present inguinal adenopathy that is likely to be somewhat Axumin avid and is not likely to be pathologic.

PET very helpful for Anal CA in my opinion. Nice paper available regarding response significance (which is important because the guideline based serial clinical exams are often equivocal and long term CT abnormalities are often present after tx). Helps define primary tumor target, and I have personally boosted non-enlarged but PET avid inguinal. peri-rectal and presacral lymph nodes on multiple occasions.
 
Palex80 said:
"All enlarged nodes >5mm should be boosted"

Excuse me, what?

Does he suggest we should boost all groinds with lymph nodes >5mm (short axis)? That would be >90% of my patients.
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Back when HIV and AIDS seemed to be a little more prevalent in the cancer clinic, boosting 5mm or larger nodes in an HIV positive patient would have been like total pelvic RT, more or less.
 
Neuronix said:
Advice on how to choose a job assumes that you have options. If you have one job offer, you take it. If you have no job offers, you start begging.

More practical advice for this specialty is:

Make whatever job you end up in work as best you can since you have no idea when you will find something else. Stay flexible and adapt.
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That's what I loved when people asked me if I wanted PP or academic. This implies a choice that I don't have. Then by the time I graduated, it was "community" vs academic, which also implies a choice I do not have. Now? Are people even serious when they ask these questions especially if you are tied to an area?
 
metallica81788 said:
Looks like all "zingers" in multiple posts have been removed. Wonder why...

Expect a red journal editorial on being "canceled" next month by #bigradonc
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Cranes post is edited as well. Very interesting. Sounds like the mednet editors are more heavy handed than the north Korean news service over at ROHub
 
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