Rad Onc Twitter

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ASTRO's priorities are not that of the non-academic radonc practitioner.

VOTE WITH YOUR DOLLARS

Just Say No Stephen Colbert GIF by The Late Show With Stephen Colbert
 
OTN said:
The quality of radonc research coming out of ESMO this year should have been a huge wake-up call to American academic radoncs. We are falling behind, dramatically, and the pace seems to be accelerating. I'm not holding my breath.
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It won't be a wake up call.

This month I learned you can join ESTRO for really cheap. They even offer a discount for forgoing the paper journal, an option only available to physicists in ASTRO! Every society should offer this now.
 
NotMattSpraker said:
It won't be a wake up call.

This month I learned you can join ESTRO for really cheap. They even offer a discount for forgoing the paper journal, an option only available to physicists in ASTRO! Every society should offer this now.
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I will say the climate is very different. US is drug heavy while Europe pushes rt cause of cost.
 
OTN said:
The quality of radonc research coming out of ESMO this year should have been a huge wake-up call to American academic radoncs. We are falling behind, dramatically, and the pace seems to be accelerating. I'm not holding my breath.
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The key is enrollment, enrollment, enrollment. As much as I like to crap on academia in it's present form, there are national structural issues holding us back.

Even our fierce independence is a cultural hinderance to meaningful, high accrual clinical trials.

Accrual and Recruitment Practices at Clinical and Translational Science Award (CTSA) Institutions: A Call for Expectations, Expertise, and Evaluation - PMC

To respond to increased public and programmatic demand to address underenrollment of clinical translational research studies, the authors examine participant recruitment practices at Clinical and Translational Science Award sites (CTSAs) and make ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
 
interesting, was wondering if it would be in Florida or somewhere else Saturated with proton
 
radOresident said:
been hearing uab
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As long as I'm not the first to have said it -

I heard the same as well. The disclaimer being I am not at that institution and lack personal proof.

But at minimum, this is clearly the "word on the street" right now and this rumor had to start somewhere and made it this far for a reason.

I hope it's not true but...I suspect it is.
 
elementaryschooleconomics said:
As long as I'm not the first to have said it -

I heard the same as well. The disclaimer being I am not at that institution and lack personal proof.

But at minimum, this is clearly the "word on the street" right now and this rumor had to start somewhere and made it this far for a reason.

I hope it's not true but...I suspect it is.
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I thought they’ve already declared bankruptcy before? Or maybe it was just in the verge of for a whole
 
medgator said:
Rising Interest rates are a bitch when you have floating rate debt
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These places seem to be fine if you have the cash to pay in full up front.

But if you took out loans (especially floating rate) the debt servicing is just crushing them. So many things in your proforma years ago on the cost side have probably gone up as well - staff salaries, power/electricity costs (can be quite large for protons), etc.
 
BobbyHeenan said:
These places seem to be fine if you have the cash to pay in full up front.

But if you took out loans (especially floating rate) the debt servicing is just crushing them. So many things in your proforma years ago on the cost side have probably gone up as well - staff salaries, power/electricity costs (can be quite large for protons), etc.
Click to expand...

This is part of why I find our national conversation surrounding proton therapy so disingenuous and I think the average rad onc should be a lot more mad about it.

A week or two ago someone sent me an annual report from NAPT. The entire report screams there is still "lack of access". I genuinely believe their goal is a proton center in every city in America. They touted that breast cancer treatments are up and simultaneously we have investigators from Penn publishing that people should not be treating early stage breast cancer with protons. This is one of those things in medicine where we can look to our European colleagues and it just feels like what we are doing is super gross.

This is also the top reason I wont support ROCR. There are thoughtful ways to include protons, but no one is interested. It is just a bail out for these centers that are on thin ice, and the architects seemingly cant admit that to themselves.

I understand that centers closing is sad and real people get hurt, but some should not have opened in the first place. What about the x-ray centers on thin ice? It seems almost universally accepted that they will suffer and be targets for consolidation. In my opinion, far more patients are eligible to be harmed by x-rays center closing than protons closing. Also, physics, nursing, and dosimetry would all have jobs, I know a lot of people hiring all of those.

Man this is driving me nuts. Of course I am not cheering for any center to close, but we've seen example proformas, I think this is self-inflicted harm.

Rant over, happy Friday 🤣
 
I wasn't sure where to put this, but it seems like we have discussed MOC/ABR OLA on here.

I usually only do the minimum required OLA questions until June and it's been a while so I logged in to check my account. Had to make sure I wasn't made non-compliant for some unclear reason, you know, that RO paranoia... 🤣

They released their first "needs assessment" data. It covers 4/2023-10/2023 and they state they will be updating this assessment quarterly. You can download the data on the OLA FAQ page.

Per their web page:

The results are presented in quartiles: Quartile 4 represents questions that were typically answered satisfactorily, whereas Quartile 1 topics represented a challenge for the group in aggregate.
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The results are kind of interesting: "EBM", field design, modality selection seem to be our weaker areas.

Youll have to go find it yourself to look. I don't feel comfortable sharing the page or data here per their vague user agreement and... RO paranoia 😵
 
The MOC thing is such an absolute joke.

Its either random trivia questions about unrelated items (hey, do you know which immuno combo is best?) or homer simpson level questions.

NOTHING, and I mean NOTHING, has any relevance to my day to day work.

I read NCCN guidelines, theMedNet, here, and use pubmed/scihub/google research to get my edumacation as needed.

MOC is an expensive waste of my time and money. A joke. Pathetic.


NBPAS as soon as it gets in every hospital, and this MOC nonsense DIES THE NEXT DAY.
 
sirspamalot said:
The MOC thing is such an absolute joke.

Its either random trivia questions about unrelated items (hey, do you know which immuno combo is best?) or homer simpson level questions.

NOTHING, and I mean NOTHING, has any relevance to my day to day work.

I read NCCN guidelines, theMedNet, here, and use pubmed/scihub/google research to get my edumacation as needed.

MOC is an expensive waste of my time and money. A joke. Pathetic.


NBPAS as soon as it gets in every hospital, and this MOC nonsense DIES THE NEXT DAY.
Click to expand...

People should definitely ask their hospital if they can use NBPAS. There is no downside to knowing about all your options.

If hospitals have ACGME programs they are required to use ABIM though. There is no RO residency at my hospital but there are other ACGME programs, so I cant use NBPAS.
 
Tigerstang said:
UAB
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The danger signs have been there. I did a part of my training at UAB and it is a fantastic institution. That said, Alabama is a tiny state in terms of population. Furthermore, their "pull" from adjacent states is mainly from rural areas which have small populations. These folks typically have Medi-Caid equivalent insurance, not PPO/HMO. True, UAB has a big children's hospital and a Pedi Oncology program to match; however, for those that know most kids don't have great insurance either.

Unless you can drive a lot of convetionally fractionated business to you practice (35 fraction H&N, 44 fraction prostate) and are able to pull from a large national/international patient base, then it is a recipe for failure.

reorg.com

Alabama Proton Therapy Center Defaults on Bonds, Highlighting Industry’s Struggle to Find Its Footing Amid Pandemic Uncertainty, Insurance Coverage Constraints

Analyzing the Alabama Proton Therapy Center bonds, our Americas Municipals team discusses the industry’s struggle to find Its footing amid uncertainty.
reorg.com
 
Gfunk6 said:
The danger signs have been there
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I'm sure the story is complicated and I have no inside info, including on their debt status.

But, in general, as much as protons should be for low dose pediatric cases, they are really for rich people.

Alabama 49/51 for GDP per capita (including DC, which is of course, the richest municipality and home to three proton centers).
 
communitydoc13 said:
I'm sure the story is complicated and I have no inside info, including on their debt status.

But, in general, as much as protons should be for low dose pediatric cases, they are really for rich people.

Alabama 49/51 for GDP per capita (including DC, which is of course, the richest municipality and home to three proton centers).
Click to expand...
Very true. UAB has a great reputation within the medical community but not outside the medical community like Mayo, MDA, or MSK who can deliver treatments to the ultra-wealthy for whom "insurance" is a dirty word.
 
Gfunk6 said:
The danger signs have been there. I did a part of my training at UAB and it is a fantastic institution. That said, Alabama is a tiny state in terms of population. Furthermore, their "pull" from adjacent states is mainly from rural areas which have small populations. These folks typically have Medi-Caid equivalent insurance, not PPO/HMO. True, UAB has a big children's hospital and a Pedi Oncology program to match; however, for those that know most kids don't have great insurance either.

Unless you can drive a lot of convetionally fractionated business to you practice (35 fraction H&N, 44 fraction prostate) and are able to pull from a large national/international patient base, then it is a recipe for failure.

reorg.com

Alabama Proton Therapy Center Defaults on Bonds, Highlighting Industry’s Struggle to Find Its Footing Amid Pandemic Uncertainty, Insurance Coverage Constraints

Analyzing the Alabama Proton Therapy Center bonds, our Americas Municipals team discusses the industry’s struggle to find Its footing amid uncertainty.
reorg.com
Click to expand...
Sad to say but treating peds in a single vault center is a quick way to bankruptcy. Poor payor mix and slows throughput with anesthesia considerations.
 
Gfunk6 said:
Very true. UAB has a great reputation within the medical community but not outside the medical community like Mayo, MDA, or MSK who can deliver treatments to the ultra-wealthy for whom "insurance" is a dirty word.
Click to expand...

A little bit of a $150M marketing budget goes a long way
 
A_DeMichele said:
I'm not sure if I'd do 39-45 fx to the prostate with capitated payments.... I think 70 / 28fx is pretty close to a sweet spot
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It's not (and never has been) about the money for me - with capitated I would still offer conventional. Same with offering 30/10 for complex bone mets in metastatic patients not approaching hospice.
 
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