Rad Onc Twitter

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TheWallnerus said:
Plastic surgery is #1 and rad onc needs a mommy makeover
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I would say this is a little over-reacting. How is pathology more desirable than rad onc? They all do multiple fellowships after residency in order to land a job that is mostly in non-desirable location. Pay is not even close to rad onc. Work is also not the most interesting
 
Residents are always prefered over cheaper options because they have no rights in our current system where institutional GMEs and national GME are generally a total sham. Vae victis if you feel me. You can force whatever nonsense on residents who also do not have unions, a 401k match and depend on you to get A job. It is a lot easier to have an explotative dynamic over residents than PAs/NPs who are not going to put up with it and demand more benefits and a structured schedule. Residents are always “cheaper”. Maybe the promise of a great job back in day made this “worth it” for many but with current environments nobody is buying it. The hellpits will continue to go unfilled because they suck. Sorry folks, buckle up!
 
thecarbonionangle said:
Residents are always prefered over cheaper options because they have no rights in our current system where institutional GMEs and national GME are generally a total sham. Vae victis if you feel me. You can force whatever nonsense on residents who also do not have unions, a 401k match and depend on you to get A job. It is a lot easier to have an explotative dynamic over residents than PAs/NPs who are not going to put up with it and demand more benefits and a structured schedule. Residents are always “cheaper”. Maybe the promise of a great job back in day made this “worth it” for many but with current environments nobody is buying it. The hellpits will continue to go unfilled because they suck. Sorry folks, buckle up!
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scribes are cheaper than NPs tho

alot of them want a job for 1-2 years where they get ready to apply to med school
 
thecarbonionangle said:
Residents are always prefered over cheaper options because they have no rights in our current system where institutional GMEs and national GME are generally a total sham. Vae victis if you feel me. You can force whatever nonsense on residents who also do not have unions, a 401k match and depend on you to get A job. It is a lot easier to have an explotative dynamic over residents than PAs/NPs who are not going to put up with it and demand more benefits and a structured schedule. Residents are always “cheaper”. Maybe the promise of a great job back in day made this “worth it” for many but with current environments nobody is buying it. The hellpits will continue to go unfilled because they suck. Sorry folks, buckle up!
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Funded residents bring in an accounting surplus in funds without taking into account the work they do. Medicare pays about 100k for each resident. Add the work that a resident does on top of this and its a no brainer to use residents as your major workforce.
 
Lol @RealSimulD this is like 5 days in a row - I haven't been to MI in a while but based on your tweets I'm now afraid I'm going to get sucked down a pot hole into the Upside Down or the Sunken Place

 
madchemist89 said:
Funded residents bring in an accounting surplus in funds without taking into account the work they do. Medicare pays about 100k for each resident. Add the work that a resident does on top of this and its a no brainer to use residents as your major workforce.
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What percentage of RO residents do you think are funded?
 
hal9k said:
I would say this is a little over-reacting. How is pathology more desirable than rad onc? They all do multiple fellowships after residency in order to land a job that is mostly in non-desirable location. Pay is not even close to rad onc. Work is also not the most interesting
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Pathology is guaranteed to be a viable speciality in 30 years….
 
madchemist89 said:
Funded residents bring in an accounting surplus in funds without taking into account the work they do. Medicare pays about 100k for each resident. Add the work that a resident does on top of this and its a no brainer to use residents as your major workforce.
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I haven't looked at this in awhile, and I know some legislation was just passed for more GME funding, but I believe the CMS funding for residents was capped ~15-20 years ago. So while some programs definitely get paid for their residents, I think basically all of the expansion has been self-funded by schools (there's a cap on funding from the government, NOT on residents).

Which, to me, is even more problematic. The days of altruistic academia are long gone. Perhaps there are some pockets left, but on average, the institutions are going to do things which make money, not lose it.

Knowing how my own residency program worked, talking to people from institutions of every size...I think they're far more similar than we realized. The resident workforce is leveraged to generate more RVUs for the institution, through no "grand scheme" but just human nature.

If you're an Assistant Professor at XYZ Health Systems, and your promotion to Associate Professor depends on grants and papers, but your salary depends on RVUs...what is invariably going to happen? If you have a resident, you're going to "allow" that resident to pick up all the work they can because you need "academic time". The resident doesn't know any better, they're "getting service for education". You justify your actions because, well, the system has also built you a mouse trap. No one is doing anything nefarious.

Zoom out, and an academic RadOnc department over the last 15 years has taken over community hospitals and named them "satellites", faculty can be pushed with higher RVU targets while still maintaining lofty tenure requirements because residents have expanded and can be leveraged to make everyone work harder. The residents are ignorant because there is NO WAY to have any life experience prior to this to stop and say "hey, wait, am I being exploited?"

Repeat. Repeat.
 
elementaryschooleconomics said:
I haven't looked at this in awhile, and I know some legislation was just passed for more GME funding, but I believe the CMS funding for residents was capped ~15-20 years ago. So while some programs definitely get paid for their residents, I think basically all of the expansion has been self-funded by schools (there's a cap on funding from the government, NOT on residents).

Which, to me, is even more problematic. The days of altruistic academia are long gone. Perhaps there are some pockets left, but on average, the institutions are going to do things which make money, not lose it.

Knowing how my own residency program worked, talking to people from institutions of every size...I think they're far more similar than we realized. The resident workforce is leveraged to generate more RVUs for the institution, through no "grand scheme" but just human nature.

If you're an Assistant Professor at XYZ Health Systems, and your promotion to Associate Professor depends on grants and papers, but your salary depends on RVUs...what is invariably going to happen? If you have a resident, you're going to "allow" that resident to pick up all the work they can because you need "academic time". The resident doesn't know any better, they're "getting service for education". You justify your actions because, well, the system has also built you a mouse trap. No one is doing anything nefarious.

Zoom out, and an academic RadOnc department over the last 15 years has taken over community hospitals and named them "satellites", faculty can be pushed with higher RVU targets while still maintaining lofty tenure requirements because residents have expanded and can be leveraged to make everyone work harder. The residents are ignorant because there is NO WAY to have any life experience prior to this to stop and say "hey, wait, am I being exploited?"

Repeat. Repeat.
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I'm slightly less cynical - as I was never at an elite institution or a place with a long history of residencies. I was in the 5th or so class after UPMC re-started training program.

UPMC, a self funded rad-onc residency - the attendings were slowed down by us. On the services I was on, the attendings were not exactly waiting for you to do contours. If you sat on a sim, Dr. B would have the contours done and smirk at you. He could do everything faster without you there. The head and neck guy at Shadyside was the same way. GK was same - you there or not, the work got done, and didn't matter to Flick. It was on you to learn - the system was not going to slow down without you there.

There are many, many places that are definitely not making money off of residents and it is net loss. My tiny ass system has a graduate medical programs that are funded by the hospital. It's a service provided and it is not a revenue generator, overall. These larger systems - what you are saying makes sense - it offloads clinical work to residents so faculty can type things. And yes, I work for a for profit system, but the residency is not generating what they cost.

So, I think it depends on where. I presume a place like Kaiser - it's nice and all having a resident - but at the end of the day, they just keep you at the office longer.
 
elementaryschooleconomics said:
I haven't looked at this in awhile, and I know some legislation was just passed for more GME funding, but I believe the CMS funding for residents was capped ~15-20 years ago. So while some programs definitely get paid for their residents, I think basically all of the expansion has been self-funded by schools (there's a cap on funding from the government, NOT on residents).

Which, to me, is even more problematic. The days of altruistic academia are long gone. Perhaps there are some pockets left, but on average, the institutions are going to do things which make money, not lose it.

Knowing how my own residency program worked, talking to people from institutions of every size...I think they're far more similar than we realized. The resident workforce is leveraged to generate more RVUs for the institution, through no "grand scheme" but just human nature.

If you're an Assistant Professor at XYZ Health Systems, and your promotion to Associate Professor depends on grants and papers, but your salary depends on RVUs...what is invariably going to happen? If you have a resident, you're going to "allow" that resident to pick up all the work they can because you need "academic time". The resident doesn't know any better, they're "getting service for education". You justify your actions because, well, the system has also built you a mouse trap. No one is doing anything nefarious.

Zoom out, and an academic RadOnc department over the last 15 years has taken over community hospitals and named them "satellites", faculty can be pushed with higher RVU targets while still maintaining lofty tenure requirements because residents have expanded and can be leveraged to make everyone work harder. The residents are ignorant because there is NO WAY to have any life experience prior to this to stop and say "hey, wait, am I being exploited?"

Repeat. Repeat.
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I believe this, especially coming from a place where some of the attendings could not function without a resident.

The other problem is if the resident does stop and is like, waaait a minute.....they are hushed or ignored or become the black sheep of the program.

I mean I loved my program, especially for my co-residents, but there were some super suss things going on.
 
RO28 said:
I believe this, especially coming from a place where some of the attendings could not function without a resident.

The other problem is if the resident does stop and is like, waaait a minute.....they are hushed or ignored or become the black sheep of the program.

I mean I loved my program, especially for my co-residents, but there were some super suss things going on.
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The small size and “get A job” dynamic combined with job market makes it very ripe for exploitation. Hellpits around the time of the ACGME survey will “warn” residents that things are best kept within the family and that disasatisfaction should be addressed elsewhere. Of course nothing ever improves or changes but the promise of vague improvement distantly is always hung like a vanishing schrodinger cat carrot. So residents put their head downs and don’t want to get their place shut down or be labeled a “problem”. It takes a lot of bravery for anyone to be the squeaky wheel because they are basically putting their career on the line. It is a lot easier to graduate and never look back than to try to actively improve a place from within, with the minimal power you might have as a resident, which is basically zero.

I always say, some of these hellpits have been bad for decades and they say well we are improving! They had decades to improve and some people believe them now? Total joke IMO. We have to shut down many programs….like yesterday.
 
Depending on how you define it residents are epxloited in every program in every field.

I think the degree to which one feels rthis to be true depends on how they feel about their attendings and the education they were getting

I never really felt that I was being exploited because my attendings were also working hard and I genuinely learned from them as well. But sure i guess I was being ‘exploited’ in that I was labor, but it never felt that way, which is probably the most important part

The people that felt exploited prob didn’t get much from their attendings

Also helped that our attendings would see patients on their own plenty
 
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I definitely agree that working hard is not exploitation if the education component is significantly there. What i am referring to is places, the “hellpits”, where education component is vastly outweighed by a service component. It might be shocking to some. I talk to many people and hear their stories. PW admitted it in his letter recounting his time at ACGME (yet did nothing apparently) where he realized the number of bad programs out there.
 
jondunn said:
Depending on how you define it residents are epxloited in every program in every field.

I think the degree to which one feels rthis to be true depends on how they feel about their attendings and the education they were getting

I never really felt that I was being exploited because my attendings were also working hard and I genuinely learned from them as well. But sure i guess I was being ‘exploited’ in that I was labor, but it never felt that way, which is probably the most important part

The people that felt exploited prob didn’t get much from their attendings

Also helped that our attendings would see patients on their own plenty
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This really depended on the rotation. Both existed where I trained.
 
also my attendings weren’t being paid by productivity - that probably doesn’t help when your attending takes an add on and you know that’s in the background.
 
RealSimulD said:
I'm slightly less cynical - as I was never at an elite institution or a place with a long history of residencies. I was in the 5th or so class after UPMC re-started training program.

UPMC, a self funded rad-onc residency - the attendings were slowed down by us. On the services I was on, the attendings were not exactly waiting for you to do contours. If you sat on a sim, Dr. B would have the contours done and smirk at you. He could do everything faster without you there. The head and neck guy at Shadyside was the same way. GK was same - you there or not, the work got done, and didn't matter to Flick. It was on you to learn - the system was not going to slow down without you there.

There are many, many places that are definitely not making money off of residents and it is net loss. My tiny ass system has a graduate medical programs that are funded by the hospital. It's a service provided and it is not a revenue generator, overall. These larger systems - what you are saying makes sense - it offloads clinical work to residents so faculty can type things. And yes, I work for a for profit system, but the residency is not generating what they cost.

So, I think it depends on where. I presume a place like Kaiser - it's nice and all having a resident - but at the end of the day, they just keep you at the office longer.
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Can be nefarious motives, I'm sure some of the EM folks can talk about all the programs started by HCA which is killing that labor market...

Too Big Too Fast? Potential Implications of the Rapid Increase in Emergency Medicine Residency Positions - PMC

Emergency medicine (EM) has expanded rapidly since its inception in 1979. Workforce projections from current data demonstrate a rapid rise in the number of accredited EM residency programs and trainee positions. Based on these trends, the specialty ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
 
jondunn said:
The people that felt exploited prob didn’t get much from their attendings

Also helped that our attendings would see patients on their own plenty
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Bingo... Being required to staff every follow up, double coverage, attending doing contours and plan review on their own without calling you etc. Some real great hellpits out there
 
as an aside to the Academic Medical Center chatter - Michigan hired a new chair - Daniel Chang from Stanford. Fairly young, non-lab backed guy.

what im hearing people tell me is that this is the new route - big AMC hospitals are going to hire young clinical people as chairs in hopes of manipulating them and operationalizing rad onc even more so and cutting out the pesky 'research' part.
 
RealSimulD said:
Why should you have a lab to be chair?

Why should you even need an academic background to be a chair?

Academic centers slowly destroying themselves because they are missing 95% of potential Talent.
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Agree you don’t need to be an academic to be chair. The big academic medical centers are going to make the A in academic smaller and smaller and emphasize the medical center part more and more

For the MBAs that are in charge of these billion dollar centers, the research is a pesky nuisance
 
UPenn did it a while ago with their chair.

Should come to no surprise that UPenn is one of the most business oriented dept around. They’ve destroyed most around them.
 
Also Steinberg at UCLA, wasnt he a PP guy who sold his practices and made millions? This model is already in existence. It might be the future as the lines are blurred even further. You are there to make “the institution” money
 
thecarbonionangle said:
“And it was all quiet on the western front…”
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99% of the chairs have done the standard thing of being lab guys. It has not served us well. How about Stu Burri from SERO? How about Bob Cardinale from Princeton? How about Matt Snyder from ARM? Pal Bajaj from INOVA?

In general we are bad at evaluating and utilizing talent, but #radonc particularly has tunnel vision.
 
jondunn said:
scribe is cheaper!

More departments should do this and not flood system with more trainees
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When I was a PGY-5, one of my attendings had a scribe during a rotation. The benefits for the attending are more apparent, but it was incredible for education. The attending had a lot more time to teach the patient and I during the visit, and even more for me after the visit.

I have brought this up so many times and I've never even had someone engage me enough to discuss it in any detail. They are cheap and of all "staff" jobs, it doesn't seem like it would hurt the team as much if there is a lot of turn over (many go to med school, etc.)
 
RealSimulD said:
99% of the chairs have done the standard thing of being lab guys. It has not served us well. How about Stu Burri from SERO? How about Bob Cardinale from Princeton? How about Matt Snyder from ARM? Pal Bajaj from INOVA?

In general we are bad at evaluating and utilizing talent, but #radonc particularly has tunnel vision.
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Dang. These are the last guys I'd want to be chairs of regional departments near me. They'd grow the footprint at the places they were hired at remarkably. Growth at this point is more damaging than anything else.

I'm of the opposite mind. For value sake (and my personal interest) academic radonc should be small, small, small and very research focused. The clinical practice of radonc can be decentralized effectively (its what I do). Maybe some academic places could represent brachytherapy centers of excellence.

Academic chairs should be rotating and not be a career goal for physician-scientists. But if they are not that, the ideal candidate is someone comfortable enough in their own skin to want to be the least talented person in the department.
 
communitydoc13 said:
Dang. These are the last guys I'd want to be chairs of regional departments near me. They'd grow the footprint at the places they were hired at remarkably. Growth at this point is more damaging than anything else.

I'm of the opposite mind. For value sake (and my personal interest) academic radonc should be small, small, small and very research focused. The clinical practice of radonc can be decentralized effectively (its what I do). Maybe some academic places could represent brachytherapy centers of excellence.

Academic chairs should be rotating and not be a career goal for physician-scientists. But if they are not that, the ideal candidate is someone comfortable enough in their own skin to want to be the least talented person in the department.
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Exactly
 
jondunn said:
Exactly
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communitydoc13 said:
Dang. These are the last guys I'd want to be chairs of regional departments near me. They'd grow the footprint at the places they were hired at remarkably. Growth at this point is more damaging than anything else.

I'm of the opposite mind. For value sake (and my personal interest) academic radonc should be small, small, small and very research focused. The clinical practice of radonc can be decentralized effectively (its what I do). Maybe some academic places could represent brachytherapy centers of excellence.

Academic chairs should be rotating and not be a career goal for physician-scientists. But if they are not that, the ideal candidate is someone comfortable enough in their own skin to want to be the least talented person in the department.
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Why? I still don’t see any evidence this model works. It seems to actively be worse and worse every year.
 
RealSimulD said:
Why? I still don’t see any evidence this model works. It seems to actively be worse and worse every year.
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Doesn’t work in what way?

The problem With ‘academics’ is that they’ve gotten taken over by large corporate interests and have become ‘academic medical centers

What is the purpose of academic centers? If it’s to build build build department size, take over private practices, and increases clinical revenue for the company - then yea go for it.

That’s exactly been the problem though, and why ‘academics’ has to come to represent what it currently does.

When academics worked at its best - it was small departments treating patients that came and tried to do basic and clinical research. When the hospital got more power than the university - problems arise.


ESE can talk about tbis all day I’m sure - but the academic medical center along with other large non academic hospital systems have totally upended medicine
 
RealSimulD said:
Why? I still don’t see any evidence this model works. It seems to actively be worse and worse every year.
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@jondunn has it down above.

The model (of expansion) has worked great for large academic hospital systems and may have even raised the profile of some radonc chairs within their institutions. (I believe Deweese was pivotal in integrating Sibley/Suburban under the JHH umbrella and Suntha was a growth guy at UMD).

The model has not worked well for the average practicing radiation oncologist or for maximizing scientific progress within the field (although some good research has been done within academic departments, often not directly radiation related).

There may not be (the universe may not have) that much room for really good rads based research going forward. But telling that Timmerman's seminal work was not at JHH or MSK or MDACC but at Indiana.
 
communitydoc13 said:
@jondunn has it down above.

The model (of expansion) has worked great for large academic hospital systems and may have even raised the profile of some radonc chairs within their institutions. (I believe Deweese was pivotal in integrating Sibley/Suburban under the JHH umbrella and Suntha was a growth guy at UMD).

The model has not worked well for the average practicing radiation oncologist or for maximizing scientific progress within the field (although some good research has been done within academic departments, often not directly radiation related).

There may not be (the universe may not have) that much room for really good rads based research going forward. But telling that Timmerman's seminal work was not at JHH or MSK or MDACC but at Indiana.
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Large technical reimbursement has not worked out well for the field, which is why I am in favor cms cuts. Our salaries and opportunities are set by supply and demand.
 
RickyScott said:
Large technical reimbursement has not worked out well for the field, which is why I am in favor cms cuts. Our salaries and opportunities are set by supply and demand.
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Dangerous slippery slope. One way to guarantee less money going into rad oncs pockets is to decrease the technical reimbursement

But yeah I agree this technical money is what has made hospital systems obsessed with getting more and more patients in their dept
 
RickyScott said:
Large technical reimbursement has not worked out well for the field, which is why I am in favor cms cuts. Our salaries and opportunities are set by supply and demand.
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Large technical reimbursement is the only way we get paid anymore. PC is a joke you either have to be committing fraud to make it work or be rural.

Supply and demand are not in our favor either. Cutting tech won’t help it’ll just make your employer cut you. You are cutting literally the last lifeline we have
 
why not increase physician fees and raise taxes to pay for it? Lol i know it wont happen.

If hospital is not going to be paid for having a ton of tech and upkeeping, why shouldnt they give you a bare bone facility? Maybe 4dct on a good day, although gator still wont use it!
 
RickyScott said:
Large technical reimbursement has not worked out well for the field, which is why I am in favor cms cuts. Our salaries and opportunities are set by supply and demand.
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Why cuts? Just do a real APM and be done with it, site and modality agnostic including PPS exempt, exclusions for brachy and particle therapy on RCTs
 
I know this is a Twitter thread, but I couldn't find a better place to post this. On my LinkedIn feed this morning, there was a job posting by Optum/United Health for a Rad Onc Medical Director (remote). Basically the job boils down to:

* Denying claims that UH wants you to deny for practicing Rad Oncs
* Educate other members of the UH team on how to deny care while still sleeping at night by use of corporate buzzwords ("optimal clinical outcomes" and "value proposition focused on quality") which are all euphemisms for "make the patient die faster so that we can keep all their premiums."
* Thanks to the states of Colorado, Connecticut and Nevada for forcing job postings to contain salary data publicly. In this case it ranges from $255k - $295k.

In case any of you are fed up with clinical Rad Onc and instead want to join the evil empire and inflict the same pain you suffered on others, this job is right up your alley.
 
Gfunk6 said:
I know this is a Twitter thread, but I couldn't find a better place to post this. On my LinkedIn feed this morning, there was a job posting by Optum/United Health for a Rad Onc Medical Director (remote). Basically the job boils down to:

* Denying claims that UH wants you to deny for practicing Rad Oncs
* Educate other members of the UH team on how to deny care while still sleeping at night by use of corporate buzzwords ("optimal clinical outcomes" and "value proposition focused on quality") which are all euphemisms for "make the patient die faster so that we can keep all their premiums."
* Thanks to the states of Colorado, Connecticut and Nevada for forcing job postings to contain salary data publicly. In this case it ranges from $255k - $295k.

In case any of you are fed up with clinical Rad Onc and instead want to join the evil empire and inflict the same pain you suffered on others, this job is right up your alley.
Click to expand...
I dont see why working for UH is ethically any worse than treating prostate with protons. Wouldnt hold it against anybody who are not in a position to uproot or leave their family.
 
RickyScott said:
I dont see why working for UH is ethically any worse than treating prostate with protons. Wouldnt hold it against anybody who are not in a position to uproot or leave their family.
Click to expand...
Hate the games, not the players. APM/payment bundles would kill the business model for Optum and evilcore, HealthHell overnight
 
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medgator said:
Hate the games, not the players. APM/payment bundles would kill the business model for Optum and evilcore and HealthHell overnight
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And probably also the RO groups themselves as the bundle is ratcheted downward.
 
Supposedly optum/UH is getting into the proton game i am hearing so they might be playing ball in multiple ways. CVS was bought by Aetna and they have a former penn RO as rad onc medical director. There might be a lot more to the iceberg tip folks!
 
thecarbonionangle said:
Supposedly optum/UH is getting into the proton game i am hearing so they might be playing ball in multiple ways. CVS was bought by Aetna and they have a former penn RO as rad onc medical director. There might be a lot more to the iceberg tip folks!
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"Thank you for dialing 911 and choosing Aetnagreens.CVS.PennAnderson.Kettering Health Systems for your emergency services. We strive to give our customers the best care possible. We are experiencing longer than normal wait times..."
 
elementaryschooleconomics said:
"Thank you for dialing 911 and choosing Aetnagreens.CVS.PennAnderson.Kettering Health Systems for your emergency services. We strive to give our customers the best care possible. We are experiencing longer than normal wait times..."
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“Unfurtunately our services are on hold currently for 24 hours due to the upcoming purge, bye bye”
 
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