Rad Onc Twitter

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Who would have thought a picture of a snack cart would set off this d*ck measuring contest? Gotta read the whole thread



All I can think when I hear that there are H&N clinics seeing 10-15 consults in one afternoon is how shortchanged this group of very sick patients must feel. This is not something to brag about.
 
pikachu said:
All I can think when I hear that there are H&N clinics seeing 10-15 consults in one afternoon is how shortchanged this group of very sick patients must feel. This is not something to brag about.
Click to expand...

Go to MSK. Navigate Manhattan traffic. Pay for parking*. Potentially wait over an hour in a room for the doctor that is running behind. See a resident that hasn't slept in a week. "World renowned" attending pops her head in for 10 minutes. Resident then contours your case at midnight. Sounds awesome.

*Ha, I got curious while writing this so searched on Google. Sounds like it's as much as $50 a day!! I hope they validate.
 
pikachu said:
Who would have thought a picture of a snack cart would set off this d*ck measuring contest? Gotta read the whole thread



All I can think when I hear that there are H&N clinics seeing 10-15 consults in one afternoon is how shortchanged this group of very sick patients must feel. This is not something to brag about.
Click to expand...

Also having ten head and neck volumes done in one afternoon doesnt sound like great care. UH is likely to drop the soap again this year. The dude is a SOAPER. Enjoy your muscle milk. Cheers!
 
The dick measuing contest began with private practice earlier this week saying he had achieved 100 years of experience in new patient consults, and now continues with academic residency malignancy (clear to all except those who actually lived through it - Stockholm Syndrome).
At least that PP guy is (hopefully) clearing 7+ figures yearly.

What a disservice to a radiation oncology resident to see 10-14 consults in a DAY. Zero time for education. Just move the meat.
 
Are there not acgme max cases per year any more? Used to be (I think it was max per year but may have been cumulative max).
 
NotMattSpraker said:
Go to MSK. Navigate Manhattan traffic. Pay for parking*. Potentially wait over an hour in a room for the doctor that is running behind. See a resident that hasn't slept in a week. "World renowned" attending pops her head in for 10 minutes. Resident then contours your case at midnight. Sounds awesome.

*Ha, I got curious while writing this so searched on Google. Sounds like it's as much as $50 a day!! I hope they validate.
Click to expand...
They don't let her have residents anymore. But she does get a Fellow.

Also, the level of craftmanship over there is definitely worth PPS-exemption:

2023 Target Volume Delineation (2015, Nancy Lee).png


Such skill.
 
Well
I’m a part of this thread
Do I sound crazy?
I feel like I’m in an alternate reality on twitter sometimes
 
pikachu said:
No way, I was referring to the insanity of people bragging on how many consults they could superficially churn through in one clinic. Such a bad look
Click to expand...

Live your life with purpose with pure intent!

My purpose and intent is to help patients with cancer and trainees without sounding like a delusional Rad Onc "leader".
 
Don't worry, MSKCC and MDACC are kind enough to leave us the Medicaid patients, uninsured patients, and patients that don't have the means to stay in Manhattan or Houston for nine weeks to get their GS 3+3 prostate cancer treated.
 
Just had an academic neighbor steal a head neck and told them to drive 100 miles each way for IMRT.

Enough to make you a Buckeye fan.

These people are relentless in their drive to have it all, damn the people’s comfort and support system.
 
My patients go to the academic center, and they mention the p word. I never see them again unless the wallet biopsy comes back negative.
 
good thing about competing with academics in knowing that their incentive is $7 per wRVU
 
I have been in practice for 1 year, community practice. seen 350 consults so far. Most I've seen in a day was 8 new patients. it actually has been pretty easy and I think there is some truth to what Spratt et al are saying. as an attending, nothing has been worse than a routine "busy" day in residency where you would see OTVs, 10 consults, follow-ups, inpatients, have "didactics" + "noon conference", and have an ***hole attending who will complain to your PD if your notes are not all in by the end of the day. My SO was always confused because I was a rad onc with an outpatient job.

My QOL has taken a huge improvement since finishing residency + passing boards. No work when im not at work. Fortunately, I have learned to be efficient and have a job that allows for that.
 
radoncftw said:
I have been in practice for 1 year, community practice. seen 350 consults so far. Most I've seen in a day was 8 new patients. it actually has been pretty easy and I think there is some truth to what Spratt et al are saying. as an attending, nothing has been worse than a routine "busy" day in residency where you would see OTVs, 10 consults, follow-ups, inpatients, have "didactics" + "noon conference", and have an ***hole attending who will complain to your PD if your notes are not all in by the end of the day. My SO was always confused because I was a rad onc with an outpatient job.

My QOL has taken a huge improvement since finishing residency + passing boards. No work when im not at work. Fortunately, I have learned to be efficient and have a job that allows for that.
Click to expand...
Infrastructure is everything.

I've also done ~350/year in the community in two different environments.

It has the potential to be relatively easy.

It has the potential to be a living nightmare.

The actual medicine part...doesn't matter much at all.
 
RealSimulD said:
I’m not gonna give much more detail.
I don’t mind if a patient leaves to go on study. But I’ve been in the room with an academic doc telling them that the community can’t handle the case (was N0 breast).
Click to expand...
I’ve had academics tell patients brain Mets can only be treated with gamma knife.
 
RealSimulD said:
I’m not gonna give much more detail.
I don’t mind if a patient leaves to go on study. But I’ve been in the room with an academic doc telling them that the community can’t handle the case (was N0 breast).
Click to expand...
I get it, but in my experience, the p16- population ain't driving. But the p16- population also probably has the less desirable insurance.
 
Fpg1245 said:
They’ll keep those patients on the table for hours. Small cell? They’ll treat all 20 Mets in a single session and still have progression 6 months out.
Click to expand...
In residency we had GK and now in practice we do Linac based SRS, I prefer Linac so much more. Logistically much easier and more convenient for patients. I see patients for FU the day after thin slice MRI and if they need another round of SRS we sim and treat within 2-3 days.
 
RickyScott said:
so what age would an md phd come out of this, ready for their first job as an instructor?
Click to expand...

Depends. I have no idea, but maybe the age of entering residency is dropping? Less PhDs more SOAPs?

I've said this on a few podcast episodes. That fellowship is the right job for a person who must be in NYC and has no other options, or has a dream of being CNS faculty at MSKCC. Things like that.

I suspect we will see more of these, so I hope people dont feel bad taking them if they align exactly with their needs. Centers should feel bad offering them.
 
NotMattSpraker said:
Depends. I have no idea, but maybe the age of entering residency is dropping? Less PhDs more SOAPs?

I've said this on a few podcast episodes. That fellowship is the right job for a person who must be in NYC and has no other options, or has a dream of being CNS faculty at MSKCC. Things like that.

I suspect we will see more of these, so I hope people dont feel bad taking them if they align exactly with their needs. Centers should feel bad offering them.
Click to expand...
So many questions-Will they be able to prescribe chemo like a traditional neuro onc (neurology) who had zero onc training before their one year fellowship?
 
RickyScott said:
So many questions-Will they be able to prescribe chemo like a traditional neuro onc (neurology) who had zero onc training before their one year fellowship?
Click to expand...

That would be cool and I wish we talked more about creating novel paths for ROs to prescribe some systemic therapies. Its a good idea.
 
RickyScott said:
So many questions-Will they be able to prescribe chemo like a traditional neuro onc (neurology) who had zero onc training before their one year fellowship?
Click to expand...
Just for sake of argument and Ive mentioned this before, but aware of at least several ROs in Canada at some point in their career have managed as a part of their practice, concurrent cabecitabine and temozolide. Not that they desired to do so per se, but due to med onc access I highly suspect. Obviously not the most common practice arrangement, but it’s doable. In before all the posts about liability etc etc. But it’s been done elsewhere before
 
taserlaser said:
Just for sake of argument and Ive mentioned this before, but aware of at least several ROs in Canada at some point in their career have managed as a part of their practice, concurrent cabecitabine and temozolide. Not that they desired to do so per se, but due to med onc access I highly suspect. Obviously not the most common practice arrangement, but it’s doable. In before all the posts about liability etc etc. But it’s been done elsewhere before
Click to expand...

It would be nice to have as an option for RO trainees, and it would be nice to have as an option for stressed centers. It shouldn't be required.

If we were smart, we'd contract residency spots, move back to 3 years, and start some official accredited fellowships that give you access to jobs in a cancer center other than being a clinical Rad Onc. With an employed doc, you can pay them a salary and have them do whatever you want. If you just want to treat, 3 years and you're done, how it used to be and how it should be.

Right now, the primary upside seems to be... cheap labor?... and all paths spit out either a clinical Rad Onc (we have enough or too many) or a researcher.
 
NotMattSpraker said:
or has a dream of being CNS faculty at MSKCC. Things like that
Click to expand...
I suspect (hope) that the MD/PhD crowd in radonc is diminishing. During peak radonc, our field was much more like Derm than Hemeonc for the MD/PhD crowd anyway. A nice lifestyle (and very competitive) gig where your PhD helped one gain access.

There were exceptions of course. I personally witnessed several Md/PhDs who happened to have done their research in the right labs before starting residency (well known immuno-onc or Onc-Genomics type labs), and were able to land real physician scientist gigs after residency without having to bust their ass doing research during training.

But for most Md/PhDs this wasn't the case at all, and the challenge was re-establishing yourself as an onc researcher while older than your cohort. Nothing like being told at age 35-38 that "if you're serious" you are going to have to put in another 1-2 years after residency to have any chance at collecting a real paycheck doing research.

The system actually favored the non MD/PhDs (as well as those rare few who were positioned for a research job prior to residency (e.g. Tim Chan).

Community radonc is littered with MD/PhDs. Community medonc is staffed by IMGs.

The terms of this fellowship are interesting. If it's 70/30 clinical, it better effing be offering expansion of clinical scope! There is no other excuse for offering this position. If it's not offering that, it is simply "blood on the streets" behavior.
 
communitydoc13 said:
I suspect (hope) that the MD/PhD crowd in radonc is diminishing. During peak radonc, our field was much more like Derm than Hemeonc for the MD/PhD crowd anyway. A nice lifestyle (and very competitive) gig where your PhD helped one gain access.

There were exceptions of course. I personally witnessed several Md/PhDs who happened to have done their research in the right labs before starting residency (well known immuno-onc or Onc-Genomics type labs), and were able to land real physician scientist gigs after residency without having to bust their ass doing research during training.

But for most Md/PhDs this wasn't the case at all, and the challenge was re-establishing yourself as an onc researcher while older than your cohort. Nothing like being told at age 35-38 that "if you're serious" you are going to have to put in another 1-2 years after residency to have any chance at collecting a real paycheck doing research.

The system actually favored the non MD/PhDs (as well as those rare few who were positioned for a research job prior to residency (e.g. Tim Chan).

Community radonc is littered with MD/PhDs. Community medonc is staffed by IMGs.

The terms of this fellowship are interesting. If it's 70/30 clinical, it better effing be offering expansion of clinical scope! There is no other excuse for offering this position. If it's not offering that, it is simply "blood on the streets" behavior.
Click to expand...

This is me! However, I did a PhD first before medical school and have never done bench research. I think it makes me a better doctor and QI leader in my institution, but that's just my opinion and I wouldnt say its required for any doctor.

Our training is super comprehensive. I went to residency with busy clinic/SBRT, protons, and brachy. I still learned so much in my first job as an assistant professor, but I was fully paid (haha "fully"). You have to offer an extremely niche training that isnt covered in residency to justify a fellowship in my opinion. Peds that directly feeds in to a job, needle heavy brachy all over the body, that kind of stuff it makes sense.

The other thing that seems "fair" is a full research fellowship preparing someone for 80-100% research in a lab. MD/PhD's who have graduated residency have never done a post-doc and that is standard in the field.

Protons, CNS, SBRT are abusive in concept IMO. Important note, I don't think the people involved are abusive! Lets not make people angry.

From the perspective of clinical experience, I do not understand why you cant hire a person on as a full assistant professor and do on the job training given they have graduated residency and are BE. The ABR would seem to agree given the content of their tests and some editorials.

Why is this not just a 70/30 assistant professor?
 
NotMattSpraker said:
This is me! However, I did a PhD first before medical school and have never done bench research. I think it makes me a better doctor and QI leader in my institution, but that's just my opinion and I wouldnt say its required for any doctor.

Our training is super comprehensive. I went to residency with busy clinic/SBRT, protons, and brachy. I still learned so much in my first job as an assistant professor, but I was fully paid (haha "fully"). You have to offer an extremely niche training that isnt covered in residency to justify a fellowship in my opinion. Peds that directly feeds in to a job, needle heavy brachy all over the body, that kind of stuff it makes sense.

The other thing that seems "fair" is a full research fellowship preparing someone for 80-100% research in a lab. MD/PhD's who have graduated residency have never done a post-doc and that is standard in the field.

Protons, CNS, SBRT are abusive in concept IMO. Important note, I don't think the people involved are abusive! Lets not make people angry.

From the perspective of clinical experience, I do not understand why you cant hire a person on as a full assistant professor and do on the job training given they have graduated residency and are BE. The ABR would seem to agree given the content of their tests and some editorials.

Why is this not just a 70/30 assistant professor?
Click to expand...
1693074458220.jpeg
 
radoncftw said:
I have been in practice for 1 year, community practice. seen 350 consults so far. Most I've seen in a day was 8 new patients. it actually has been pretty easy and I think there is some truth to what Spratt et al are saying. as an attending, nothing has been worse than a routine "busy" day in residency where you would see OTVs, 10 consults, follow-ups, inpatients, have "didactics" + "noon conference", and have an ***hole attending who will complain to your PD if your notes are not all in by the end of the day. My SO was always confused because I was a rad onc with an outpatient job.

My QOL has taken a huge improvement since finishing residency + passing boards. No work when im not at work. Fortunately, I have learned to be efficient and have a job that allows for that.
Click to expand...

Probably the only benefit of training at a standard hellpit program is you [should] learn to become efficient very quickly or perish

That kind of work can translate very well to real the world. As you said, even the worst days in the community aren't even close to routine busy days in residency.
 
.
metallica81788 said:
Probably the only benefit of training at a standard hellpit program is you [should] learn to become efficient very quickly or perish

That kind of work can translate very well to real the world. As you said, even the worst days in the community aren't even close to routine busy days in residency.
Click to expand...
15+ yrs ago: residents in programs like maryland and Jeff seemed to work 12 hr days, but attendings averaged around 10 or less pts. Never could understand this.
 
pikachu said:
Who would have thought a picture of a snack cart would set off this d*ck measuring contest? Gotta read the whole thread



All I can think when I hear that there are H&N clinics seeing 10-15 consults in one afternoon is how shortchanged this group of very sick patients must feel. This is not something to brag about.
Click to expand...

Update: this went totally off the rails in a way that could only happen on Twitter (X)
 
winstonfoot5 said:
Update: this went totally off the rails in a way that could only happen on Twitter (X)
Click to expand...
I know that thread caught a lot of attention.

My favorite thing I saw was someone lamenting RadOnc "airing dirty laundry on Twitter again", or something of the sort.

If anyone finds themselves thinking that way, I would ask - is it really a problem?

Meaning, virtually all of us who are active in digital RadOnc on any platform - we've been here for years. Both before and after the collapse.

While the competitiveness of the specialty has changed, personalities have not. Almost everyone on SDN and Twitter who engage regularly are attendings.

I've been mired in the swamp since before Obama was president. This is how its always been - except people had to find out the hard way who was a psychopath, or what programs were malicious, etc etc.

At least this way, it's all out in the open. The dirty laundry exists, whether or not some poor med student considering RadOnc knows it or not. I'd rather they have a fighting chance.

Though folks can read between the lines on my opinion on this particular instance from this particular exchange - I'm referencing...everything. Not just this. I managed to swim the swampy waters better than most because I was warned about stuff from friendly mentors. Many of my colleagues were not as fortunate.

The internet levels the playing field.
 
elementaryschooleconomics said:
I know that thread caught a lot of attention.

My favorite thing I saw was someone lamenting RadOnc "airing dirty laundry on Twitter again", or something of the sort.

If anyone finds themselves thinking that way, I would ask - is it really a problem?

Meaning, virtually all of us who are active in digital RadOnc on any platform - we've been here for years. Both before and after the collapse.

While the competitiveness of the specialty has changed, personalities have not. Almost everyone on SDN and Twitter who engage regularly are attendings.

I've been mired in the swamp since before Obama was president. This is how its always been - except people had to find out the hard way who was a psychopath, or what programs were malicious, etc etc.

At least this way, it's all out in the open. The dirty laundry exists, whether or not some poor med student considering RadOnc knows it or not. I'd rather they have a fighting chance.

Though folks can read between the lines on my opinion on this particular instance from this particular exchange - I'm referencing...everything. Not just this. I managed to swim the swampy waters better than most because I was warned about stuff from friendly mentors. Many of my colleagues were not as fortunate.

The internet levels the playing field.
Click to expand...
Agree. “Sunlight is said to be the best of disinfectants” and whatnot
 
elementaryschooleconomics said:
I know that thread caught a lot of attention.

My favorite thing I saw was someone lamenting RadOnc "airing dirty laundry on Twitter again", or something of the sort.

If anyone finds themselves thinking that way, I would ask - is it really a problem?

Meaning, virtually all of us who are active in digital RadOnc on any platform - we've been here for years. Both before and after the collapse.

While the competitiveness of the specialty has changed, personalities have not. Almost everyone on SDN and Twitter who engage regularly are attendings.

I've been mired in the swamp since before Obama was president. This is how its always been - except people had to find out the hard way who was a psychopath, or what programs were malicious, etc etc.

At least this way, it's all out in the open. The dirty laundry exists, whether or not some poor med student considering RadOnc knows it or not. I'd rather they have a fighting chance.

Though folks can read between the lines on my opinion on this particular instance from this particular exchange - I'm referencing...everything. Not just this. I managed to swim the swampy waters better than most because I was warned about stuff from friendly mentors. Many of my colleagues were not as fortunate.

The internet levels the playing field.
Click to expand...
“When people show you who they are… Believe them”
 
taserlaser said:
Just for sake of argument and Ive mentioned this before, but aware of at least several ROs in Canada at some point in their career have managed as a part of their practice, concurrent cabecitabine and temozolide. Not that they desired to do so per se, but due to med onc access I highly suspect. Obviously not the most common practice arrangement, but it’s doable. In before all the posts about liability etc etc. But it’s been done elsewhere before
Click to expand...

What is the liability exactly? If you follow the protocols and monitoring, why would it be any different that a medonc giving it?

Urologists give systemic therapies (Abi, Provenge, Immunotherapy, etc etc), Neuroonc gives TMZ, Derms are giving Erivedge. Hell - many of these drugs are new and half or more of these other specialists NEVER had training giving them.

Seriously - we just need to do it (safely) and set the precedent and take our place back as leaders in Oncology.
 
thesauce said:
What is the liability exactly? If you follow the protocols and monitoring, why would it be any different that a medonc giving it?

Urologists give systemic therapies (Abi, Provenge, Immunotherapy, etc etc), Neuroonc gives TMZ, Derms are giving Erivedge. Hell - many of these drugs are new and half or more of these other specialists NEVER had training giving them.

Seriously - we just need to do it (safely) and set the precedent and take our place back as leaders in Oncology.
Click to expand...
Neuro oncs give a lot more than tmz
 
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