Radiation Oncology is not the best field in medicine.

[deleted950463]

I agree with you. two things to point out though:
1. In the 90's numerous programs/spots were eliminated largely due to increasing ACGME requirements so there is precedent that the concept at least has some chance of being effective
2. A much more pragmatic/even handed approach to the issue of "it shouldn't be me that has to reduce spots" would be this:
if you have 8-14 total spots you give up 2 (one every other year). If you have 16+ spots you give up 4 (one every year). This would have the net effect of decrease spots by about 40 per year across the country which would be reasonable. Although, no one has the power to just make this sort of blanket declaration (or some variation of it) and execute it...thus we are left with less direct strategies like increasing ACGME requirements.

So you are saying places like MDA or Sloan with huge resident compliments should cut slots while podunk U or community radonc with 1 resident a year doesn’t? Shouldn’t it be the other way around?

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[Old rad onc]

Yes, we run very lean. We have been hypofractionating everything for years before ASTRO guidelines came out. There is less pressure to churn when you own the machines and can access technical fees. We will hire more RO MDs in future but this is due to geographic expansion.

And thus begins our end game. It will be very complex as it will pit private practice vs universities, Insurance companies against hospitals, Med Onc’s, surgeons, and Rad Oncs against each other by specialties and groups. The Bundled payment will get extremely complicated as he who controls the payment wins.... period.

Oncology is far and away the most complicated field in medicine to bundle.... bar none as it also involves pathology, radiology, and all oncology fields including subspecialists ( urology, ENT, GYN, CT surgeons, GI, Neurosurg, and more) but will be tried because of the possible savings involved. I believe insurance companies have the upper hand ( Kaiser, WellPoint, etc) followed by hospitals, and next Med Onc’s. Surgeons and Rad Oncs will be weaker so alliances are important . Few practices are buying new equipment( unless you have a foundation) and hiring is getting cautious.

Why do you think Walmart, Berkshire Hathaway, Amazon, Big Banks( JP Morgan) are all trying to get involved with HealthCare? Trump added a trillion dollars to defense and is looking where he can save money.... Medicare is the obvious target! That is also why McKesson bought US Oncology and Vantage. To ensure it’s own survival of supply chain.

Patrick Soon-Shiong of biotech and pharmacy fame has now bought 6 hospitals in both northern and Southern California . His focus is cancer.....

The big centers: MDA, MSK, Penn, Ohio St, City of Hope, USC and a few others negotiated a sweetheart deal to get paid about 3x more than anyone else

I used to do a lot of permanent seed prostate brachytherapy. It was great with regards to cost , complications and effectiveness. But it died years ago because Medicare stopped paying for seeds and it is little used except in a few places( Seattle....)

The bundled payment if it happens will bring insanity to our field especially if it is manditory. All private practices will be forced to join big groups, hospitals or insurances. Good night to all our autonomy.

The only good thing I see is that oncology is so complex, that bundling will take a few years to actually work, but I don’t believe it will stop the momentum from the government from trying. Just as current Academics don’t care much about the future problems of our young cub rad Onc’s or private practice; they will be more concerned about saving their own necks than they will saving our field. But,meantime we have little hope but to rely on them to give us some voice at the table. To use the Star Wars analogy, we are the rebel fleet as the Death Star approaches . May the rag tag Crew of SDN continue to fight for what is fair and ultimately good for our patients which also our best hope! May the Force be with us all

 

[Haybrant]

And thus begins our end game. It will be very complex as it will pit private practice vs universities, Insurance companies against hospitals, Med Onc’s, surgeons, and Rad Oncs against each other by specialties and groups. The Bundled payment will get extremely complicated as he who controls the payment wins.... period.

Oncology is far and away the most complicated field in medicine to bundle.... bar none as it also involves pathology, radiology, and all oncology fields including subspecialists ( urology, ENT, GYN, CT surgeons, GI, Neurosurg, and more) but will be tried because of the possible savings involved. I believe insurance companies have the upper hand ( Kaiser, WellPoint, etc) followed by hospitals, and next Med Onc’s. Surgeons and Rad Oncs will be weaker so alliances are important . Few practices are buying new equipment( unless you have a foundation) and hiring is getting cautious.

Why do you think Walmart, Berkshire Hathaway, Amazon, Big Banks( JP Morgan) are all trying to get involved with HealthCare? Trump added a trillion dollars to defense and is looking where he can save money.... Medicare is the obvious target! That is also why McKesson bought US Oncology and Vantage. To ensure it’s own survival of supply chain.

Patrick Soon-Shiong of biotech and pharmacy fame has now bought 6 hospitals in both northern and Southern California . His focus is cancer.....

The big centers: MDA, MSK, Penn, Ohio St, City of Hope, USC and a few others negotiated a sweetheart deal to get paid about 3x more than anyone else

I used to do a lot of permanent seed prostate brachytherapy. It was great with regards to cost , complications and effectiveness. But it died years ago because Medicare stopped paying for seeds and it is little used except in a few places( Seattle....)

The bundled payment if it happens will bring insanity to our field especially if it is manditory. All private practices will be forced to join big groups, hospitals or insurances. Good night to all our autonomy.

The only good thing I see is that oncology is so complex, that bundling will take a few years to actually work, but I don’t believe it will stop the momentum from the government from trying. Just as current Academics don’t care much about the future problems of our young cub rad Onc’s or private practice; they will be more concerned about saving their own necks than they will saving our field. But,meantime we have little hope but to rely on them to give us some voice at the table. To use the Star Wars analogy, we are the rebel fleet as the Death Star approaches . May the rag tag Crew of SDN continue to fight for what is fair and ultimately good for our patients which also our best hope! May the Force be with us all

Can you expand more on why Walmart, Berkshire, Amazon are gung go to get into healthcare if Medicare is the obvious target?

 

[medgator]

Can you expand more on why Walmart, Berkshire, Amazon are gung go to get into healthcare if Medicare is the obvious target?

Buffett has referred to the increasing GDP spent on healthcare each year as the "tapeworm" on the US economy. If anything, Medicare and the new conglomerate headed by Dr Atul Gawande are targeting the same thing...excess (ideally unnecessary) costs

 

[Old rad onc]

Can you expand more on why Walmart, Berkshire, Amazon are gung go to get into healthcare if Medicare is the obvious target?

It’s about control and of course money. What drives health care ultimately is who can provide quality healthcare at an affordable price. Those that have conquered all want a crack at the greatest mystery of all. Canada only has worked because the under class their is small and US is the back up for those that cannot wait. If you want to see what awaits us if single payer ever wins, then look no further than the UK where wait times for cancer is 6months and doctors are fleeing like rats on a sinking ship.....

 

[Ray D. Ayshun]

It’s about control and of course money. What drives health care ultimately is who can provide quality healthcare at an affordable price. Those that have conquered all want a crack at the greatest mystery of all. Canada only has worked because the under class their is small and US is the back up for those that cannot wait. If you want to see what awaits us if single payer ever wins, then look no further than the UK where wait times for cancer is 6months and doctors are fleeing like rats on a sinking ship.....

6 month wait time? Who's your source, Sean Hannity?

 

[Old rad onc]

6 month wait time? Who's your source, Sean Hannity?

Cancer patient waited 541 days for NHS treatment, report says

Here you go. Not Sean Hannity. No need to be hostile!

 

[Ray D. Ayshun]

Cancer patient waited 541 days for NHS treatment, report says

Here you go. Not Sean Hannity. No need to be hostile!

Hostile? Not really. Though i think it might be warranted as there are data out there regarding this very subject, but you’ve opted to focus on an outlier that supports your argument. This happens in the US, too.

 

[Old rad onc]

Hostile? Not really. Though i think it might be warranted as there are data out there regarding this very subject, but you’ve opted to focus on an outlier that supports your argument. This happens in the US, too.

Ok 6 months is an outlier, but over 26,000 waited over 2 months, and over 10,000 waited over 3 months and the data shows its getting worse every year. That coupled with the fact that many doctors are leaving the UK will likely make things worse.

Thousands of new doctors opting for a better life abroad

If you have other data for reason that UK NHS will be doing better I would love to see it!

 

[medgator]

Hostile? Not really. Though i think it might be warranted as there are data out there regarding this very subject, but you’ve opted to focus on an outlier that supports your argument. This happens in the US, too.

Ummm, the wait under the public system in Canada got so atrocious they actually subcontracted out to the private sector. As per my link below, this was occurring well over a decade ago. You can't change basic human nature and behavior.

Hopefully the nyt isn't too right wing for you: Canada's Private Clinics Surge as Public System Falters

 

[Ray D. Ayshun]

If youll notice, ive not made an assertion beyond saying 6 months is not the wait time for cancer treatment in the uk. I dont really give a **** what type of medical system we have as long as people get the care they need, and its sustainable. Had old rad onc originally posted what he just posted, id happily read and refrain from commenting, but his 6 month wait list assertion reeks of right wing hyperbole, which i am inundated with where I live. It’s disingenuous at best. I recognize the shortcomings of nationalized healthcare, and have plenty of experience with the shortcomings of our system. Neither is perfect, but misrepresenting reality bothers me.

 

[Gfunk6]

It is really quite simple. We can continue on our current course and bankrupt the economy or we can contain costs (either via death panels/CMS negotiating prices of services or quality masked as cost containment). Either will be exceedingly painful but, as always, there will be leaders and entrepreneurs who emerge. These men and women will embrace the change, prepare for it, and prosper despite it. The majority will be dragged kicking and screaming into the future.

The only way for physician autonomy to survive is for MDs to merge and form mega-groups that are philosophically aligned. The irony is that such groups will eventually evolve into entities like Kaiser or very large hospital foundations which have a far more corporate culture than the private practice groups from which they evolve.

 

[Old rad onc]

If youll notice, ive not made an assertion beyond saying 6 months is not the wait time for cancer treatment in the uk. I dont really give a **** what type of medical system we have as long as people get the care they need, and its sustainable. Had old rad onc originally posted what he just posted, id happily read and refrain from commenting, but his 6 month wait list assertion reeks of right wing hyperbole, which i am inundated with where I live. It’s disingenuous at best. I recognize the shortcomings of nationalized healthcare, and have plenty of experience with the shortcomings of our system. Neither is perfect, but misrepresenting reality bothers me.

You previously stated that hostility might be warranted as there are ( should be is) data out there showing what exactly? Shorter wait times in the UK and Canada? Let’s see your data? I am expressing a view and your misrepresentation bothers me. I do not care for Sean Hannity so insulting me with that is ignorant and offensive. As for not giving a ****** what medical system we have, you left out how it will be paid for , how we get paid , and the current system will not be sustainable. So get off your high left wing horse...... for your info I’m a moderate..... not right wing.

 

[Ray D. Ayshun]

You previously stated that hostility might be warranted as there are ( should be is) data out there showing what exactly? Shorter wait times in the UK and Canada? Let’s see your data? I am expressing a view and your misrepresentation bothers me. I do not care for Sean Hannity so insulting me with that is ignorant and offensive. As for not giving a ****** what medical system we have, you left out how it will be paid for , how we get paid , and the current system will not be sustainable. So get off your high left wing horse...... for your info I’m a moderate..... not right wing.

You: it takes 6 months to get cancer care in the uk

Me: no it doesn’t

You: in a minority of patients it takes more than 2, so dont tell me that the uk/canadian system is better than the us system, especially if you cant tell me how to pay for it

 

[Old rad onc]

You: it takes 6 months to get cancer care in the uk

Me: no it doesn’t

You: in a minority of patients it takes more than 2, so dont tell me that the uk/canadian system is better than the us system, especially if you cant tell me how to pay for it

You:

You: it takes 6 months to get cancer care in the uk

Me: no it doesn’t

You: in a minority of patients it takes more than 2, so dont tell me that the uk/canadian system is better than the us system, especially if you cant tell me how to pay for it

Still waiting for your data which you stated are so it means you have multiple sources....... ok so show it or just state you have none

 

[Ray D. Ayshun]

You:


Still waiting for your data which you stated are so it means you have multiple sources....... ok so show it or just state you have none

Im sorry, what am i missing? You provided links to the data re wait times in the uk, which are not 6 months. What is it you think im arguing?

 

[Old rad onc]

If youll notice, ive not made an assertion beyond saying 6 months is not the wait time for cancer treatment in the uk. I dont really give a **** what type of medical system we have as long as people get the care they need, and its sustainable. Had old rad onc originally posted what he just posted, id happily read and refrain from commenting, but his 6 month wait list assertion reeks of right wing hyperbole, which i am inundated with where I live. It’s disingenuous at best. I recognize the shortcomings of nationalized healthcare, and have plenty of experience with the shortcomings of our system. Neither is perfect, but misrepresenting reality bothers me.

Ok you did make an assertion that my data was from Sean Hannity . My assertion was that wait times in Canada and UK were long. Too long. I stated some wait as long as 6 mos. I corrected with the article. 2-3 months or more is too long In my opinion.

You:also asserting my long wait list reeks of right wing hyperbole and disingenuous at best

My original point was that big business is getting involved to help solve healthcare costs and shortcomings. My true assertion is that looking to Canada and the UK will not be of much help....

End. Happy Thanksgiving Everybody....

 

[Old rad onc]

Im sorry, what am i missing? You provided links to the data re wait times in the uk, which are not 6 months. What is it you think im arguing?

What you are missing is civility. The original article and many others have shown incredibly long wait times. I did show wait times for some longer than 6 months.

Your baseless left wing attacks are what I have objected to. I am not right wing so I find your comments and attacks offensive.

 

[OTN]

Stage-for-stage, cancer patients in the US have better survival than those in the NHS. Google it.

If you’re going to wade into the healthcare political debate as an oncologist, it’s important to know that fact.

 

[medgator]

Stage-for-stage, cancer patients in the US have better survival than those in the NHS. Google it.

If you’re going to wade into the healthcare political debate as an oncologist, it’s important to know that fact.

EU vs US Cancer Care: You Get What You Pay For

 

[scarbrtj]

US breast patients would still be getting ~6 weeks of XRT were it not for Canada. We probably never would've had hypofractionation in the US were it not for Canada and the UK. (Recall the days when US academics rejected non-US trials and data?) Hypofractionation is superior. So at least some medical care in the UK and Canada must be superior too! Necessity is the mother of invention. Ironically those long wait times gave rise to superior medical care, one might say.

 

[medgator]

US breast patients would still be getting ~6 weeks of XRT were it not for Canada. We probably never would've had hypofractionation in the US were it not for Canada and the UK. (Recall the days when US academics rejected non-US trials and data?) Hypofractionation is superior. So at least some medical care in the UK and Canada must be superior too! Necessity is the mother of invention. Ironically those long wait times gave rise to superior medical care, one might say.

Hypofx won't make up for getting delayed access to systemic therapies based on what the NICE feels is medically appropriate and the data seems to bear that out

 

[OTN]

US breast patients would still be getting ~6 weeks of XRT were it not for Canada. We probably never would've had hypofractionation in the US were it not for Canada and the UK. (Recall the days when US academics rejected non-US trials and data?) Hypofractionation is superior. So at least some medical care in the UK and Canada must be superior too! Necessity is the mother of invention. Ironically those long wait times gave rise to superior medical care, one might say.

Except the data shows that, overall, cancer outcomes are worse.

 

[Ray D. Ayshun]

Stage-for-stage, cancer patients in the US have better survival than those in the NHS. Google it.

If you’re going to wade into the healthcare political debate as an oncologist, it’s important to know that fact.

Yes. Not sure if its me youre responding to, but if so, as i continue to repeat, i have said nothing about the relative quality of one medical system vs the other, only that the average wait time is not 6 months in the uk, which is a gross misrepresentation. Is it known what it is in the us, or even how to compare? I’ve seen plenty of patients 3 months after the first mammographic abnormality was noted as they wended their way through the system, as I suspect many have.

With regard to your point, perhaps there’s way more gs 6 prostate cancer found in the us, which never really needed to be found.

 

[RadOncDoc21]

Sometimes I feel like our field has taught us too well how to argue for argument sake.

Maybe the expansion of residency programs has indirectly created a pool of weekend lawyers.

I’m not criticizing anyone (because I do it a lot) just making an observation.

 

[Ray D. Ayshun]

Sometimes I feel like our field has taught us too well how to argue for argument sake.

Maybe the expansion of residency programs has indirectly created a pool of weekend lawyers.

I’m not criticizing anyone (because I do it a lot) just making an observation.

Perhaps the poorly conceived and controlled, multi-armed, pre-expansion clinical trials that have turned chart rounds into mental masturbation has selected for people who like to talk about nothing...

 

[evilbooyaa]

Yes. Not sure if its me youre responding to, but if so, as i continue to repeat, i have said nothing about the relative quality of one medical system vs the other, only that the average wait time is not 6 months in the uk, which is a gross misrepresentation. Is it known what it is in the us, or even how to compare? I’ve seen plenty of patients 3 months after the first mammographic abnormality was noted as they wended their way through the system, as I suspect many have.

With regard to your point, perhaps there’s way more gs 6 prostate cancer found in the us, which never really needed to be found.

OK dude, we get it. Not all UK cancer patients wait 6 months. You win on that point that nobody is arguing any further. A significant number of them wait over 2 months for cancer treatment, which by itself is unreasonable to me.

 

[Ray D. Ayshun]

OK dude, we get it. Not all UK cancer patients wait 6 months. You win on that point that nobody is arguing any further. A significant number of them wait over 2 months for cancer treatment, which by itself is unreasonable to me.

Look, i wasnt trying to be a jerk, but if someones going to casually throw around false data, they should be called out. I agree, 2 months is too long, but it happens here as well. Our data is not as concrete, but I saw a relatively recent asco story that suggested the median wait time here is 29 days, or more by now. This may not be an apples to apples comparison, but as treatment starts in 80-90% of patients by 62 days in the uk system, it doesn’t seem like the median start time would substantially differ, though, sure, it could. I didn’t start this uk vs us comparison, and this is hardly the appropriate thread, but I’d prefer it be an honest discussion.

 

[deleted950463]

Look, i wasnt trying to be a jerk, but if someones going to casually throw around false data, they should be called out. I agree, 2 months is too long, but it happens here as well. Our data is not as concrete, but I saw a relatively recent asco story that suggested the median wait time here is 29 days, or more by now. This may not be an apples to apples comparison, but as treatment starts in 80-90% of patients by 62 days in the uk system, it doesn’t seem like the median start time would substantially differ, though, sure, it could. I didn’t start this uk vs us comparison, and this is hardly the appropriate thread, but I’d prefer it be an honest discussion.

Do you have literatures to back what you are saying up?

 

[Old rad onc]

Look, i wasnt trying to be a jerk, but if someones going to casually throw around false data, they should be called out. I agree, 2 months is too long, but it happens here as well. Our data is not as concrete, but I saw a relatively recent asco story that suggested the median wait time here is 29 days, or more by now. This may not be an apples to apples comparison, but as treatment starts in 80-90% of patients by 62 days in the uk system, it doesn’t seem like the median start time would substantially differ, though, sure, it could. I didn’t start this uk vs us comparison, and this is hardly the appropriate thread, but I’d prefer it be an honest discussion.

Here is the official site for wait times from cancer uk research:

Cancer waiting times | Cancer in general | Cancer Research UK

It states that all these wait times are for a diagnosis of 28 days from a referral to find out if they have cancer in England only ( Wales, Scotland and Northern Ireland have not set these targets) and will not require showing hospitals are meeting this target until April 2020. Hospitals don’t have to start collecting this information on diagnosis of 28 days until after April 2019.

There are categories in the above for all the different things you have to wait for which includes: 2 weeks for an Urgent consult to a Specialist for suspected cancer in England, 2 weeks only if you have Breast cancer in Northern Ireland, no time limit in Scotland or Wales.

Then other paragraphs are for waiting for tests, followed by a paragraph for waiting for scan results. It usually takes a couple weeks for scan results but it might be sooner than that if the specialist marks urgent on the form.

By the way, the 28 day Faster Diagnosis Standard only applys in England if you have Breast Cancer,bowel cancer, or cervical screening.

As far as waiting times to start treatment:

• no more than 2 months (62 days) wait between the date the hospital receives an urgent referral for suspected cancer and the start of treatment
• no more than 31 days wait between the meeting at which you and your doctor agree the treatment plan and the start of treatment

You might have to wait longer if you need extra tests to fully diagnose the cancer. Waiting times can vary depending on the type of cancer and the type of treatment you are going to have.

I can assure you most patients in the US with GBM, lung, head and neck, melanoma, and sarcoma would not be happy with this. Remember these waits won’t be enforced in England until April 2020, and not outside of England at all.

 

[lemmiwiinks]

Concord 3 study Lancet- no difference in cancer survival between us and canada.

 

[medgator]

Concord 3 study Lancet- no difference in cancer survival between us and canada.

Canada =/= UK. There is parallel private system in Canada, actually encouraged/utilized by the govt there to get care delivered faster in some cases.

previous post:

Canada's Private Clinics Surge as Public System Falters

 

[Fpg1245]

When it comes to national healthcare and cancer, regardless of the noninferity studies they churn out, as a physician I wouldn’t want any part of it. I’d Pick something else or get out entirely. To me it just means do less with less. As for the UK or Canada, neither systems seems to have a particularly robust role for Rad Onc. Plenty of Canadian ROs spinning their wheels in fellowships in North America just chomping at the bit to get back home. A soorry state. As for the UK, pretty sure the oncologists there would like nothing more than to never have to radiate another person again. They equate convincing a patient to undergo RT with a used car salesman selling a clunker to an unsuspecting customer. Not a terribly high opinion. The shear expense of oncology and the stress it puts on these systems puts oncologists in an unusually awkward position. The US is headed this way for sure. After 2020, I hope the majority of ROs love additional training because they’re won’t be much need for them in the clinic.

 

[RO2019]

After 2020, I hope the majority of ROs love additional training because they’re won’t be much need for them in the clinic.

This is the kind of stuff that reflects poorly on this forum.

 

[RickyScott]

When it comes to national healthcare and cancer, regardless of the noninferity studies they churn out, as a physician I wouldn’t want any part of it. I’d Pick something else or get out entirely. To me it just means do less with less. As for the UK or Canada, neither systems seems to have a particularly robust role for Rad Onc. Plenty of Canadian ROs spinning their wheels in fellowships in North America just chomping at the bit to get back home. A soorry state. As for the UK, pretty sure the oncologists there would like nothing more than to never have to radiate another person again. They equate convincing a patient to undergo RT with a used car salesman selling a clunker to an unsuspecting customer. Not a terribly high opinion. The shear expense of oncology and the stress it puts on these systems puts oncologists in an unusually awkward position. The US is headed this way for sure. After 2020, I hope the majority of ROs love additional training because they’re won’t be much need for them in the clinic.

Radiation is actually very cost efficient when utilized appropriately and (detached from unreasonable US prices). In terms of the future, I seriously doubt we will have a national health care system, but there will undoubtedly be increased hospital consolidation and probably some form of a single payor at some point. Either way, there will be a need for less radoncs and linacs in an environment where you ultimately have fewer but larger centers.

BTW: in the UK, a clinical oncologist is trained in both radiation and medical oncology. In Canada, the problem, I understand is that there is competition for the few desirable cities and no one wants to work in Edmonton or Saskatoon.

 

[radiaterMike]

BTW: in the UK, a clinical oncologist is trained in both radiation and medical oncology.

clinical oncologists can give chemotherapy, but medical oncologists in the UK are trained as a separate specialty.

 

[Fpg1245]

Radiation is actually very cost efficient when utilized appropriately and (detached from unreasonable US prices). In terms of the future, I seriously doubt we will have a national health care system, but there will undoubtedly be increased hospital consolidation and probably some form of a single payor at some point. Either way, there will be a need for less radoncs and linacs in an environment where you ultimately have fewer but larger centers.

BTW: in the UK, a clinical oncologist is trained in both radiation and medical oncology. In Canada, the problem, I understand is that there is competition for the few desirable cities and no one wants to work in Edmonton or Saskatoon.

Right, like how most ROs probably don’t want to work in Nebraska or South Dakota. In Canada like the US, they are probably training too many as well. Good luck getting med oncs to cede the “priviliage” of giving systemic agents to Rad Onc without making a 5 year ordeal out of it on top of whatever you need to be considered a competant radiation oncologist.

 

[Phantom1]

When it comes to national healthcare and cancer, regardless of the noninferity studies they churn out, as a physician I wouldn’t want any part of it. I’d Pick something else or get out entirely. To me it just means do less with less. As for the UK or Canada, neither systems seems to have a particularly robust role for Rad Onc. Plenty of Canadian ROs spinning their wheels in fellowships in North America just chomping at the bit to get back home. A soorry state. As for the UK, pretty sure the oncologists there would like nothing more than to never have to radiate another person again. They equate convincing a patient to undergo RT with a used car salesman selling a clunker to an unsuspecting customer. Not a terribly high opinion. The shear expense of oncology and the stress it puts on these systems puts oncologists in an unusually awkward position. The US is headed this way for sure. After 2020, I hope the majority of ROs love additional training because they’re won’t be much need for them in the clinic.

I hope for your sake that some idiot took over your account for a day. You have no clue what you are talking about and your post shows that you dont know much at all about oncology or management of cancer patients. Good luck with your career, with that attitude I feel for your patients..

I bet your a med onc who takes a curable patient and strings them along with chemotherapies alone for a year or two until they met out..

Mods do you allow this ridiculous trolling of this forum??

 

[Neuronix]

Mods do you allow this ridiculous trolling of this forum??

We allow you to respond. We do not censor opinions, even if they are unpopular. The crowd can click the like button or rebut whatever they like.

In my opinion the job market is over-saturated and worsening every year. There is a growing supply of residents while demand for radiation oncologists is flat (this was shown by Ben Smith's updated paper).

Canada already has this problem. I've been told by a Canadian grad that there are years when there is no permanent employment in the entire country for their graduating residents. They can either go part-time, locums, or do at least one fellowship while they wait for a job to open up.

But let's not overstate it. The specialty is not going to collapse in two years. I think that's just crazy talk. Also, I know UK rad oncs (clinical oncologists) and they do not hate their specialty or radiation therapy.

 

[deleted18755]

We allow you to respond. We do not censor opinions, even if they are unpopular. The crowd can click the like button or rebut whatever they like.

In my opinion the job market is over-saturated and worsening every year. There is a growing supply of residents while demand for radiation oncologists is flat (this was shown by Ben Smith's updated paper).

Canada already has this problem. I've been told by a Canadian grad that there are years when there is no permanent employment in the entire country for their graduating residents. They can either go part-time, locums, or do at least one fellowship while they wait for a job to open up.

But let's not overstate it. The specialty is not going to collapse in two years. I think that's just crazy talk. Also, I know UK rad oncs (clinical oncologists) and they do not hate their specialty or radiation therapy.

I agree with Neuronix 110%. My wife and I are first/second generation Indians with many doctors in our family in Canada (Toronto and middle of nowhere), the UK (England and elsewhere) and for what it’s worth Australia, Singapore, and of course India. There are problems everywhere but please quit the hyperbole since I bet a lot of people who visit this forum can’t tell objective fact from hyperbole.

I highly doubted that clinical oncologists hate the RT aspect of their job over systemic therapies but was honestly curious if they even slightly preferred one over the other so I texted an “uncle” or two who have been clinical oncologists for decades in the UK and he laughed (except with regards to lymphomas ... everybody favors systemic therapies over RT these days).

Please quit the nonsense (but again realize that even my post above is a random guy on the internet who is giving secind hand information about what his dad’s cousin’s husband in a practice two hours outside of London said in a text!)

 

[Fpg1245]

I hope for your sake that some idiot took over your account for a day. You have no clue what you are talking about and your post shows that you dont know much at all about oncology or management of cancer patients. Good luck with your career, with that attitude I feel for your patients..

I bet your a med onc who takes a curable patient and strings them along with chemotherapies alone for a year or two until they met out..

Mods do you allow this ridiculous trolling of this forum??

Getting all that vitriol out of you is probably therapeutic. Keep it coming. At the end of the day, Med Onc has the pharma backing, govt grants, and the intellectual capital to turn out the lights in RO. Right or wrong. Any nobel prizes in physiology/medicine doled out to Rad bio last 15 years?

Just to be clear, Rad Onc will not collapse in 2 years just like Nuc Med or Pathology didn’t immediate collapse. It’s the slow steady decline marked by neglect, outside technological advancement, and changing payment models that is what will ultimately bring it down. Nobody wants a collapse on their hands neither the providers nor the govt financiers.

Also, if Rad Onc was as cost effective as the people in this forum claim wouldn’t it be marked by an uptick in RO utilization relative to chemo utilization? Wouldn’t socialized systems like the NHS and Medicare in Canada and Australia which presumably are always looking for ways to save the taxpayer money be much more interested in what RO has to offer? It doesn’t seem to be working that way probably because Radiation is not
An adequate substitute for chemo. I’d love to see data to contrary. As far as I know AUS and CA have this issue precisely because RO is viewed as the first place to start cutting back with no unexpected increase adverse events within a predefined margin of error of course.

 

[deleted18755]

Getting all that vitriol out of you is probably therapeutic. Keep it coming. At the end of the day, Med Onc has the pharma backing, govt grants, and the intellectual capital to turn out the lights in RO. Right or wrong. Any nobel prizes in physiology/medicine doled out to Rad bio last 15 years?

Just to be clear, Rad Onc will not collapse in 2 years just like Nuc Med or Pathology didn’t immediate collapse. It’s the slow steady decline marked by neglect, outside technological advancement, and changing payment models that is what will ultimately bring it down. Nobody wants a collapse on their hands neither the providers nor the govt financiers.

Also, if Rad Onc was as cost effective as the people in this forum claim wouldn’t it be marked by an uptick in RO utilization relative to chemo utilization? Wouldn’t socialized systems like the NHS and Medicare in Canada and Australia which presumably are always looking for ways to save the taxpayer money be much more interested in what RO has to offer? It doesn’t seem to be working that way probably because Radiation is not
An adequate substitute for chemo. I’d love to see data to contrary. As far as I know AUS and CA have this issue precisely because RO is viewed as the first place to start cutting back with no unexpected increase adverse events within a predefined margin of error of course.

I actually agree with much/most of everything you posted above. I just ask everybody to not use hyperbole or exaggerations that may be obvious to those of us doing this for awhile but unclear to others who may view this forum.

 

[medgator]

. At the end of the day, Med Onc has the pharma backing, govt grants, and the intellectual capital to turn out the lights in RO.

Everyone heard this thinking in the 70s, 80s and 90s. And still, here we are.

Maybe now they'll finally discover the PD-L1 inhibitor to cure early stage glottic/lung/skin/anal cancer! That's the ticket.

. After 2020, I hope the majority of ROs love additional training because they’re won’t be much need for them in the clinic.

When you make statements like the above and what you said before, you become like the boy that cried wolf and erode your credibility in this forum

 

[Phantom1]

Getting all that vitriol out of you is probably therapeutic. Keep it coming. At the end of the day, Med Onc has the pharma backing, govt grants, and the intellectual capital to turn out the lights in RO. Right or wrong. Any nobel prizes in physiology/medicine doled out to Rad bio last 15 years?

Just to be clear, Rad Onc will not collapse in 2 years just like Nuc Med or Pathology didn’t immediate collapse. It’s the slow steady decline marked by neglect, outside technological advancement, and changing payment models that is what will ultimately bring it down. Nobody wants a collapse on their hands neither the providers nor the govt financiers.

Also, if Rad Onc was as cost effective as the people in this forum claim wouldn’t it be marked by an uptick in RO utilization relative to chemo utilization? Wouldn’t socialized systems like the NHS and Medicare in Canada and Australia which presumably are always looking for ways to save the taxpayer money be much more interested in what RO has to offer? It doesn’t seem to be working that way probably because Radiation is not
An adequate substitute for chemo. I’d love to see data to contrary. As far as I know AUS and CA have this issue precisely because RO is viewed as the first place to start cutting back with no unexpected increase adverse events within a predefined margin of error of course.

I dont have vitriol. I’m just stating that you have no clue what you are talking about. How about this, why dont you list the solid malignancies that are cured with chemotherapy alone?

I doubt you know much about it at all, in fact I doubt you are an oncologist because you clearly have no idea what an integral part radiation therapy plays in curing the most common malignancies: ie Prostate, Breast, Lung, Colorectal, etc. So go ahead and list the cancer types which are treated definitively with curative intent using chemotherapy alone. Or I’ll make it a little easier for you, how about any systemic therapy alone, including targeted therapies.. looking forward to your answer..

 

[scarbrtj]

So go ahead and list the cancer types which are treated definitively with curative intent using chemotherapy alone. Or I’ll make it a little easier for you, how about any systemic therapy alone, including targeted therapies.. looking forward to your answer.

Of course there is an exception to every rule, especially in medicine. Chemo cures teeny, tiny solid tumors all the time or adjuvant chemo couldn't work (ie cure micrometastatic disease) in lung, breast, colorectal, etc. Systemic, targeted therapies are curing patients, just way too rarely (although herceptin has made it way more common in Stage IV breast overall, e.g.). Theoretically, since there is more cure of Stage IV solid tumors nowadays than there was 10 or 20 or 30 years ago, the trend line will keep on its current trajectory. Moore's law and all.

 

[RickyScott]

Just wanted to throw something out there: A significant portion of residency expansion (as well as inordinate prices) originates from health systems with proton centers. Thought really should be given to a vocal advocacy campaign within the specialty against reimbursement for protons. The Proton-radiation complex and their overexpanded residency programs are a source of many of the ills in this specialty. The high prices at these centers and their satellites, puts the entire field in the crosshairs.

Why should medicare/insurance pay for protons in all but exceptional cases? We all know common cancers such as prostate and lung will likely have worse/at most equal toxicities despite invasive manuvers like rectal balloons and spacers. These centers should secure their own funding for registry trials and treatments, not sink the field with them. At the end of the day, even if you work for such a center, your long term interests and the public good are not aligned with these complexes and the ASTRO leadership who support them. A campaign against proton reimbursement will target much of what is harming the field,including residency expansion.

 

[evilbooyaa]

Everyone heard this thinking in the 70s, 80s and 90s. And still, here we are.

Maybe now they'll finally discover the PD-L1 inhibitor to cure early stage glottic/lung/skin/anal cancer! That's the ticket.


When you make statements like the above and what you said before, you become like the boy that cried wolf and erode your credibility in this forum

I won't pile on fpg further, but this is the general principle I agree with. The answers from the FAQ have not largely changed, even all these years later.

The concept of 'turning the lights out' on our field is laughable.

There's two separate issues here: the job market, and elimination of radiation oncology as a utilized specialty of medicine. Everyone knows my stance on the former, and the latter I don't see decreased consults for radiation (outside of the number of fractions that are treated as many academics are evaluating hypofractionation for everything under the sun)

 

[w00tz]

both clin oncs (CO) and med oncs (MO) do 2 years of 'foundation training' (?internship) followed by 2 years of 'core medical training' (?residency).
following this MO will do 4 years of 'speciality training' (?fellowship), whereas CO will do 5 years.

almost all MO will do a 2-3 year research degree (PhD usually) at some point during training, whereas about half of CO will do one.

CO generally arent exposed to systemic therapy for melanomas or RCCs, or high dose chemo (HD-MTX, etc). also in the UK all haem onc systemic therapy is done by haematologists and all paediatric systemic therapy is done by paediatricians.

in most smaller centres the CO will do both the RT and most of the chemo, and 1-2 MO will cover whats left.
in larger centres however there will be a near equal split, and the MO will give the chemo and the CO will focus on RT / concurrent chemoRT.

most new patients / referrals are sent to clinic following an MDT meeting (?tumour board), where CO and MO (+surgeons, path, radiol, etc) will be present, and most clinics are run with CO / MO together so its easy to divvy up patients appropriately.

Interesting...

Thoughts on the statement below?

As for the UK, pretty sure the oncologists there would like nothing more than to never have to radiate another person again. They equate convincing a patient to undergo RT with a used car salesman selling a clunker to an unsuspecting customer. Not a terribly high opinion.

 

[nkmiami]

Interesting...

Thoughts on the statement below?

Med school+college is 6 years overseas so first 2 years of foundation training are like our 3/4th year of med school

 

[radiation]

Gold medal winner Ralph Weichselbaum talking about ASTRO