Was never really a fan of Dr Spratt when he was posting on this forum. Always thought there was a lot of arrogance in the way he was posting on here and on Twitter. I don’t know him personally or professionally but he definitely comes across as someone I would never want to work for.
I feel the same way about Dan Spratt that I do about Kanye West.
I enjoy and respect their work, but they're not the kind of people I want to know personally.
I know Spratt and others blame Simul and SDN for RadOnc's "fall from grace". I'm sure that drove a lot of today's vitriol. So, to turn it around, if someone reading my words right now feels that way - why?
As we have clearly seen, though the Match rate for RadOnc is low, virtually all spots are being filled through other mechanisms.
Those spots, by definition, are going to physicians. Those physicians are, by definition, people who have successfully completed medical school and are eligible (or have already completed) all the steps required to be licensed to practice medicine in the United States.
Are you worried these physicians are not going to be able to complete our residency training and pass our 4 board exams? If they are able to complete medical school and pass all of the USMLE exams, yet struggle with RadOnc - is that a problem with them, or our training/board certification process? There is nothing inherently special or more difficult about Radiation Oncology compared to any other specialty in medicine. Any person capable of graduating medical school and completing the steps required for a medical license
should be able to become board certified in RadOnc.
Are you worried that these physicians are not the historical "rock stars" of the past 15-20 years, and we're not going to be able to have the impact on medicine that we used to have? For all of our MD-PhD, AOA, 20+ publication medical students we've Matched - what do we have to show for it? While our Match stats are "better", has that translated to a more powerful impact later on? There doesn't appear to be much of a correlation.
Are practice patterns and reimbursement trends moving in a positive direction, or a neutral-to-negative one? We have some of the worst wage stagnation in all of medicine. I need to double check the numbers, but I believe CMS has cut our reimbursement ~25% compared to a decade ago. Our major innovation over the last 10 years is reducing the number of fractions we use to treat cancer, which, while amazing for patients, has a direct impact on the "demand" side of our specialty.
Are leadership positions being made available to the next generation? Or are the majority of people in Chair or Vice Chair positions the people that have been in that role for 15, 20, 25+ years?
When private practice docs are retiring, are they handing the reigns off to the next generation, or are they selling their practice to hospitals/academic systems?
For the early-to-mid career "academic" docs, what does their day-to-day look like? Are they at the main campus, with protected academic time and appropriate resources to grow an academic career? Or are they relegated to satellite sites, functioning essentially as community docs for academic pay and little chance for advancement, since their "academic time" is from 5PM-9PM?
If you are one of the people who believes RadOnc has "fallen from grace", you need to check your hubris at the door.
1) We have virtually the same number of residency spots and programs as we did 5 years ago (perhaps more)
2) We are filling virtually all those spots with physicians
If physicians who were eligible to fill a residency spot are struggling to finish residency or pass board exams, whereas 5 years ago they were not - that means your training program is bad and you were previously surviving because you Matched people who were good at taking tests. You don't deserve to have residents.
If your training program can produce board-certified graduates but people aren't applying to your program - that means there are concerns about the career itself. If you believe a graduating medical student in 2022 can have a vibrant career in RadOnc - a career that could span 30-40 years - why do you believe that? Are you pointing at an ARRO jobs survey filled out by residents yet to graduate, or word of mouth from your friends, or something more substantial? We'd all love to know.
Until and unless available spots in Radiation Oncology are not being filled
at all, then Dan Spratt and everyone else has the raw material they need to prove everyone wrong.
I'll be here, waiting. I want to be proven wrong.
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