Rad Onc Twitter

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thecarbonionangle said:
The important question is: is our children learnin’? The answer in many hellpits is undoubtedly not and people are basically teaching themselves. The amount of terrible places is embarassing for this field. The hellpit story is very similar from many people who trained at these places: little educational value, clinic all day writing notes as a grunt, tons of scut. It is not surprising how someone can graduate and have no idea how to treat breast when basically their only job was doing scut.

We need a massive closing of bad programs.
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Oh absolutely! So many programs where education is not great.
 
metallica81788 said:
I came out of residency with pCR rate of German Rectal Study engrained in my head but did not know how to treat or plan breast cancer
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And you're obviously a very good doctor. But, man, that residency program totally failed in its mission. Call it "residency education malpractice"... and thus, it should lose its license to educate residents.
 
thecarbonionangle said:
The important question is: is our children learnin’? The answer in many hellpits is undoubtedly not and people are basically teaching themselves. The amount of terrible places is embarassing for this field. The hellpit story is very similar from many people who trained at these places: little educational value, attendings who have no skin in game in success of residents, absent chairs, clinic all day writing notes as a grunt, tons of scut. It is not surprising how someone can graduate and have no idea how to treat breast when basically their only job was doing scut. A good resident keeps their head down, says yes sir, and writes a good note and contours on time. Who the hell cares if they know what is going on?
But hey at least they know pCR in german was about <10%, or was it? They ain’t even sure about that either!

We need a massive closing of bad programs.
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This is why we need to keep ranking the hellpit programs.
 
I avoid hiring from hell pit programs. Sorry to say.
 
RickyScott said:
When I think about data onanism, it is more about sites like prostate and breast than lymphoma. With breast and prostate radonc it seems like thought leaders create and often cite exponentially accruing retrospective crap. Ontologically, there is just not much depth to prostate and breast radiation vs the systemic treatment of those diseases. Pumping out hundreds of papers as a breast radonc just seems like desperation to stay academically relevant to med/surg onc peers. It almost feels like data is so heavily emphasized because there is just not that much to the delivery and management of these pts.
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Breast is the worst!
 
jondunn said:
I avoid hiring from hell pit programs. Sorry to say.
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Would be great to have a list (could be anonymously sent to mods? Maybe new thread?) of actual programs that people in positions to hire avoid hiring from due to reputation.
 
CaesarRO said:
Would be great to have a list (could be anonymously sent to mods? Maybe new thread?) of actual programs that people in positions to hire avoid hiring from due to reputation.
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In truth, up until a year or 2 ago, even some of the worst programs were graduating high achievers, but that’s going to change on a dime.
 
RickyScott said:
In truth, up until a year or 2 ago, even some of the worst programs were graduating high achievers, but that’s going to change on a dime.
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High achiever or not, if not trained well, takes longer to be ready for good practice. I also like to
Work with oncologists, not technicians
 
CaesarRO said:
Would be great to have a list (could be anonymously sent to mods? Maybe new thread?) of actual programs that people in positions to hire avoid hiring from due to reputation.
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If Someone is BC no matter where they trained they have earned my respect. Graduates from bad places are not my goal to hurt. It is the enabler people at these places which hurt us all
 
RickyScott said:
In truth, up until a year or 2 ago, even some of the worst programs were graduating high achievers, but that’s going to change on a dime.
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Hence the suggestion. I think it's a lot more concrete than just listing rumored bad places.

If someone can actually say "I don't hire out of program X because of the reputation of their training" that's a much starker red flag than some of the general hearsay, imo.

Some of the places mentioned here in the past I know have excellent practical training even though they are busier programs that are definitely not as "chill" as other programs, which is often looked down on by applicants.

I'm interested in actual hiring decisions based on these things.
 
thecarbonionangle said:
If Someone is BC no matter where they trained they have earned my respect. Graduates from bad places are not my goal to hurt. It is the enabler people at these places which hurt us all
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So at least a year or of training. May have had some good post-grad mentoring from whoever did take them on
 
Seems like a very subjective measure. Hell, there were some residents I could see myself working with forever and others I couldn’t stand at my own program. Different skill sets, etc. We all graduated and seemed to be doing well in very different environments. I’m not sure there is much of an indicator of which programs pedigree is superior to another one.
 
jondunn said:
High achiever or not, if not trained well, takes longer to be ready for good practice. I also like to
Work with oncologists, not technicians
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ROs that graduated 5-10 years ago are going to be great irrespective of program. Look at the candidate, not the program imo
 
‘peak’ rad onc applicants if we want to go by the Med school gunner era is still ongoing, 2-3 more years of peak classes graduating
 
I can speak as someone from a higher "pedigree" program that the training aint that great here either. Even though we are 1:1. Resident is in clinic all day seeing consults, OTVs, f/u. Writing all the notes. This gives attending time to do the things that require more brain power like plan review, image review.
Little time for learning other practical component like simulation, planning, image review. It is sad. I thought I'd have more time as a senior resident to learn some of these things but it just is not a priority. I guess that it was what my PGY-6 year (1st year attending) will be for. We have a strong reputation nonetheless and graduates from our program succeed in both community + academic settings.
 
radoncftw said:
I can speak as someone from a higher "pedigree" program that the training aint that great here either. Even though we are 1:1. Resident is in clinic all day seeing consults, OTVs, f/u. Writing all the notes. This gives attending time to do the things that require more brain power like plan review, image review.
Little time for learning other practical component like simulation, planning, image review. It is sad. I thought I'd have more time as a senior resident to learn some of these things but it just is not a priority. I guess that it was what my PGY-6 year (1st year attending) will be for. We have a strong reputation nonetheless and graduates from our program succeed in both community + academic settings.
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Yeah prestige isn’t 1 and 1 with good residency program all the time. This is why word of mouth is good for people applying to residency. If you’re still going to go into rad onc in 2021, make sure it’s a good program for education and culture
 
Training aside, the 100 or so us mds can all match in mid to top tier programs. I have concerns about their lack of judgement to begin with that would be compounded should they decide on a program with a sh—y rep like Arkansas, miss, Tennessee, Columbia etc.
For the next 10-20 years, you really don’t have to hire a new grad! There will be plenty of itinerant grads from radoncs prime years- with experience- looking to change jobs, leave fellowships or toxic academic department etc. Since most of us are employed, it’s not like it helps my bank account to hire newbie at a low salary, just the opposite. (The more the hospital pays another radonc, better for me when it comes to contract renewal)
 
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Ray D. Ayshun said:
Why don't we just approach that trend like all of the trials attempting to eliminate radiotherapy? A 3% drop isn't significant. In all seriousness, that trend pretty much exactly corresponds to the competitiveness of the field.
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Yeah, I think Dan forgot about that pesky confounder of "we became the least desirable speciality in all of medicine during the time frame of this study":

1633783469989.png
 
‘For the next 10-20 years, you really don’t have to hire a new grad!’

when do we think this is going to start? What is the prediction?
 
jondunn said:
‘For the next 10-20 years, you really don’t have to hire a new grad!’

when do we think this is going to start? What is the prediction?
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I would say match toally tanked 3 years ago. If I was looking, maybe next year or the following would be last year to consider hiring a new grad . Even today there are plenty of radoncs with several years experience and on paper far exceed me, looking to get out of exploitative or rural jobs.
 
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jondunn said:
‘For the next 10-20 years, you really don’t have to hire a new grad!’

when do we think this is going to start? What is the prediction?
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Just to add my personal 2 cents; when our next senior partner retires I'm certain that we will not replace that person. Furthermore, I do not see there being enough growth in volume to counteract the continued move to hypofractionation as well as the loss of compensation from declining reimbursement. I really hate to say this but I would not be surprised if we do not increase the total number of partners for my entire career. I think about it every day and feel awful for others who are going to suffer.
 
dieABRdie said:
Just to add my personal 2 cents; when our next senior partner retires I'm certain that we will not replace that person. Furthermore, I do not see there being enough growth in volume to counteract the continued move to hypofractionation as well as the loss of compensation from declining reimbursement. I really hate to say this but I would not be surprised if we do not increase the total number of partners for my entire career. I think about it every day and feel awful for others who are going to suffer.
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Without a question, le breadlines are here. It is going to be very bad and very soon. I feel very sad for the posterity.
 
jondunn said:
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URMs are smart and are avoiding this field because they know how horrible the market is. That is what is causing the decline in URM rad oncs. How about fix the problem and contract residency spots and make the job more desirable so we have competitive applicants (URM and non-URM) apply? It's not that difficult to understand.
 
metview said:
URMs are smart and are avoiding this field because they know how horrible the market is. That is what is causing the decline in URM rad oncs. How about fix the problem and contract residency spots and make the job more desirable so we have competitive applicants (URM and non-URM) apply? It's not that difficult to understand.
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This is truly the problem and only solution at this point in time.
 
RealSimulD said:
Why in the world would we target any specific group in this current state of his affairs is maddening…
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Makes a good red herring to keep those residency slots filled rather than contracting them.

They unfortunately insult the better intelligence of URMs when they do that
 
unpopular opinion, but there's not much inherently wrong with treatment de-esclalation in cancer care, including learning which patients need less or no radiation.

it just needs to be coupled with understanding that this has on the job market.
 
jondunn said:
unpopular opinion, but there's not much inherently wrong with treatment de-esclalation in cancer care, including learning which patients need less or no radiation.

it just needs to be coupled with understanding that this has on the job market.
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I don’t know that most of us don’t agree that HF has been fantastic for patients. Is this an unpopular opinion ? I think it’s been great. If we held at 2008ish numbers, we wouldn’t be in this situation.
 
RealSimulD said:
I don’t know that most of us don’t agree that HF has been fantastic for patients. Is this an unpopular opinion ? I think it’s been great. If we held at 2008ish numbers, we wouldn’t be in this situation.
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Just replying to the post above mine. But also I think you are probably more on board than others. You’ve tweeted before a few times asking what it will take for people to finally start doing more 8/1 rather than 30/10 for bone Mets, so you may be more on the train than others.
 
jondunn said:
Just replying to the post above mine. But also I think you are probably more on board than others. You’ve tweeted before a few times asking what it will take for people to finally start doing more 8/1 rather than 30/10 for bone Mets, so you may be more on the train than others.
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I dont think anyone here has ever said that HF or omission does not benefit pts, just that relative to other fields, it takes up a disproportionate amount of our research.
 
jondunn said:
unpopular opinion, but there's not much inherently wrong with treatment de-esclalation in cancer care, including learning which patients need less or no radiation.

it just needs to be coupled with understanding that this has on the job market.
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Yet you don't see this in med onc, esp when it comes to IO where the indications for therapy keep exploding. Hypo/SBRT Tx is great for patients and society. We just need to acknowledge how that impacts our workforce and need for graduating RO labor going forward
 
Hypo fractionation is absolutely awesome when it achieves the same outcomes. In some cases that is true. In other cases the outcomes are close enough that we say less treatment time is worth some % toxicity. There will never be universal agreement on that.

It’s the madness of increasing residency slots and the previous generation (academic and pp sham partnership track alike) while we are actively doing less work. Ignoring the workforce survey. And now the 5(?) year or longer charade of not only this but less rt utilization, the apm, and supervision changes - all of which are clear points to destroy demand - and the old guard actively ignoring all of this to pump out record residents. But then they dunk on us “oh those sdn ppl hate hypofx, look at those greedy pigs” while those same senior ppl sit at the tail end of careers and wealth never available to us, nor something they even fought to help preserve. It’s great strategy for them, they won. And the longer they discredit us the longer they can feed their machine until the data and struggle is so obvious you get to the emperor has no clothes moment.

It’s almost at a sociopathic level to have so much focus on minutiae data and a glaring, willful ignorance of data and factors on employment, because doing so would cause some poor senior physician to have to write their own notes more.
 
Big focus in Med onc right
medgator said:
Yet you don't see this in med onc, esp when it comes to IO where the indications for therapy keep exploding. Hypo/SBRT Tx is great for patients and society. We just need to acknowledge how that impacts our workforce and need for graduating RO labor going forward
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You do see it in Med onc. The TailorRX being a recent NEJM paper, but ongoing, lots of interest in using circulating timorDNA to pick who actually needs adjuvant IO
 
Also I’ve been highly critical of urologists but active surveillance studies and approaches have been largely led by them, which is great
 
jondunn said:
Big focus in Med onc right


You do see it in Med onc. The TailorRX being a recent NEJM paper, but ongoing, lots of interest in using circulating timorDNA to pick who actually needs adjuvant IO
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You do see it in MO on occasion.

Do you feel proportionately they add indications / innovate more or less than we do?

My opinion (somewhat less informed since I don’t know what new and cool in MO) is that we do it to an extent that is probably not serving us well unless a goal of RO is to reduce / eliminate itself as a modality. And I mean that is an end in itself, not as “improve cancer care” objective.
 
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