Rad Onc Twitter

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communitydoc13 said:
The numbers here are very strange. A single first year MD/PhD for 3 years with 93 residual active MD/PhDs as of 2020? This in a residency that is 4-5 years long? Was half the class from 2017 MD/PhD? Just doesn't seem plausible. Are there residual MD/PhDs extending their training through fellowship and counting as active?

Unless the data is somehow wildly misrepresented, this reveals a radical shunning of the field by MD/PhDs. (It should be noted that this table refers to the real deal: Dual degree MD/PhD from US med school, not jokers like me who had a PhD and then went to med school.)

If it does represent a radical shunning, there is likely one reason for this, and it is not SDN. MD/PhD folks are typically very close to their very small cohort and classes ahead of them. I suspect downstream MD/PhDs must have been discouraging their upstream friends based on personal experience.

Edit: I noticed that no specialty without commonly integrated PGY-1 had significant numbers of first year MD/PhD's listed. I suspect this explains the tiny number of listed first year residents.

The trend remains significant but not radical. Nineteen fewer MD/PhDs in 2020 vs 2018, likely with significant frontloading of the duel degree cohort among remaining more senior classes.
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The chart is limited to Holman Path only, not the specialty's residency at large. The conclusion we can draw is that they're shunning the Holman Pathway (though I suspect that does indeed apply to the broader specialty).

Basically flipped overnight from all MD/PhDs to all MDs.

Best guess is the participants found it to be unproductive and had limited post graduation opportunities to further research (i.e. they ended up in academic satellite seeing bone mets), and thus discouraged their fellow MD/PhDs from pursuing.
 
Mandelin Rain said:
The chart is limited to Holman Path only, not the specialty's residency at large.
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I was referencing Table B4 from @radiation post above. This refers to residency as a whole and you can glean some significant trends, just not by the first year residency numbers, which are confounded by peculiarities of transitional/intern years.

As an aside. The residencies clearly trending up with MD/PhDs are Psych and Anesthesia. SDN does have a finger on the pulse of things.
 
communitydoc13 said:
I was referencing Table B4 from @radiation post above. This refers to residency as a whole and you can glean some significant trends, just not by the first year residency numbers, which are confounded by peculiarities of transitional/intern years.

As an aside. The residencies clearly trending up with MD/PhDs are Psych and Anesthesia. SDN does have a finger on the pulse of things.
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My bad.
 
communitydoc13 said:
I was referencing Table B4 from @radiation post above. This refers to residency as a whole and you can glean some significant trends, just not by the first year residency numbers, which are confounded by peculiarities of transitional/intern years.

As an aside. The residencies clearly trending up with MD/PhDs are Psych and Anesthesia. SDN does have a finger on the pulse of things.
Click to expand...
Psych has essentially flip flopped with rad Onc when you look at things now vs a decade or two in terms of competitiveness and allure for US MD students.

Essentially was a ton of fmgs over a decade ago now has become quite desirable among Us medical students given the wide open job market and increasing starting salaries (not that far off from starting academic RO salaries from what I've seen)
 
medgator said:
Psych has essentially flip flopped with rad Onc when you look at things now vs a decade or two in terms of competitiveness and allure for US MD students.

Essentially was a ton of fmgs over a decade ago now has become quite desirable among Us medical students given the wide open job market and increasing starting salaries (not that far off from starting academic RO salaries from what I've seen)
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If you look at the stuff on twitter about rad onc labour supply and medicare reimbursement (declining, and tightening its spread), and look into rad onc's past, rad onc is behaving like a seasonal business. And prior to Christmas all the stores (and Amazon, and FedEx, etc) add more workers because it's getting busier and busier. Except now it's after Christmas and we are STILL adding workers!
 
jondunn said:
And just like any seasonal business, WOMEN run the show


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Don’t these numbers seem kinda of low compared to what one expect? Would think it would be closer to 50% looking to leave. 11/12 having a sense of belonging seems extremely high. Such garbage “research.”
 
fiji128 said:
Don’t these numbers seem kinda of low compared to what one expect? Would think it would be closer to 50% looking to leave. 11/12 having a sense of belonging seems extremely high. Such garbage “research.”
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Easy enough to have a control group here. yawn.

edit: leaving academia? pretty much everyone i know in academia is considering leaving it. they just can't. it's everywhere.
 
Ray D. Ayshun said:
Easy enough to have a control group here. yawn.

edit: leaving academia? pretty much everyone i know in academia is considering leaving it. they just can't. it's everywhere.
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Considering what they are paid and how they are treated, most would bail to pp in a heartbeat given the chance, unfortunately the good pp jobs are increasingly harder to find
 
medgator said:
Considering what they are paid and how they are treated, most would bail to pp in a heartbeat given the chance, unfortunately the good pp jobs are increasingly harder to find
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Thanks to academics dominating everything given that ability by arbitrary govt dictat and lobbying.
 
communitydoc13 said:
I was referencing Table B4 from @radiation post above. This refers to residency as a whole and you can glean some significant trends, just not by the first year residency numbers, which are confounded by peculiarities of transitional/intern years.

As an aside. The residencies clearly trending up with MD/PhDs are Psych and Anesthesia. SDN does have a finger on the pulse of things.
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I think its hard to draw any conclusions about trends in MD/Phd numbers, numbers also going down in Derm and Optho, which are still competitive specialities and stable in Path, which is worse off than rad onc
 
radiation said:
I think its hard to draw any conclusions about trends in MD/Phd numbers, numbers also going down in Derm and Optho, which are still competitive specialities and stable in Path, which is worse off than rad onc
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I think the data regarding total MD/PhDs in the field is what it is. Clear decline in radonc, which was grossly overvalued by MD/PhDs for years.

The issue of competitiveness is different than what percentage of residents are MD/PhDs. Ortho has always been competitive but has never been a repository for MD/PhDs in high numbers.

Total conjecture here, but I think MD/PhDs present a unique subset of med students. They are older by a small but critical amount. There is a big difference between 27 and 32 on average when it comes to committing to relationships, starting families etc. among the highly educated crowd. They have already committed significant time to research and have likely already formed a world view regarding what good research means. They are sometimes less than enthusiastic about intense clinical care when they return from years in the lab to clinical rotations. They are selected slightly differently than your average medical student.

The holy grail presented to some molecular/cell bio type MD/PhDs from a generation ago was being paid more than their medonc colleagues while running a lab and working in clinic 1-2 days a week with good support. This is a vanishing rare proposition presently and the medonc model of lower pay, low volume continuity clinic, call 1-2 mos/year and running a lab is much more sustainable. Medonc MD/PhDs are stable.

The tired MD/PhDs, who just want a good clinical job without crazy hours are now gravitating to other fields because of clear job market concerns.

There will always be a niche for physics related PhDs (often not MSTP folks) going into radonc.

Declining MD/PhD numbers in the field is not a problem. Probably a reasonable correction.
 
Mandelin Rain said:
1 in 5 seems incredibly low.

For instance, the AMA conducts "burnout" studies and Medscape did a 15k doc survey. I assume burnout would be STRONGLY correlated with potentially looking to leave your current position.

Overall physician burnout rates hover 40-50%. Lowest specialty is ophtho at 30%.

To have ~80% job satisfaction is almost unheard of in modern medicine and should be celebrated.
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I'd like to see what percentage of male academic oncologists were considering leaving academia in 5 years. Kind of strange to feature rates for women without those rates for men. Hard to know what to make of the numbers for women.
 
Mandelin Rain said:
Like I said, it seems that roughly 80% of women are satisfied with their academic jobs. I'm not even sure a comparison between genders is needed. Just on the face of it. Find any sub group of Americans where 80% are satisfied with literally anything.

I find it as an almost unbelievably optimistic number, rather than even slightly condemnable in the current environment.

EDIT: I honestly don't believe it.
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i know this is a troll move, but can't help myself...



FCaGTxoWEAI3aBQ
 
radiation said:
i know this is a troll move, but can't help myself...

FCaGTxoWEAI3aBQ
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I don't think this is a troll move - we should be discussing this.

Here's the key issue with the ARRO data: literally none of the people in this survey have even started the job yet.

This is our main indicator of the job market (!!). When this survey is conducted in May/June of the PGY5 year - all of these jobs are still hypothetical. Literally no one has worked a single day of any of these jobs.

This is like publishing a paper on cosmesis in breast radiation where all the data was collected between CTSIM and the start of treatment.

Or publishing a paper on the side effect profile of a 6-month ADT injection, but you collected the data while the patient was still sitting in your clinic, band-aid on his arm, because he got the shot 10 minutes ago.

Maybe it's more analogous to reporting the efficacy of Immodium in treating diarrhea, but the patient is in their car, driving to CVS to pick up a box.

There are still people out their hanging their hats on this data, even though the Conclusions are not supported by the authors' Materials & Methods.

Interestingly, the people who run to this data to say "everything's fine" are generally the folks who stand to benefit from maintaining the current system of residents. The Lou Potters and Paul Wallners of the world have OBVIOUS conflicts of interest on this topic. The people who don't have conflicts of interest with the residency numbers - people with jobs in the community or at academic centers without a residency program - don't seem to share the same positive spin.
 
elementaryschooleconomics said:
Maybe it's more analogous to reporting the efficacy of Immodium in treating diarrhea, but the patient is in their car, driving to CVS to pick up a box.
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In this case, residency is the diarrhea and Imodium is the contract. Who knows if it’ll work out or not. You’re just really ready to stop the the current ****.
 

Any of the other searches end yet? Haven’t seen much else posted yet.
 
RadsWFA1900 said:
Time consuming? What planet do you live on. We have more grads and less patients. On my list of **** I worry about, the workflow issues are at the bottom. We have basically cut out all the fat already automated and streamlined everything. Contouring is literally the only time I actually feel like I use my training.
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Self taught training....
 
I saw someone on Medtwitter recently showcasing a prostate VMAT case and like about 59 structures were contoured. It gave me anxiety. In my low risk prostate cases I contour a prostate, a couple of PTVs, a rectum, and bladder. That’s it. And my DVHs look as good as Pete Davidson’s girlfriends.
 
Couple of PTVs?
Treating low risk patients?
 
TheWallnerus said:
I saw someone on Medtwitter recently showcasing a prostate VMAT case and like about 59 structures were contoured. It gave me anxiety. In my low risk prostate cases I contour a prostate, a couple of PTVs, a rectum, and bladder. That’s it. And my DVHs look as good as Pete Davidson’s girlfriends.
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Ah yes, I saw that as well. There were some good tricks in there to occasionally apply if needed.

But, if that level of contouring/planning/review is done for every case:

 
Eh, February 2022 Red Journal is out, with the teased workforce stuff:

1641611218004.png


Mostly talking about Canada. Opens with this spicy passage:

1641611260634.png


1) They're choosing to reference 2020 grads? That class got smacked by COVID (remember when Anderson reneged on contracts? good times!) and I'm not sure we want to be hanging our hats on the class of 2020 (on either side of the debate).

2) Ah yes. The ARRO survey. The ARRO survey which is the equivalent of me planning to treat breast patients with 81 Gy in 45 fractions, promising them the moon and stars at consult, having them sign consent, then my nurse comes in with a survey asking about their side effects.

I'm the best doctor ever, according to that survey!
 
jondunn said:
Click to expand...


Is he insinuating us lowly community plebs take less time to contour because we're not as "good" - that's sure how it comes across.

Or that we may take a few days to contour a head and neck since we're not "experts"

Too bad consulting the UPenn palliative network takes so long it's really bringing up my average...
 
TheWallnerus said:
I cheat a few mm on the posterior prostate for my last 11.1111…% of dose. That percent is a mathematical tell-tale of my Rx dose.
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I usually have:

PTV_7920 (which is the largest volume)
PTV_7921 (1 cGy cone down for sensitizing)
PTV_8099 (second to last cone down)
PTV_8100 (final 1 cGy as a "night cap", if you will)

I stayed at a Tampa Holiday Inn once, it's where I picked this up.
 
TheWallnerus said:
I saw someone on Medtwitter recently showcasing a prostate VMAT case and like about 59 structures were contoured. It gave me anxiety. In my low risk prostate cases I contour a prostate, a couple of PTVs, a rectum, and bladder. That’s it. And my DVHs look as good as Pete Davidson’s girlfriends.
Click to expand...

Everyone knows The Wallnerus and Pete both have that BDE
 
elementaryschooleconomics said:
I usually have:

PTV_7920 (which is the largest volume)
PTV_7921 (1 cGy cone down for sensitizing)
PTV_8099 (second to last cone down)
PTV_8100 (final 1 cGy as a "night cap", if you will)

I stayed at a Tampa Holiday Inn once, it's where I picked this up.
Click to expand...
you can pick up more than that at a Tampa Holiday Inn
 
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elementaryschooleconomics said:
I usually have:

PTV_7920 (which is the largest volume)
PTV_7921 (1 cGy cone down for sensitizing)
PTV_8099 (second to last cone down)
PTV_8100 (final 1 cGy as a "night cap", if you will)

I stayed at a Tampa Holiday Inn once, it's where I picked this up.
Click to expand...
Can't believe you don't add an extra fraction if patient is not having watery stools by the end a la skin isn't red enough in breast RT!
 
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