Rad Onc Twitter

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RealSimulD said:
How did I not know about Sprout!!?!?
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Talk about a sprout... SCHWING.

Now this is a Quad Shot folks

n9hw5TD.jpg
 
I don't understand how anyone can declare that things are improving based on things so far. We have not cut spots, the spots that do not fill in SOAP are largely filled outside of SOAP, and the changes to residency standards will lead to minimal if any contraction. Is there some big announcement pending from ASTRO here?

I'm repeatedly annoyed by Chelain continuing to claim that the future is bright because positions are not filling. The majority of positions continue to fill outside of SOAP, and this reality is being ignored on Twitter. @RealSimulD I appreciated your data on this and hope you can drive home this point on Twitter. Maybe we need yet another paper on this topic?
 
At this the point, the "positions aren't filling" and "we're doing something as a field to fix this" statements are wrong.

The positions are filling (just maybe behind the scenes which IMO is worse), nothing is truly being done. It's all theatre, lipstick on a pig, virtue signaling, and hiding the real ugly truth.
 
metallica81788 said:
At this the point, the "positions aren't filling" and "we're doing something as a field to fix this" statements are wrong.

The positions are filling (just maybe behind the scenes which IMO is worse), nothing is truly being done. It's all theatre, lipstick on a pig, virtue signaling, and hiding the real ugly truth.
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The ugly truth here is that retraining after 5 years of this bull**** is an actually on the table.

I don’t expect chairs and PDs to do anything except lie about the situation.
 
metallica81788 said:
At this the point, the "positions aren't filling" and "we're doing something as a field to fix this" statements are wrong.

The positions are filling (just maybe behind the scenes which IMO is worse), nothing is truly being done. It's all theatre, lipstick on a pig, virtue signaling, and hiding the real ugly truth.
Click to expand...

Yes. The stuff we can see with bottom of the class students filling in the match and surgery rejects SOAPing is bad enough.
The out-of-the-match stuff we don't see to supply the warm bodies is next level crazy. People who finished internship many years ago and never matched to residency, FMGs, practicing physicians in other specialties, pretty much anything goes. Unless there is a real mechanism to stop programs from pulling these shenanigans (hard limit on training spots), none of this matters.
 
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The hellpits continue to hellpit into deeper depths of doom. This is abundantly clear. Anyone claiming future is “bright” is lying to you or at best misinformed/ignorant. Hellpits threw themselves self-congratulatory “match parties”. The narrative is all is well and another great match passed us by. Imagine having your head that deep in the sand and up your chairman’s butt. Such is life in many of these hellpits. Truth and reality does not really matter, if it ever did.
 
Mandelin Rain said:
RRC just has to dramatically raise standards for residency until it becomes infeasible to keep many of them open, and residents receive actual good training.

Opening salvo was kind of meek, imo.
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I have some personal insight into ACGME handling programs with citations / on probation.
No push to close.
Also funny that Vapiwala tags ASTRO which is even more withdrawn from the issue
 
seper said:
I have some personal insight into ACGME handling programs with citations / on probation.
No push to close.
Also funny that Vapiwala tags ASTRO which is even more withdrawn from the issue
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NV has fired ammo in the literature on this issue, where it counts, so have to give her credit for that. And Shah is working with ASTRO now on the workforce. So maybe just maybe NV knows something. Or she is deluded, or falling for patronization. Equally as possible.
 
seper said:
I have some personal insight into ACGME handling programs with citations / on probation.
No push to close.
Also funny that Vapiwala tags ASTRO which is even more withdrawn from the issue
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ASTRO can probably whip members into line through some mechanism. I'm sure academic types want to stay in their good graces.
 
seper said:
I have some personal insight into ACGME handling programs with citations / on probation.
No push to close.
Also funny that Vapiwala tags ASTRO which is even more withdrawn from the issue
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I don’t want steal neha’s thunder, but rumor is that she will announce at Astro that all programs must have both a linac and an hdr afterloader!
 
RealSimulD said:
I'd love to see a list of the programs that have dropped spots. Anyone have one?
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The answer is officially none. Some programs have completely shut down though. Some larger programs seem to not be entering in all their spots through the match but they are not officially contracting through the ACGME either. As of 1/12/2022 there were a total of 815 potential training spots of which 771 have residents enrolled.

forums.studentdoctor.net

Programs that have increased/decreased resident numbers and closed 2019 to 2021.

Programs that have closed with approved resident spots prior to withdrawal of accreditation; Drexel in 2019 (4), Medical College of Georgia in 2019 (4), California Pacific in 2019 (4) and Cornell 2021 (6). Programs to have officially increased spots from 2019 to 2021; Loma Linda 5 to 6, Case...
forums.studentdoctor.net forums.studentdoctor.net

See post #44 for 2022 update.
 
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fiji128 said:
The answer is officially none. Some programs have completely shut down though. Some more larger programs seem to not to be entering in all their spots into the match but they are not officially contracting either through the ACGME either. A total of 815 potential training spots of which 771 have residents enrolled as of 1/12/2022.

forums.studentdoctor.net

Programs that have increased/decreased resident numbers and closed 2019 to 2021.

Programs that have closed with approved resident spots prior to withdrawal of accreditation; Drexel in 2019 (4), Medical College of Georgia in 2019 (4), California Pacific in 2019 (4) and Cornell 2021 (6). Programs to have officially increased spots from 2019 to 2021; Loma Linda 5 to 6, Case...
forums.studentdoctor.net forums.studentdoctor.net

See post #44 for 2022 update.
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These are the only numbers that matter. Total number of trainees. YOY NRMP data is corrupted by On-cycle/off-cycle years at various programs, Outside of match shenanigans, Transfers from other specialties, Etc..
 
What was the gender of the person responsible for creating the transcript? Lol.

Edit:. My most important person on earth is a woman who's an engineer. It sucks in medicine, but there are worse fields. Things don't change overnight.
 
medgator said:
And?
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Congrats to him!

I also do not understand why jondunn re-posts many of the tweets without context.

Some have suggested that I moderate non-sequitur posts, but I'm sitting on the sidelines on this one for now.
 
dd.jpg


Our homeboy doubles down. I can play this game as well!

1a) not seeing how APM would affect radonc demand is just as obtuse as not seeing how hypofx could affect it.
1b) no one said it was worse for patients. We're saying its worse for radonc
1c) he must not have received the memo that APM is likely dead
2) just because it's the same as everyone doesn't mean we should ignore it - how does that make any sense?
3a) Increase in radonc compensation of 5% over a year in which inflation rose 8% = decrease in real wages.
3b) One could have a decrease in per-pt reimbursement with rising salaries overall, as practicing MDs would increase their patient complement to make up for lost per-pt revenue...which would negatively impact the job market.
4) "evidence pre COMET, etc" I think means that he thinks COMET data will make up for loss of other indications. [citation needed]
 
OTN said:
View attachment 352288

Our homeboy doubles down. I can play this game as well!

1a) not seeing how APM would affect radonc demand is just as obtuse as not seeing how hypofx could affect it.
1b) no one said it was worse for patients. We're saying its worse for radonc
1c) he must not have received the memo that APM is likely dead
2) just because it's the same as everyone doesn't mean we should ignore it - how does that make any sense?
3a) Increase in radonc compensation of 5% over a year in which inflation rose 8% = decrease in real wages.
3b) One could have a decrease in per-pt reimbursement with rising salaries overall, as practicing MDs would increase their patient complement to make up for lost per-pt revenue...which would negatively impact the job market.
4) "evidence pre COMET, etc" I think means that he thinks COMET data will make up for loss of other indications. [citation needed]
Click to expand...

'Kenneth Olivier, what you've just said is one of the most insanely idiotic things I've ever heard. At no point in your rambling, incoherent response was there anything that could even be considered a rational thought. Everyone in this room is now dumber for having listened to it.
 
SubserviantToABR said:
'Kenneth Olivier, what you've just said is one of the most insanely idiotic things I've ever heard. At no point in your rambling, incoherent response was there anything that could even be considered a rational thought. Everyone in this room is now dumber for having listened to it.
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jondunn said:



This is why 50 year olds need to retire!
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Seriously, he needs to go now. Medical students, beware. People like Kenneth Olivier do not care about you or the future of radiation oncology. They care more about getting their nut. He has been in position to make changes with ADROP and did absolutely nothing. He's a fraud, blowhard, and grifter.
 
SubserviantToABR said:
Seriously, he needs to go now. Medical students, beware. People like Kenneth Olivier do not care about you or the future of radiation oncology. They care more about getting their nut. He has been in position to make changes with ADROP and did absolutely nothing. He's a fraud, blowhard, and grifter.
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KO has never seen a grift he did not like
 
Mayo Jacksonville getting a rad onc residency is one of his best grifts
 
OTN said:
View attachment 352288

Our homeboy doubles down. I can play this game as well!

1a) not seeing how APM would affect radonc demand is just as obtuse as not seeing how hypofx could affect it.
1b) no one said it was worse for patients. We're saying its worse for radonc
1c) he must not have received the memo that APM is likely dead
2) just because it's the same as everyone doesn't mean we should ignore it - how does that make any sense?
3a) Increase in radonc compensation of 5% over a year in which inflation rose 8% = decrease in real wages.
3b) One could have a decrease in per-pt reimbursement with rising salaries overall, as practicing MDs would increase their patient complement to make up for lost per-pt revenue...which would negatively impact the job market.
4) "evidence pre COMET, etc" I think means that he thinks COMET data will make up for loss of other indications. [citation needed]
Click to expand...

I hate how KO acts like he has all the answers. As if everyone's concerns are just completely unfounded and so easily dismissed.

1) Hypofx/RO-APM: I want to preface this discussion with the fact that I hypofractionate almost all of my patients. I choose wisely. This is not an indictment on hypofractionation so much as it is meant to make a point that sometimes the things we do that we think are "good for patients" can have unintended consequences. Let's say you have a small clinic in rural Minnesota. You serve a small area, run an efficient operation, have 10-12 patients on treatment at a time. You make a decent salary but operate on pretty thin margins. Insurance companies begin forcing you to hypofractionate which makes those thin margins even thinner. You have a couple bad years and decide it's time to call it quits. One of two things happens. Your patients now have to drive 1+ hour away for their treatments and follow ups, or you get bought out by BigRadOnc who is PPS exempt or has stronger insurance contracts (i.e. more expensive for patients). Whoever takes your place doesn't want to be in rural Minnesota long term so every 1-2 years when the new graduate who took this job can't justify a raise and decides to move on, a new new grad takes their place. Seeing a new doc every few years is bad for patient care. Driving further for your care is bad for patient care. Paying more money for fewer fractions vs. less money for more fractions may save you a bit of time, but it may be a wash financially.

Now let's tackle RO-APM and why it matters for reimbursement. If we are already "choosing wisely" it doesn't affect us much. It may even bump our reimbursements up. It's great for patients! People start doing 5 fraction breasts, SBRT or 20 fraction prostates, more brachytherapy, etc. This is great for patients. A few years down the line, medicare re-evaluates the program. They see that now they are paying out X amount for breast treatments assuming an average of 20 fractions, but now the average breast treatment is only 10 fractions! You're not rewarded for doing what's right for patients. Instead, your reimbursement is cut 50%. Private payers begin to follow suit. Radonc compensation goes down. Job market collapses. We start cutting costs. Patients start seeing more APNs. There's more pressure for us to see patients so we have less and less time to spend with our patients. The good RadOncs retire or leave for pharma jobs, the bad RadOncs stay because they have nowhere to go. Med student recruitment suffers further. All bad for patient care.

2) Automation - Personally I think the automation fears are unfounded and it's more likely to help us than to replace us.

3/4) Decreasing reimbursements/Decreasing indications - I touched on decreasing reimbursements above. Overall, reimbursements are going down. That is the only direction they will go. Period. You can argue that compensation has stayed the same or even gone up because of increasing utilization of SBRT/SRS and other advanced therapies, but compensation and reimbursement are different. On the topic of COMET, I'm not sure how we can say that "hypofractionation is great for patients because it decreases costs" while in the same breath espousing our treatment of oligometastatic disease as a means to bump up our case numbers. This is high cost low value care. That doesn't mean it's worthless, there is plenty of money being spent on worse things, but we're spending thousands of dollars to give patients a few extra months at best and to make no difference or cause toxicity at worst. Let's not kid ourselves into believing that after a decade of pouring resources into hypofractionation studies in order to provide lower cost higher value care, the savior of our field is going to be the exact opposite.

A lot of this is certainly doom and gloom/doomsday scenarios. One can definitely make rational arguments against some of my points, but my main takeaway is that sometimes the things we do have unintended consequences. It's hard to argue with "it's better for patients" but sometimes better is the enemy of good. Is 3 extra weeks of radiation for a prostate (44 fx vs 28 fx) or 2 extra weeks for a breast (6 weeks instead of 4 weeks) really SUCH a big deal? Sure, it's better for patients, but was it ever bad to begin with?

Lastly, there's a world where we can both do "what's good for patients" while still doing what's good for us. We devote so much time and resources to eating our own by hypofractionating or finding ways to omit radiation entirely. If we've committed to going down this path, why don't we make sure there's enough food on the table. This starts by reducing the number of mouths we need to feed.
 
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