Rad Onc Twitter

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UCSD faculty positions had weird reputations since at least the mid-2000s. I wonder why exactly
 
medgator said:
Alaska _____ make BANK

Milk costs $8 a gallon. Better be banking it

edit: even more in podunk AK

www.foxbusiness.com

Extreme grocery prices in rural Alaska shock TikTok: '$18 for milk'

TikTok user @emilyinalaska_ posted a video last week showcasing “Grocery prices in rural Alaska.” The video has been viewed 2.4 million times.
www.foxbusiness.com www.foxbusiness.com
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Alaska doesn’t sound so bad. Beautiful summers. Beautiful scenery. Lots of oil money. High cost of living in some areas, not not bad in others. Most nice houses in Anchorage are less then 500k.

Just gotta make sure your job has enough vacation for you to get out of dodge for some of the winter. Or do half time in Alaska, half in Hawaii.
 
CurbYourExpectations said:
This sounds like a job for the poor mans Scarb.

Approximately 1,000,000 get radiation for cancer in America.
Assuming in the near future there will be an average of 15-20 tx day span. Let's assume 15
There are 250 treatment days per year.
To have an average of 12 people on treatment per year how many RadOncs would be needed?

15 million (Patients*treatment days)
Divided by 250 possible days of treatment and 12 patients per RadOnc
Comes to 5000 RadOncs at any given time could carry this load.

5000 RadOncs divided by the average length of career (35 years?) = around 140 RadOncs in an out every year for equilibrium

I will ask physics to check my math

Wow that is almost how many US applicants there are.

Economists coming up with supply and demand and market correction theories be like:
dumb and dumber bar GIF
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Which brings us back to... Drumroll please....

The nadir of slots we had around 2007-2008 during peak rad Onc..... When AOA folks like myself were interviewing at ****holes and the Nature pub MD PhDs with 260+ on step 1 got to sniff the air at Sloane, Dana and Anderson
 
CurbYourExpectations said:
This sounds like a job for the poor mans Scarb.

Approximately 1,000,000 get radiation for cancer in America.
Assuming in the near future there will be an average of 15-20 tx day span. Let's assume 15
There are 250 treatment days per year.
To have an average of 12 people on treatment per year how many RadOncs would be needed?
Click to expand...

FWIW as a generalist (~40% calculated breast/prostate volume), I've completed 270 and 350 patients' treatments in the past two years and averaged out slightly over 15fx per patient. I started keeping track after an earlier discussion on here about average number of fx/patient going forward.
 
medgator said:
Which brings us back to... Drumroll please....

The nadir of slots we had around 2007-2008 during peak rad Onc..... When AOA folks like myself were interviewing at ****holes and the Nature pub MD PhDs with 260+ on step 1 got to sniff the air at Sloane, Dana and Anderson
Click to expand...

I mean if you weren’t published at 16, had a PhD, got AOA, and had a purported IQ of 190 then how could you possibly treat prostate cancer with radiation!

My biggest regret really was buying into their bull****. I pay for it everyday I come to work.
 
CurbYourExpectations said:
This sounds like a job for the poor mans Scarb.

Approximately 1,000,000 get radiation for cancer in America.
Assuming in the near future there will be an average of 15-20 tx day span. Let's assume 15
There are 250 treatment days per year.
To have an average of 12 people on treatment per year how many RadOncs would be needed?

15 million (Patients*treatment days)
Divided by 250 possible days of treatment and 12 patients per RadOnc
Comes to 5000 RadOncs at any given time could carry this load.

5000 RadOncs divided by the average length of career (35 years?) = around 140 RadOncs in an out every year for equilibrium

I will ask physics to check my math

Wow that is almost how many US applicants there are.

Economists coming up with supply and demand and market correction theories be like:
dumb and dumber bar GIF
Click to expand...
Hinges on 12 pts under beam per RO on avg if I'm reading your math right, and 5000 ROs would be the right amount for that. Welllll.... there were 5338 rad oncs in 2017. Adding 200 ROs per yr, with about 70/yr retiring, we should hit 6000 ROs this year or next. Which with ~6/5ths as many ROs (vs 5000), we can expect to have 5/6ths as many pts on beam, so we are heading to ~10 pts on beam per RO on average.

That is going to make salaries quite low. Maybe we could have 25% more patients than 12/day, like 15? That means we only need 4/5ths as many radoncs.... like 4000. If we could have 24 under beam per day.... 2500 ROs in America?

In short, we have a gusher of rad oncs in the USA!
 
I'm not a big fan of all the detailed prognosticating of job numbers. The problem is just not well defined in terms of human behavior. The fact is, radonc graduates have less ability to determine location than almost any of their peers and this has been the case for awhile.

For the clinically minded doc, I'm not sure the job is that intellectually stimulating. (This does not apply to those running a lab, who happen to be those who are viewed as "serious" by the academic establishment). I personally value my work and the lifestyle it has afforded me. I feel like I'm on the outside looking in as oncology evolves annually around me., and I am not that motivated to pursue further advances in conformality. The patients are great but my deepest conversations with them often involve prognosis, effectiveness and toxicity of systemic therapy, which I am not giving. I rarely make a diagnosis. I spend more time learning about medical oncology than radiation oncology at this point.

As a GenXer, who is roughly 8 years older than my professional peers, I have noticed some trends that make job prognostication difficult.

Millennials had to work much harder, in a much more competitive academic environment, than their predecessors to get to medical school and excel there. This, combined with their observations of their job-obsessed, boomer parents, makes them much more likely to walk away from money and emphasize time and life-style over cash as they approach middle age. (It doesn't hurt that many of them have parents who are sitting on substantial portfolios).

The boomers, like all of us, will die.
 
communitydoc13 said:
I'm not a big fan of all the detailed prognosticating of job numbers. The problem is just not well defined in terms of human behavior. The fact is, radonc graduates have less ability to determine location than almost any of their peers and this has been the case for awhile.

For the clinically minded doc, I'm not sure the job is that intellectually stimulating. (This does not apply to those running a lab, who happen to be those who are viewed as "serious" by the academic establishment). I personally value my work and the lifestyle it has afforded me. I feel like I'm on the outside looking in as oncology evolves annually around me., and I am not that motivated to pursue further advances in conformality. The patients are great but my deepest conversations with them often involve prognosis, effectiveness and toxicity of systemic therapy, which I am not giving. I rarely make a diagnosis. I spend more time learning about medical oncology than radiation oncology at this point.

As a GenXer, who is roughly 8 years older than my professional peers, I have noticed some trends that make job prognostication difficult.

Millennials had to work much harder, in a much more competitive academic environment, than their predecessors to get to medical school and excel there. This, combined with their observations of their job-obsessed, boomer parents, makes them much more likely to walk away from money and emphasize time and life-style over cash as they approach middle age. (It doesn't hurt that many of them have parents who are sitting on substantial portfolios).

The boomers, like all of us, will die.
Click to expand...

Boomers will die…if history is any guide It won’t be pretty. They will soon be buried with their money than give it to anyone.

They have most of the money property stocks than any subsequent generation. They enjoyed stock returns and career advancement the likes of which you will never see. I could see them pissing it away in the end. A nice little **** you to close out an entire lifetime of good breaks.
 
communitydoc13 said:
For the clinically minded doc, I'm not sure the job is that intellectually stimulating. (This does not apply to those running a lab, who happen to be those who are viewed as "serious" by the academic establishment). I personally value my work and the lifestyle it has afforded me. I feel like I'm on the outside looking in as oncology evolves annually around me., and I am not that motivated to pursue further advances in conformality. The patients are great but my deepest conversations with them often involve prognosis, effectiveness and toxicity of systemic therapy, which I am not giving. I rarely make a diagnosis. I spend more time learning about medical oncology than radiation oncology at this point.
Click to expand...
My exact take
 
I’d also expect a 35 year career average is an overestimate. That would have people retiring between 65-75 depending on when you completed residency. Most folks will retire between 60-65, not even taking into account people who FIRE, go part time, retire for medical reasons, or pass away.
 
DoctwoB said:
I’d also expect a 35 year career average is an overestimate. That would have people retiring between 65-75 depending on when you completed residency. Most folks will retire between 60-65, not even taking into account people who FIRE, go part time, retire for medical reasons, or pass away.
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You rarely see surgeons operating into their 70s but it is not uncommon to have old guys sitting at the top making tons of money in our field, taking advantage of younger colleagues. We have some ridiculously greedy people in practice.
These people will all die working. There are multiple big cities I am aware of where old people have a total grip and blockade anybody from getting a job there because they simply refuse to go. Florida is one of the worst when it comes to this but not alone. Even think about jobs in less desirable states? When was the last time you saw a job posted in these states? They are full!
 
RadsWFA1900 said:
Boomers will die…if history is any guide It won’t be pretty. They will soon be buried with their money than give it to anyone.

They have most of the money property stocks than any subsequent generation. They enjoyed stock returns and career advancement the likes of which you will never see. I could see them pissing it away in the end. A nice little **** you to close out an entire lifetime of good breaks.
Click to expand...
Yeah.... now that I've finally paid off my debts; I am treading very cautiously about jumping into stocks at this time. I know damn well those dinguses are going to yank it the moment they see a crash coming. That's a lot of boomer money exiting the market at one time and I'm not getting left holding that bag.
 
dieABRdie said:
Yeah.... now that I've finally paid off my debts; I am treading very cautiously about jumping into stocks at this time. I know damn well those dinguses are going to yank it the moment they see a crash coming. That's a lot of boomer money exiting the market at one time and I'm not getting left holding that bag.
Click to expand...

At some point they cannot take the risks that they used to but they will need to keep some in the market because returns elsewhere are dog****.

At any rate, anyone who wasn’t a boomer doesn’t stand a chance Financially. They run the show and all those new medical innovations will keep them going forever.
 
dieABRdie said:
Yeah.... now that I've finally paid off my debts; I am treading very cautiously about jumping into stocks at this time. I know damn well those dinguses are going to yank it the moment they see a crash coming. That's a lot of boomer money exiting the market at one time and I'm not getting left holding that bag.
Click to expand...
Inactually welcome a crash so i can buy the dip and HODL.
 
communitydoc13 said:
I'm not a big fan of all the detailed prognosticating of job numbers. The problem is just not well defined in terms of human behavior. The fact is, radonc graduates have less ability to determine location than almost any of their peers and this has been the case for awhile.

For the clinically minded doc, I'm not sure the job is that intellectually stimulating. (This does not apply to those running a lab, who happen to be those who are viewed as "serious" by the academic establishment). I personally value my work and the lifestyle it has afforded me. I feel like I'm on the outside looking in as oncology evolves annually around me., and I am not that motivated to pursue further advances in conformality. The patients are great but my deepest conversations with them often involve prognosis, effectiveness and toxicity of systemic therapy, which I am not giving. I rarely make a diagnosis. I spend more time learning about medical oncology than radiation oncology at this point.

As a GenXer, who is roughly 8 years older than my professional peers, I have noticed some trends that make job prognostication difficult.

Millennials had to work much harder, in a much more competitive academic environment, than their predecessors to get to medical school and excel there. This, combined with their observations of their job-obsessed, boomer parents, makes them much more likely to walk away from money and emphasize time and life-style over cash as they approach middle age. (It doesn't hurt that many of them have parents who are sitting on substantial portfolios).

The boomers, like all of us, will die.
Click to expand...

Memento Boomori
 
RickyScott said:
Chelaine G and others hard at work on this in breast cancer. mdacc should think about changing their logo to crossing out radiation in cancer.
Click to expand...
Because ofcourse they are. Im getting the feeling the reason alot of these MD PhDs liked RO so much is because it really isn't so demanding and they can focus on research. The gatekeepers though "oh if we have al these MD PhDs they'll help us innovate" news flash they didn't, They are too busy conspiring to end RO for good so they can finally get that 100% research job they always wanted.
 
RadsWFA1900 said:
They are too busy conspiring to end RO for good so they can finally get that 100% research job they always wanted.
Click to expand...
Haha! No. But, taking a single intervention, with indications based on large clinical trials with diverse patient characteristics (evidence based medicine), and dismantling these indications through the process of personalized, molecular medicine, is much easier than creating new therapeutics that will somehow find their way under the purview of radiation oncology.
medgator said:
Getting a radiation course done quicker or not at all does help you get more time back in the lab and make it more likely for out of towners to get treatment at the big academic mothership.
Click to expand...
I agree.

As a community clinician, I understand that academics (not through malice) are largely working to reduce my volume of patients.
 
‘the process of personalized, molecular medicine, is much easier’

Yeah so easy. Come on folks this is nuts.


I much prefer the more logical point of view - this type of work is great for patients, great for society, is an unstoppable immutable force in that if one person isn’t doing it, someone else will, as it’s common sense, when you have a robust circulating marker like HPV DNA. Great for society but needs to come along with a reduction in workforce


I imagine you were also angry when early salvage versus post op RT trials were planned for prostate cancer
 
jondunn said:
‘the process of personalized, molecular medicine, is much easier’

Yeah so easy. Come on folks this is nuts.


I much prefer the more logical point of view - this type of work is great for patients, great for society, is an unstoppable immutable force in that if one person isn’t doing it, someone else will, as it’s common sense, when you have a robust circulating marker like HPV DNA. Great for society but needs to come along with a reduction in workforce


I imagine you were also angry when early salvage versus post op RT trials were planned for prostate cancer
Click to expand...
Any other academic Satellite talking points you wish to share with us?
 
RickyScott said:
A large reduction in adjuvant breast radiation sometime in the next 20 years would kill a lot of careeers. A medstudent who doesn’t consider this is an idiot.
Click to expand...

Yes they absolutely should consider it. I agree. This is not being disputed and is besides the point.

Also I don’t really think we are anywhere close in breast. Not even.

With HPV, we are, but the bigger impact in HPV will be vaccination anyways.
 
RickyScott said:
A large reduction in adjuvant breast radiation sometime in the next 20 years would kill a lot of careeers. A medstudent who doesn’t consider this is an idiot.
Click to expand...

ctDNA sure would make consults easier, though, no doubt about that. "Your surgeon didn't get it all, and here's the proof so we need to treat." Done.

For academic places to do this research, however, and not acknowledge the large impact it would have on our workforce, volumes, etc, is asinine.
 
jondunn said:
‘the process of personalized, molecular medicine, is much easier’

Yeah so easy. Come on folks this is nuts.


I much prefer the more logical point of view - this type of work is great for patients, great for society, is an unstoppable immutable force in that if one person isn’t doing it, someone else will, as it’s common sense, when you have a robust circulating marker like HPV DNA. Great for society but needs to come along with a reduction in workforce


I imagine you were also angry when early salvage versus post op RT trials were planned for prostate cancer
Click to expand...
I think you're misinterpreting the sentiment.

It is great, but it should also be accompanied by a clear reduction in radonc workforce. It is also easier (but not easy) than creating new therapeutics. Prove me wrong. A new drug is overwhelmingly likely to be a failure. A study refining indications for an existing therapy is much more likely to impact clinical practice than a study of a new therapy.

The only thing I'm blaming on academic radonc is their willful refusal to acknowledge the shrinking clinical footprint of their specialty and continued overtraining.

Well that's not all. Recently had a prestigious academic place with a shared patient tell me that if "they" felt palliative stereotactic treatment was appropriate, they would prefer to administer themselves, but if they felt "standard palliative" radiation was appropriate, that they wanted me to do it. WTF? Meanwhile, in typical fashion, not clear to me that docs at this place had had the hard conversations about prognosis and why they would consider one treatment vs the other with this patient. So there is a cultural element of interaction with academic radonc that can be painful.
 
communitydoc13 said:
It is great, but it should also be accompanied by a clear reduction in radonc workforce.
Click to expand...


yes, this is what I said. not what you said. but now that you said it, I agree with you.

I am a community doc, but despite what people in academics may think at times, this does NOT mean I am greedy, dumb, or not keeping up with the way the field is going.

I have no desire to impact a head and neck cancer patient's quality of life more than I have to. I can NOT wait until I can give 60 Gy or lower rather than 70 Gy for HPV OPSCC, for example. I can't wait!

It is strange to me if any of you are annoyed by this. especially when one less OTV may not even matter in a future billing mechanism.
 
communitydoc13 said:
I think you're misinterpreting the sentiment.

It is great, but it should also be accompanied by a clear reduction in radonc workforce. It is also easier (but not easy) than creating new therapeutics. Prove me wrong. A new drug is overwhelmingly likely to be a failure. A study refining indications for an existing therapy is much more likely to impact clinical practice than a study of a new therapy.

The only thing I'm blaming on academic radonc is their willful refusal to acknowledge the shrinking clinical footprint of their specialty and continued overtraining.

Well that's not all. Recently had a prestigious academic place with a shared patient tell me that if "they" felt palliative stereotactic treatment was appropriate, they would prefer to administer themselves, but if they felt "standard palliative" radiation was appropriate, that they wanted me to do it. WTF? Meanwhile, in typical fashion, not clear to me that docs at this place had had the hard conversations about prognosis and why they would consider one treatment vs the other with this patient. So there is a cultural element of interaction with academic radonc that can be painful.
Click to expand...

If theres anything to be learned by other troubled specialties, its that nobody is coming to the rescue. The only way to dig your self out is to come up with things to increase demand. Training slots will not change and may actually go up. Reimbursement will always go down. Indications are what you need to stay relevant.

Academics the real hard core ones are always in denial about how things really get done in US medicine and are too busy being morally outraged about 30/10 bone mets
 
jondunn said:
‘the process of personalized, molecular medicine, is much easier’

Yeah so easy. Come on folks this is nuts.


I much prefer the more logical point of view - this type of work is great for patients, great for society, is an unstoppable immutable force in that if one person isn’t doing it, someone else will, as it’s common sense, when you have a robust circulating marker like HPV DNA. Great for society but needs to come along with a reduction in workforce


I imagine you were also angry when early salvage versus post op RT trials were planned for prostate cancer
Click to expand...

No bc they all still got RT
 
jondunn said:
yes, this is what I said. not what you said. but now that you said it, I agree with you.

I am a community doc, but despite what people in academics may think at times, this does NOT mean I am greedy, dumb, or not keeping up with the way the field is going.

I have no desire to impact a head and neck cancer patient's quality of life more than I have to. I can NOT wait until I can give 60 Gy or lower rather than 70 Gy for HPV OPSCC, for example. I can't wait!

It is strange to me if any of you are annoyed by this. especially when one less OTV may not even matter in a future billing mechanism.
Click to expand...

You still can do that. MSKCC doing 30 Gy to nodes off trial for HPV+

Stop trying to act all high and mighty
 
ROforbetterorworse said:
No bc they all still got RT
Click to expand...


No……… they did not.

That’s literally the point of early salvage.

I’m alarmed you think this

If every patient was going to get salvage RT anyways then we would just treat them post op
 
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