Rad Onc Twitter

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medgator said:
Rad oncs with a spine need to be speaking up at TB. Albain study pretty clear
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Spine? Lol. Yeah maybe in academia they can do that without repercussion. But they won't. Meanwhile in PP land..

It takes the referral and it rubs it all over its bank account. What goes on in the basement is of no concern upstairs at most places.
 
sirspamalot said:
Spine? Lol. Yeah maybe in academia they can do that without repercussion. But they won't. Meanwhile in PP land..

It takes the referral and it rubs it all over its bank account. What goes on in the basement is of no concern upstairs at most places.
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Out in the real world, most CT surgeons aren't stupid enough to operate on bulky n2/n3 disease
 
medgator said:
Out in the real world, most CT surgeons aren't stupid enough to operate on bulky n2/n3 disease
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angry looney tunes GIF by Looney Tunes World of Mayhem

Academic Thoracic Surgeons ^^^
 
After 60-66 Gy, there aren’t good studies. This is the second place where I’ve worked where people still like to operate after full dose.

I think the people doing trimodality are not stopping at 45 Gy. And selecting better - avoiding pneumonectomies. I don’t know that surgery is dead. I think more to be learned. And hanging on to Albain is a little Boomerish.

Well selected patients randomized to 60 Gy with chemo + / - surgery and everyone gets Durva. That would be interesting.
 
RealSimulD said:
After 60-66 Gy, there aren’t good studies. This is the second place where I’ve worked where people still like to operate after full dose.

I think the people doing trimodality are not stopping at 45 Gy. And selecting better - avoiding pneumonectomies. I don’t know that surgery is dead. I think more to be learned. And hanging on to Albain is a little Boomerish.

Well selected patients randomized to 60 Gy with chemo + / - surgery and everyone gets Durva. That would be interesting.
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I think in large t3/t4 pts, absolutely a role, we aren't controlling those with chemorads. Bulky n2/n3 pts, no role imo
 
medgator said:
I think in large t3/t4 pts, absolutely a role, we aren't controlling those with chemorads. Bulky n2/n3 pts, no role imo
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This is true but I dont know that surgery does a better job than RT as a local modality. Look at Lung ART.

Today, Albain should do nothing but motivate people to want to run IO-surgery versus Pacific.
 
We have a
Lamount said:
Most referrals for lung on coming from CT surg... they are coming from pulm.
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i think it is very institutionally dependent. Ours perform a lot of interventional pulm such as ion bronch, lasers and stents etc. in last few years almost all our biopsies are coming from ion bronch
 
Mandelin Rain said:
"Heels"?

Lars Leksell DIED in 1986. He invent radiosurgery in the latter 1940's I believe.
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Radiosurgical outcomes sucked (vs now) until 3D planning became possible though; ie the advent of computerized TPSs using CT and MRI data (below: perils of biplanar angiography). And that didn’t happen until the 1990s. So kind of on heels 🙂

D187E3A1-D5D1-4A27-9B51-A17C38DD6228.png
 
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HAHAHAHAHAAHAHAH

I mean I am in academics, and this is accurate for some of the residents I've worked with.

I know SDN loves to hate on academics and academic attendings, but if I ever ask a resident to do more than they want to do there is hell to pay.

Also the Instragram part is golden.

"I wake up, go on a run by the water, making sure to post pictures to Instagram and twitter to remind everyone how my life is better than theirs." -- I literally have docs in other specialties asking me why our residents are posting from the gym/beach/wherever in the middle of the day. Amazing satire!
 
Neuronix said:
HAHAHAHAHAAHAHAH

I mean I am in academics, and this is accurate for some of the residents I've worked with.

I know SDN loves to hate on academics and academic attendings, but if I ever ask a resident to do more than they want to do there is hell to pay.

Also the Instragram part is golden.

"I wake up, go on a run by the water, making sure to post pictures to Instagram and twitter to remind everyone how my life is better than theirs." -- I literally have docs in other specialties asking me why our residents are posting from the gym/beach/wherever in the middle of the day. Amazing satire!
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In all seriousness, that description was not too far off from my residency.
 
Neuronix said:
HAHAHAHAHAAHAHAH

I mean I am in academics, and this is accurate for some of the residents I've worked with.

I know SDN loves to hate on academics and academic attendings, but if I ever ask a resident to do more than they want to do there is hell to pay.

Also the Instragram part is golden.

"I wake up, go on a run by the water, making sure to post pictures to Instagram and twitter to remind everyone how my life is better than theirs." -- I literally have docs in other specialties asking me why our residents are posting from the gym/beach/wherever in the middle of the day. Amazing satire!
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During peak rad onc, there was hell to pay if you didn't staff every boomer attendings fu/clinic pt, also inpatients etc. Things have changed i guess with this buyers market
 
medgator said:
During peak rad onc, there was hell to pay if you didn't staff every boomer attendings fu/clinic pt, also inpatients etc. Things have changed i guess with this buyers market
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COVID changed things significantly. education suffered. the in-person didactics and "fear" of getting pimped actually pushed me to study harder. also changed the need to be in dept/clinic 5 days a week. if attendings had academic day, residents got one too. during peak covid residents on research were discouraged from coming into the dept. i literally spent large periods of time on my research block in a different state.
 
RealSimulD said:
I feel like that Reddit post is very underappreciated. Or is it so good that #radonc Twitter just ignoring it.
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Nobody in academics is allowed to joke about residents.

It's like a totally forbidden thing now.

If you say anything a resident doesn't like, even if you don't mean anything by it, it will be reported and used as evidence of attending abuse.

So I would assume that #radonc Twitter is ignoring commenting on it for political reasons.

dieABRdie said:
I'd love their "Diary During the Job Search"...
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Haha you should totally write that one.
 
RealSimulD said:
I feel like that Reddit post is very underappreciated. Or is it so good that #radonc Twitter just ignoring it.
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Some of the local med oncs really liked it haha. I was also sent the ‘Hospital Admin’ one which is also pretty good
 
RadOncDoc21 said:
So crazy how a field that was one of the most competitive is now at the bottom, yet the people in charge are still running the show.
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It just went back full circle to where it started. Have you met people that matched in the 70s or mid-to-late 90s?

Mid to bottom tier programs that wouldn't have looked at DOs or Caribbean grads a decade ago have no problem being excited about matching them now. Didn't get an interview at tufts either when i applied 2 decades ago 😂

 
In retrospect, the intense competitiveness for residency spots was a bubble. Even so called bottom tiered programs “priced” their spots very high. The top tier programs priced their spots astronomically. That bubble has burst. There are other bubbles in radiation oncology…
 
The interviews at our "top 10" place were full of 'perfect' candidates, who were using us as a fall back from Harvard/Stanford/MSK/MDAH. Nature publications, top 5% Step I, etc.

None of which, of course, make you a good radonc. But if you're rolling the dice, I'll take it over anything from the islands/DO land.
 
sirspamalot said:
The interviews at our "top 10" place were full of 'perfect' candidates, who were using us as a fall back from Harvard/Stanford/MSK/MDAH. Nature publications, top 5% Step I, etc.

None of which, of course, make you a good radonc. But if you're rolling the dice, I'll take it over anything from the islands/DO land.
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Very few md/phds ultimately get r01 grants in this field. Despite matriculating at msk with a nature publication under belt, 10 years from now they are much more likely to be covering a satellite in Kansas (or worse), than in thier own lab. To me, this reflects really poor judgement.
 
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sirspamalot said:
The interviews at our "top 10" place were full of 'perfect' candidates, who were using us as a fall back from Harvard/Stanford/MSK/MDAH. Nature publications, top 5% Step I, etc.

None of which, of course, make you a good radonc. But if you're rolling the dice, I'll take it over anything from the islands/DO land.
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None of them are even remotely nessesary and yet we took these candidates who likely should have gone elsewhere.

I know at least 3 in a similar category to what you describe who spend their days at satellites with academic time which is basically when they aren’t seeing a full patient load

The smartest academics in rad onc have either gone to industry, PP/community, or taken chair spots so they can lean on others to publish.
 
I should probably have added "circa 2004" to my post. step I is now pass fail.. but anyone with the engine to do top 15% should* be smart enough TO RUN THE F AWAY from radonc.. and I really like being one, but HELL NO
 
TheWallnerus said:
In retrospect, the intense competitiveness for residency spots was a bubble. Even so called bottom tiered programs “priced” their spots very high. The top tier programs priced their spots astronomically. That bubble has burst. There are other bubbles in radiation oncology…
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Yeah. Tough for anyone to be caught in a bubble of any sort. It means you have overestimated value somewhere and you are going to be taking losses.

When I think of the peak radonc bubble, I am OK with folks like me, who ended up in community jobs that they thought they were too good for, but have been paid fairly well and learned to live away from big cities.

It's the group of aspiring academics one tier down from the top 5-10 or so graduates per year that I wonder about. A group, that during peak radonc, could have called their academic trajectory in almost any other field, been given support and been expected to produce academically as opposed to clinically. I bet there was a good 10-12 year period there, where 30-50 graduating radonc residents per year had the academic bonifieds to make almost anyone in medicine blush, but were not looking forward to fruitful academic careers once they graduated.

Why has derm been different? Why hasn't there been a derm bubble?

I would say this. Derm always knew where their prestige came from. They knew it was about lifestyle and money, and they knew that to preserve these, controlling the supply/demand dynamic was critical.

While I'm sure derm aspirants had to put on a dog and pony show about about academic or community service aspirations, collectively everyone knew the real narrative. Derm is a field that you work hard to get into, so that you don't have to work so hard once you are in. It is prestigious only because the folks in the residency program are AOA/260+ types.

Radonc got carried away. Most importantly, leadership during peak radonc got carried away. They forgot the real narrative...that by and large, we radiate the medical oncologist's or surgeon's patients and don't take much call and radiation pays. They imagined that great and generalizable oncology knowledge would emerge from a very limited specialty, if they just acquired enough remarkable young talent. Many in leadership imagined themselves as great. A few were able to ingratiate themselves to the larger medical community and sail away. (Hahn, Deweese, etc)
 
Yes, from their lofty well feathered perch they gave forth their erudite recommendations that turned.. our specialty.. into a shythouse.

Dumb and dumber.. and the few crammed at the top will do anything to make sure they are safe while garnering cheap labor. The whole house of cards needs to crash..
 
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