Rad Onc Twitter

[TheWallnerus]

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Even if the money where going directly into my pocket, I would draw the line at oop protons to middle class pt.
If I owned the machine or worked for proton center, I could probably hold my integrity in check while treating those with good insurance or the super wealthy.

I’m sure they gave the kind and very scared high school teacher a sizable discount on the standard proton price 🙂

Oh I did forget to mention his community helped raise funds for his treatment

 

[TheWallnerus]

I am more ethically flexible than many on this board, but that makes me sick.

Don’t get so nauseated RS

I am also told that at the Local Academic Proton Center they have no problem treating their breast patients with photon instead of proton … because when the proton skin side effects get too much (“these breast patients get toasted” said the proton tech to me), they just switch to photons. That’s good patient care!

 

[jondunn]

Don’t get so nauseated RS

I am also told that at the Local Academic Proton Center they have no problem treating their breast patients with photon instead of proton … because when the proton skin side effects get too much (“these breast patients get toasted” said the proton tech to me), they just switch to photons. That’s good patient care!

this stuff is wild because it's very true and many have us heard the same. it's a plain as day fact that so many in our field just ignore on a day to day. all of the proton BS

 

[theradiator]

This is straight from the elite playbook. Do a head fake with ESG, DEI and BLM while stealing with both hands. Same thing with these elite proton purveyors, distract with DEI or "at least we aren't treating prostate" and continue running our field into the ground. "We billed the football coach and his GoFundMe but of course he can submit to his insurance".

 

[TheWallnerus]

this stuff is wild because it's very true and many have us heard the same. it's a plain as day fact that so many in our field just ignore on a day to day. all of the proton BS

The patients may feel worse, but the proton DVHs look better. Are you saying DVHs are BS?! 😉

 

[Gfunk6]

This was the point I was trying to make in the now locked Rad Onc Supreme Court thread.

My view is that if graduating ROs further limit their geography then bad things will accelerate.

Also, for those of you who follow The Onion:

 

[radoncle]

Guys I have many a story of patient going to Local Proton Academic Center and paying out of pocket for proton.

A HS football coach who’s a friend of a friend recently paid OOP $50k for ipsilateral proton RT for a salivary SM gland neoplasm postop.

There’s just no honor among thieves anymore.

Mayo has patients literally driving hours to be treated at 10 pm with protons for right-sided DCIS. The deceit they must be feeding the patients to have then doing that.. I’ve literally seen them justify this by stating it’s for cardiac sparing. How bad is their aim?! Cardiac-sparing for right-sided intact breast?

 

[deleted1111261]

Mayo has patients literally driving hours to be treated at 10 pm with protons for right-sided DCIS. The deceit they must be feeding the patients to have then doing that.. I’ve literally seen them justify this by stating it’s for cardiac sparing. How bad is their aim?! Cardiac-sparing for right-sided intact breast?

I heard they do 3 fractions

 

[RickyScott]

This was the point I was trying to make in the now locked Rad Onc Supreme Court thread.

My view is that if graduating ROs further limit their geography then bad things will accelerate.

Also, for those of you who follow The Onion:

View attachment 356602

I

This was the point I was trying to make in the now locked Rad Onc Supreme Court thread.

My view is that if graduating ROs further limit their geography then bad things will accelerate.

Also, for those of you who follow The Onion:

View attachment 356602

I heard #women who curie are offering their prayers and concerns to single black female radoncs who are forced to take jobs in Oklahoma?

 

[RickyScott]

I heard they do 3 fractions

Of course, get to bill quite a bit less if you do 2?

 

[temujim]

This was the point I was trying to make in the now locked Rad Onc Supreme Court thread.

My view is that if graduating ROs further limit their geography then bad things will accelerate.

Also, for those of you who follow The Onion:

View attachment 356602

So it'll be tougher to attract residents into rad onc in certain states... Decreasing overall numbers?? Did not anticipate this particular outcome.

 

[Lamount]

Metaphor

Both can be true -e.g. comparing our specialty to an abscess.

 

[jondunn]

 

[TheWallnerus]

Both can be true -e.g. comparing our specialty to an abscess.

Comparing is simile 😉

 

[Ray D. Ayshun]

View attachment 356604

So it'll be tougher to attract residents into rad onc in certain states... Decreasing overall numbers?? Did not anticipate this particular outcome.

If a state makes getting an abortion illegal, aren't they making it illegal to match into rad once in that state?

 

[Lamount]

Comparing is simile 😉

Grammar fight! Both metaphors and similes make comparisons. The only difference is the simile use “like” or “as”.
Simile and Metaphor—What’s the Difference?

…just sayin’ 🤓

 

[deleted1111261]

hyperbole would be saying that an abscess is too much, but in reality it’s more like a sub clinical bacterial infection or exposure.

 

[TheWallnerus]

“Some” centers are for profit. HA.

 

[TheWallnerus]

Grammar fight! Both metaphors and similes make comparisons. The only difference is the simile use “like” or “as”.
Simile and Metaphor—What’s the Difference?

…just sayin’ 🤓

Haha. I will concede you are not incorrect, but there is some controversy here (in some circles). For example, the Bard could have used metaphor and said “Thou art a summer’s day” instead of “Shall I compare thee to a summer’s day?” Metaphor is direct, says a thing IS a thing instead of, like, comparing it to a thing. IMHO.

 

[elementaryschooleconomics]

Grammar fight! Both metaphors and similes make comparisons. The only difference is the simile use “like” or “as”.
Simile and Metaphor—What’s the Difference?

…just sayin’ 🤓

You strike me as someone who would write "all elephants are animals, but not all animals are elephants" in their Tinder bio.

(The post was indeed meant as a metaphor, as part of my portfolio submission for a Hugo Award)

 

[Lamount]

You strike me as someone who would write "all elephants are animals, but not all animals are elephants" in their Tinder bio.

(The post was indeed meant as a metaphor, as part of my portfolio submission for a Hugo Award)

I was fortunate enough to meet a wonderful woman before tinder was a thing… otherwise, you would probably be right on.

You strike me as someone who read a lot of comic books… and who thought about writing for a living

 

[OTN]

“Some” centers are for profit. HA.

Health economics has known for decades that he behavior of not-for-profit and for-profit healthcare entities behave the exact same in the marketplace. Labeling something as "for profit" is a classic misdirection away from the profit-seeking behaviour of one's own not-for-profit entity.

 

[OTN]

Something tells me radoncs will take jobs in Texas/the South/etc.

 

[deleted1116990]

I was fortunate enough to meet a wonderful woman before tinder was a thing… otherwise, you would probably be right on.

Lucky you. Getting married before the post-Tinder world. I find it amusing when older generations comment about modern dating as if they don't understand that dating apps have melted the brains of a large percentage of the single population by turning them into shallow zombies addicted to swiping for new partners the same way casinos addict people with slot machines. "Wonderful" person on Tinder? Not likely. If you're looking for psychopathy and an incurable STI, though, boy are you in luck.

 

[RickyScott]

There is some bad sht out there. Man gets painful, drug-resistant ‘super gonorrhea’ on international vacation

 

[deleted1111261]

Lucky you. Getting married before the post-Tinder world. I find it amusing when older generations comment about modern dating as if they don't understand that dating apps have melted the brains of a large percentage of the single population by turning them into shallow zombies addicted to swiping for new partners the same way casinos addict people with slot machines. "Wonderful" person on Tinder? Not likely. If you're looking for psychopathy and an incurable STI, though, boy are you in luck.

What?

 

[jondunn]

Lucky you. Getting married before the post-Tinder world. I find it amusing when older generations comment about modern dating as if they don't understand that dating apps have melted the brains of a large percentage of the single population by turning them into shallow zombies addicted to swiping for new partners the same way casinos addict people with slot machines. "Wonderful" person on Tinder? Not likely. If you're looking for psychopathy and an incurable STI, though, boy are you in luck.

This is certainly a post.

 

[deleted1111261]

Something tells me radoncs will take jobs in Texas/the South/etc.

Americans barely will move to another city for better opportunity for themselves, much less another state, even if this means remaining on welfare/disability.

I don't think anyone will make any career geography changes based on this. Many, many Democrats live in Texas, probably 40% of the 29 million people. I don't think even a 0.5% of those 12 million people are going to move anywhere. Same for Florida. People are not moving there or leaving there for political reasons. They go for opportunity. I didn't move to any of the states I've lived in because of how they vote and I truly don't know anyone that has. Someone that wasn't going to move to Texas still won't. Just look at the posts from MDACC and faculty - this is a pretty liberal group of people. They would be left in shambles if people considered the state's politics before taking a job there. Someone that is hell bent on living in coastal Florida is going to still try to do so.

This is why when something "bad" happens and people say they are moving to Canada, nobody ever does.

I'm not saying I'm supportive of last week's decision by any means. I just don't think people change their geography based on it.

 

[RickyScott]

Americans barely will move to another city for better opportunity for themselves, much less another state, even if this means remaining on welfare/disability.

I don't think anyone will make any career geography changes based on this. Many, many Democrats live in Texas, probably 40% of the 29 million people. I don't think even a 0.5% of those 12 million people are going to move anywhere. Same for Florida. People are not moving there or leaving there for political reasons. They go for opportunity. I didn't move to any of the states I've lived in because of how they vote and I truly don't know anyone that has. Someone that wasn't going to move to Texas still won't. Just look at the posts from MDACC and faculty - this is a pretty liberal group of people. They would be left in shambles if people considered the state's politics before taking a job there. Someone that is hell bent on living in coastal Florida is going to still try to do so.

This is why when something "bad" happens and people say they are moving to Canada, nobody ever does.

I'm not saying I'm supportive of last week's decision by any means. I just don't think people change their geography based on it.

I fully agree. Texas is increasingly democratic in places like Austin. The only place where politics may stop me from moving is San Fran mostly because how idealism impacts daily life- crime, homeless crapping in the street, schools etc

 

[deleted1111261]

I fully agree. The only place where politics may stop me from moving is San Fran mostly because how idealism impacts daily life- crime, homeless crapping in the street, schools etc

Ah. Yes. Never for me, either. Human feces and open air drug usage incompatible with the way I live my life.

 

[RickyScott]

Ah. Yes. Never for me, either. Human feces and open air drug usage incompatible with the way I live my life.

I saw a passenger shoot up on BART 10 years ago. Texas would almost certainly go democratic if they could capture most of the Hispanic vote (many of them are put off by blm, Latinx, wokeism etc)
Ted cruz beat out by Beto by 2.6% in last election.

 

[TheWallnerus]

Health economics has known for decades that he behavior of not-for-profit and for-profit healthcare entities behave the exact same in the marketplace. Labeling something as "for profit" is a classic misdirection away from the profit-seeking behaviour of one's own not-for-profit entity.

The Economics of Innocent Fraud

 

[Mandelin Rain]

Ah. Yes. Never for me, either. Human feces and open air drug usage incompatible with the way I live my life.

There are thresholds to everything.

As some states choose to become more and more evangelical, it will eventually drive people away.

Ban abortion? Most people, especially someone at the end of a 5 year medical residency, aren't imminently planning on needing an abortion. So most will just bite their tongue and go along.

Ban gay marriage or interracial marriage or whatever else people think Jesus wanted? Yeah, people will be moving.

 

[RickyScott]

Ah. Yes. Never for me, either. Human feces and open air drug usage incompatible with the way I live my life.

btw: poop patrol, makes more than an clinical instructor at Stanford. W/overtime- and you know there is plenty of overtime- they probably are doing better than many Bay Area radoncs starting out.
San Francisco 'Poop Patrol' employees make $184,000 a year

 

[deleted1111261]

Re: poop patrol.

Weird way to calculate it and use $184k as the comp. Says $71k in salary. I don't think most people add in health care, retirement to say how much money they earn.

That being said, the remarkable thing is that this is a job.

 

[deleted1111261]

There are thresholds to everything.

As some states choose to become more and more evangelical, it will eventually drive people away.

Ban abortion? Most people, especially someone at the end of a 5 year medical residency, aren't imminently planning on needing an abortion. So most will just bite their tongue and go along.

Ban gay marriage or interracial marriage or whatever else people think Jesus wanted? Yeah, people will be moving.

Yeah, I think those two going down would be a real damper. I guess I could go back to Canada in that case.

 

[deleted1116990]

I fully agree. Texas is increasingly democratic in places like Austin. The only place where politics may stop me from moving is San Fran mostly because how idealism impacts daily life- crime, homeless crapping in the street, schools etc

Lots of people move based on state and local tax policies. At the end of the day, that's what people really care about, which should surprise no one. You can see what happened post 2017 SALT reform. Suddenly the LCOL unacceptable states became not so unacceptable after all to those in VHCOL blue states with increasing tax burdens and COL.

While established rad oncs may not quit and move because of changing laws on social issues, I believe the number of graduating residents who will not consider starting careers in certain states, and especially rural communities in these states because of the social laws and culture is not zero. I know highly educated people who I would not even consider very liberal who refuse to move to Florida because they fully expect it to be underwater in their lifetimes.

btw: poop patrol, makes more than an instructor/fellow at Stanford. San Francisco 'Poop Patrol' employees make $184,000 a year

Forget that. Lifeguards can make over 500k then get pension at 2/3rds of that when they retire. That sounds sustainable to the taxpayers.

 

[RickyScott]

Re: poop patrol.

Weird way to calculate it and use $184k as the comp. Says $71k in salary. I don't think most people add in health care, retirement to say how much money they earn.

That being said, the remarkable thing is that this is a job.

You have never used snapcrap?

'Snapcrap' App Developer Hopes to Help Clean Up San Francisco Streets

No, Snapcrap isn’t a weird bathroom parody of Snapchat. The new app released on Tuesday to iOS users is trying to help clean up the dirty streets of San Francisco, according to its developer Sean Miller, a San Francisco engineer who moved from Vermont to South of Market in 2017 and immediately...

www.nbcbayarea.com

 

[Gfunk6]

btw: poop patrol, makes more than an clinical instructor at Stanford. W/overtime- and you know there is plenty of overtime- they probably are doing better than many Bay Area radoncs starting out.
San Francisco 'Poop Patrol' employees make $184,000 a year

Shhh . . . I'm trying to keep my Bay Area retirement strategy under wraps!

 

[RickyScott]

Re: poop patrol.

Weird way to calculate it and use $184k as the comp. Says $71k in salary. I don't think most people add in health care, retirement to say how much money they earn.

That being said, the remarkable thing is that this is a job.

Dont want to get into the habit of shtposting, but these are tremendous benefits. Typically benefits are 20-30% of salary. In CA state workers seem to be able to retire after 20-25 yrs on pension w/ full salary. We arent there yet, but it will become a routine path for stanford grads to take a gig as clinical instructors for a few years at worse overall compensation than those on poop patrol 30 miles up us101.

 

[deleted1111261]

Shtposting

Well played, sir

 

[jondunn]

 

[TheWallnerus]

Assuming it’s hospital based, CMS has said “no physician RO presence needed for treatment” until it’s blue in the face. Rad onc has collectively ignored this for the most part, at least not embraced it… eventually had to change as the financial upside was too tempting. For freestanding, IMRT supervision just needs to be 2 out of 5 days per week (appears to be a new surreptitious thing, like a major Supreme Court opinion that drops Friday evening).

 

[medgator]

Assuming it’s hospital based, CMS has said “no physician RO presence needed for treatment” until it’s blue in the face. Rad onc has collectively ignored this for the most part, at least not embraced it… eventually had to change as the financial upside was too tempting. For freestanding, IMRT supervision just needs to be 2 out of 5 days per week (appears to be a new surreptitious thing, like a major Supreme Court opinion that drops Friday evening).

Link to the 2 day thing?

Saw this. Still not sure if it is kosher

 

[TheWallnerus]

Link to the 2 day thing?

Saw this. Still not sure if it is kosher

It’s kosher. The govt can’t fault (or sue) anyone for following plainly written guidelines. But could this LCD be stretched to cover the whole country? Obama would say yes, Trump wouldn’t care, and Ron DiGiamo would say no.

 

[medgator]

It’s kosher. The govt can’t fault (or sue) anyone for following plainly written guidelines. But could this LCD be stretched to cover the whole country? Obama would say yes, Trump wouldn’t care, and Ron DiGiamo would say no.

Which LCD is it exactly?

Edit: novitas, duh.

The LCD Development Process

www.novitas-solutions.com

Yeah not sure I'd be using that outside of that specific LCD.... Would like trying to use an outside LCD to get paid on imrt/sbrt or something

 

[radiaterMike]

Ron DiGiamo would say no

unless he stands to make more $ saying so

 

[RickyScott]

I just don’t see how the government could ever win at trial if one of the lcd states that this is appropriate. This is a federal issue and at the very least underscores that there are multiple appropriate interpretations.

 

[TheWallnerus]

I just don’t see how the government could ever win at trial if one of the lcd states that this is appropriate. This is a federal issue and at the very least underscores that there are multiple appropriate interpretations.

Unsupervised radiation is safe in Mississippi but unsafe in Florida. I have been saying this for years. The rad oncs in Mississippi are brilliant enough to run their clinics without presence! Or teeth 🙂 I kid.

 

[medgator]

I just don’t see how the government could ever win at trial if one of the lcd states that this is appropriate. This is a federal issue and at the very least underscores that there are multiple appropriate interpretations.

it wouldn't fly for payment imo, so not sure why it would fly for anything else.... Again, kinda being conservative here considering the notoriety our specialty has had the last couple of decades.