Ridiculous Moments in Rad Onc History

[TheWallnerus]

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I'm not interested in repeating that ridiculous bit of rad onc history.

What have been the ridiculous moments in rad onc history. The SDN Google Doc thing certainly was, but not a biggie. Also blood bath in the red journal. Maybe ASTRO president’s employer trying to get other rad oncs fired or ASTRO legally threatening people over memes.

But I think the biggies have been
1) unchecked residency expansion
2) protons/neutrons/heavy ion expansion/spending without data
3) APM and ROCR, legislative fronts in general (think: trying to make supervision happen)
4) consolidation and loss of robust private practice rad onc (prob present in many specialties though)

What are yours

 

[Mandelin Rain]

Failing more than a quarter of residents based on faulty methodology and then doubling down by calling them stupid.

 

[TheWallnerus]

Failing more than a quarter of residents based on faulty methodology and then doubling down by calling them stupid.

That was a doozy

 

[metallica81788]

Failing more than a quarter of residents based on faulty methodology and then doubling down by calling them stupid.

Will never forget personally being in the room for that (as one of the members of that resident class)

 

[winstonfoot5]

In hindsight, I think the anti-urorads campaign was massively detrimental to the field

 

[winstonfoot5]

Some recency bias here... but the academic chairs (SCAROP) openly wage-fixing faculty compensation. Totally un-American and, to the proposed prompt, a "ridiculous" moment

 

[RadOncDoc21]

How there was once a time when having a MD/PhD mattered in regards to being competitive in the field.

 

[winstonfoot5]

This is too easy. How about the 1998 ASTRO split from American College of Radiology. Followed by hiring a career administrator CEO with no rad onc experience... for the next 22 years.

 

[winstonfoot5]

"ridiculous"

 

[medgator]

In hindsight, I think the anti-urorads campaign was massively detrimental to the field

💯💯💯

ASTRO PAC basically only looking out for high cost academic and hospital-based centers and trying to get rid of the in-office ancillary exemption (IOAE) for physicians to own linacs.

Essentially, ASTRO (through their PAC), was willing to screw over PP rad oncs and multi-specialty groups to get back at the urologists/urorads setups.

Also, silence for years as HOPPS billing at hospitals didn't go through what happened at freestanding centers which took single to double digit percentages in cuts every year (looks to be occurring again in 2026!)

The above is really one of the original sins in this field IMO after it came back from the dead with the advent of IMRT.

They've since tried to scrub this similar to their "choosing wisely" campaign screw ups, but the Internet will always remember

The AUA and LUGPA eventually won out with common sense well before ASTRO was starting to look like a 🤡 organization to CMS this decade wrt supervision rules.

 

[TheWallnerus]

This is too easy. How about the 1998 ASTRO split from American College of Radiology. Followed by hiring a career administrator CEO with no rad onc experience... for the next 22 years.

Crazy

Heard an ASTRO speaker say this year that we are “literally” the most multidisciplinary specialty (I disagree). I once saw a news anchor say that Britney Spears was literally on a roller coaster to hell. I believe many people don’t understand the word “literally.”

We would be a lot more multidisciplinary if we had stuck with radiology roots and did something like 2 radiology years followed by three rad onc years of training

 

[OTN]

Abandoning the treatment of benign disease for more than a half century needs to be on the list.

 

[RickyScott]

Fraction and modality/imrt shaming and overall widespread disdain for community practicioners by those charging 10x cms rates.

 

[NotMattSpraker]

Abandoning the treatment of benign disease for more than a half century needs to be on the list.

Then coming roaring back with new societies and boards, classes for sale, the usual gatekeeping. Gross.

For me it is far and away the re-writing history. They've done this multiple times, but for me the peak is... allowing faculty to do a residency match/ERAS session at ASTRO 2023 then deleting it and pretending it never happened because they didn't like the data that was presented in the session.

 

[medgator]

Then coming roaring back with new societies and boards, classes for sale, the usual gatekeeping. Gross.

For me it is far and away the re-writing history. They've done this multiple times, but for me the peak is... allowing faculty to do a residency match/ERAS session at ASTRO 2023 then deleting it and pretending it never happened because they didn't like the data that was presented in the session.

Wouldn't surprise me one bit. Try to find the anti PP stuff from ASTRO PAC now. You won't find it

 

[allseasons]

What have been the ridiculous moments in rad onc history. The SDN Google Doc thing certainly was, but not a biggie. Also blood bath in the red journal. Maybe ASTRO president’s employer trying to get other rad oncs fired or ASTRO legally threatening people over memes.

But I think the biggies have been
1) unchecked residency expansion
2) protons/neutrons/heavy ion expansion/spending without data
3) APM and ROCR, legislative fronts in general (think: trying to make supervision happen)
4) consolidation and loss of robust private practice rad onc (prob present in many specialties though)

What are yours

Is there a thread on ROCR? I thought it was supposed to be neutral to positive long term because hypofractionation wouldn't affect reimbursement as much.

 

[NotMattSpraker]

Is there a thread on ROCR? I thought it was supposed to be neutral to positive long term because hypofractionation wouldn't affect reimbursement as much.

There have been some threads I think? Worth reading the ASTRO materials on it to see their perspective, then listening to Out of the Basement Podcast to get an alternate perspective on some niche aspects. A few have published on the topic, good papers worth reading.

It's important to remember that it has a low chance of passing as it stands today and for many of us, the reimbursement of RO services is almost completely disconnected from our pay. A lot of the discussion is very freestanding-centric, but the chances you will ultimately work for a freestanding center instead of a hospital is very low. The chance you own a linac and need to worry about it is even lower.

I work for a very large national hospital company that is not signed on in support. I asked my executive team what they thought about ROCR and their answer was "what is ROCR?".

So.

 

[BobbyHeenan]

Agree with what has been said.

I think residency expansion and proton are the two biggest.

I'll add: Allowing (?most?) of our biggest voices to come from PPS-Exempt Cancer Hospitals to have a say in committees/policy decisions/legislation that has minimal impact on them (or may not even apply to them at all).

 

[Neuronix]

Will never forget personally being in the room for that (as one of the members of that resident class)

Similarly, I was in the room for Anthony Zietman's session about the job market in radiation oncology at ASTRO 2015 in San Antonio.

The room was packed, all seats were filled. A number of residents were seated on the floor. Before the session started Zietman compared them to kindergartners. On the one hand I can understand the resemblance, but on the other hand this seemed to be the perfect analogy for how many academic attendings patronize residents and medical students.

He gave his "Canary in the Coal Mine" speech, where he stated essentially that:
1. Residency sizes cannot be regulated
2. The job market isn't bad
3. If the job market was bad, then a drop in residency competitiveness would be the "canary in the coal mine."

All of this would was written in the red journal as he was the editor-in-chief.

When the residency competitiveness cratered, unsurprisingly the academic leadership never viewed it as "the canary in the coal mine." Instead, they turned SDN its members into scapegoats while continuing to repeat that residency sizes cannot be regulated and the job market isn't bad.

Moving to the present...

At this year's ASTRO, current president Sameer Keole indicated that "ASTRO is your society," and he wants to hear dissenting voices. He said he'd put dissenters on committees. I have an SDN member who reported that SK tried to have them fired, so did that have nothing to do with a dissenting voice? That member reports that they were banned from ASTRO committees, and I haven't been picked in a suspiciously long time.

 

[NotMattSpraker]

At this year's ASTRO, current president Sameer Keole indicated that "ASTRO is your society," and he wants to hear dissenting voices. He said he'd put us dissenters on committees. So when he tried to get an SDN member fired, I take it that had nothing to do with a dissenting voice? That member was banned from ASTRO committees, and I haven't been picked in a suspiciously long time.

Politicians doing politician things 🙂

I know of at least one other person that is in a multi-month discussion trying to get on a committee to just... help. Zero answers or response.

 

[Neuronix]

Politicians doing politician things 🙂

I know of at least one other person that is in a multi-month discussion trying to get on a committee to just... help. Zero answers or response.

Sometimes it's hard to know if there's something wrong with you or if it's just that you're not faculty at one of the favored academic institutions. I imagine they're still looking heavily at diversity as well. I have been told multiple times in private that I was not picked for committees or speaking engagements because I am a white man.

 

[Gfunk6]

Well speaking as the hearld of doom in Rad Onc's non-competitiveness (as proclaimed by ASTRO apparently), I did them a favor and dropped out of the organization. No more paying money to dig my own grave.

@Neuronix when Zeitman made his (in)famous canary in a coal mine speech, I actually gave him the benefit of the doubt. My post on that is a matter of historical record. In fact, many (rightly, especially in retrospect) criticized my stance at the time. So to say that I've always been opposed to ASTRO's positions is a fallacy. It is an evolved position with the OP giving the laundry list as to why.

 

[NotMattSpraker]

Sometimes it's hard to know if there's something wrong with you or if it's just that you're not faculty at one of the favored academic institutions. I imagine they're still looking heavily at diversity as well. I have been told multiple times in private that I was not picked for committees or speaking engagements because I am a white man.

Strongly suspect its the latter unless you have a personal enemy on the board. I've also seen a president guarantee committee positions for faculty from their institution. I agree ASTRO's view of diversity is of gender or skin color, not institution, site of practice, or ideas.

I put out a podcast basically sharing my experience on two committees and said ASTRO has integrity and transparency problems. I saw it in physician board volunteers and employed staff. Sometimes even committee leadership seemed to be in it for their own career rather than helping out the field. There are so many ways to help patients and physicians without existing in the beehive of self promotion, in-fighting, and COI that is ASTRO. That is why I quit and am not a member. It's pretty simple.

It's sad to me that busy physicians want to volunteer and are turned away. Our time is highly valuable, they should be thrilled to have it.

ASCO has a much more standardized and transparent process for committee membership and volunteering. They seem to welcome Rad Oncs. You might consider checking that out if you're looking to participate in organized medicine.

 

[Neuronix]

Strongly suspect its the latter unless you have a personal enemy on the board.

The board knows who I am. Sameer Keole messaged me on my personal LinkedIn with my SDN screenname, so that message was clear.

Are they my enemy? No.

Do they think I'm their enemy given my work on SDN? Maybe. SDN is the scapegoat for this specialty's ills, and I've been told twice that I shouldn't have a job in this field for my work here. Not everyone feels this way of course, but it's hard to know who feels that way and who doesn't.

There are so many ways to help patients and physicians without existing in the beehive of self promotion, in-fighting, and COI that is ASTRO. That is why I quit and am not a member. It's pretty simple.

It's sad to me that busy physicians want to volunteer and are turned away. Our time is highly valuable, they should be thrilled to have it.

ASCO has a much more standardized and transparent process for committee membership and volunteering. They seem to welcome Rad Oncs. You might consider checking that out if you're looking to participate in organized medicine.

I'm glad to hear that. I was interested in one society that is disease site specific in my area, but their leaders are almost all medical oncologists, and several of them are rabidly anti-radiation. I'm considering giving up that membership first.

Is there a thread on ROCR? I thought it was supposed to be neutral to positive long term because hypofractionation wouldn't affect reimbursement as much.

My time in the specialty has led to me believe that the largest factor for pay as an employed radiation oncologist is supply of and demand for radiation oncologists. For this reason, it's hard for me to be interested in ROCR or any of these other reimbursement changes.

 

[NotMattSpraker]

Do they think I'm their enemy given my work on SDN? Maybe. SDN is the scapegoat for this specialty's ills, and I've been told twice that I shouldn't have a job in this field for my work here. Not everyone feels this way of course, but it's hard to know who feels that way and who doesn't.

The idea that someone should not have a job treating patients as a physician because they moderate an online forum is very Rad Onc.

 

[RadOncDoc21]

The idea that someone should not have a job treating patients as a physician because they moderate an online forum is very Rad Onc.

Yea the fragile egos in this field and need for approval is amazing!

Please select like or love to my post btw!

 

[thesauce]

Some of these 5 fraction versus 3 fraction trials have to be up there

 

[medgator]

At this year's ASTRO, current president Sameer Keole indicated that "ASTRO is your society," and he wants to hear dissenting voices. He said he'd put dissenters on committees. I have an SDN member who reported that SK tried to have them fired, so did that have nothing to do with a dissenting voice? That member reports that they were banned from ASTRO committees, and I haven't been picked in a suspiciously long time.

Sameer lead ASTRO PAC last decade and brandished his "private practice" credentials while pushing the agenda of closing the IOAE so rad oncs couldn't own linacs to get back at the urologists and rad oncs that had the audacity to partner with them. I guess Sameer and co. at ASTRO preferred inappropriate RP, hifu and upfront cryo for these patients instead 🤷‍♂️ Urologists needed to be at the table and ASTRO had no interest in playing in the sandbox.

The "leadership" in this specialty is, has been, and continues to be insular. They just dont get it. The rot runs deep and has been long-standing in our de facto medical organization

 

[fiji128]

The board knows who I am. Sameer Keole messaged me on my personal LinkedIn with my SDN screenname, so that message was clear.

This is really a sad commentary on these people and is not even the only time it has happened that I am aware of. I would think if Astro was a serious and self aware organization, this type of threating behavior over what is a fundamentally an attack on free speech, would require those doxing and threating to resign from any "leadership" role in the organization in disgrace.

 

[TheWallnerus]

This is really a sad commentary on these people and is not even the only time it has happened that I am aware of. I would think if Astro was a serious and self aware organization, this type of threating behavior over what is a fundamentally an attack on free speech, would require those doxing and threating to resign from any "leadership" role in the organization in disgrace.

ASTRO leadership has always historically lacked, shall we say, introspection.

 

[medgator]

ASTRO leadership has always historically lacked, shall we say, introspection.

Specialty still had better leadership in the 90s when they shut a bunch of programs down/reduced spots and extended training by a year to counter an abysmal job market

Since the last decade?

 

[allseasons]

Specialty still had better leadership in the 90s when they shut a bunch of programs down/reduced spots and extended training by a year to counter an abysmal job market

Since the last decade?

that reasoning for adding a year to residency training always seemed crazy to me. They're doing that in EM rn too.

 

[TheWallnerus]

that reasoning for adding a year to residency training always seemed crazy to me. They're doing that in EM rn too.

The extend a year trick works (to help a bad job market), simple supply and demand

 

[medgator]

The extend a year trick works (to help a bad job market), simple supply and demand

They coupled it with reducing spots/shutting down programs

The last decade you had Paul harari, Dennis hallahan and co. claiming antitrust when discussing the bad job market (all the while colluding on propietary scarop salary survey data).

ASTRO was eventually strong-armed into doing and releasing a watered down workforce survey that still shows uncertainty and problems for the RO workforce starting in 2030+!

 

[allseasons]

Speaking of shutting down programs, did cornell shut down this year? They had slots on VSLO for away rotations, but none on ERAS

 

[medgator]

Speaking of shutting down programs, did cornell shut down this year? They had slots on VSLO for away rotations, but none on ERAS

Didn't Cornell shut down a few years ago?

 

[allseasons]

Didn't Cornell shut down a few years ago?

oh wow, I didn't know. I was just surprised they still had VSLO away rotations this year then.

 

[CurbYourExpectations]

Great thread.

Extending a year doesn't do as much as you would hope, especially when many programs are already at that higher year number. Like Gator said, RadOnc benefitted from cutting significant spots and being able to bill a lot more all of a sudden.

 

[medgator]

Great thread.

Extending a year doesn't do as much as you would hope, especially when many programs are already at that higher year number. Like Gator said, RadOnc benefitted from cutting significant spots and being able to bill a lot more all of a sudden.

At least they cared back then. Scarop/ASTRO leadership doesn't give a **** now and it's been painfully obvious for over a decade.

Big enough of a specialty problem for me not to recommend Rad Onc to any MS4 unless they literally can't be happy or content doing anything else and accept the livelihood/geographic uncertainty inherent in the field, esp in 2030+ given even ASTROs workforce study results

 

[CurbYourExpectations]

I think this could be said any time in RadOnc history, geographic flexibility should be considered. I would never try to convince someone to enter the field, even though I love the field. Gambling in the past really paid off for all of us, so if someone is certain they want to do this I think they should do this, because none of us really knows. I tell people I love the field, but I am honest if a medical student or anyone else asks me about what I think the future is. I do not think this lasts, I could talk for hours about why, but I could be wrong.

If someone wants to do the digging and find it, I am pretty sure there was discussion in old papers about cutting spots during the 90s oversupply due to increased competition from private groups and decreased learning opportunities in academics for trainees due to decreasing patient numbers. My... how the tables have turned due to consolidation now that most of RadOncs are academic and can bill higher, but don't necessarily get an increase in salary from their work. It allows for over hiring in academic centers, it allows for academics to out compete private groups, all thanks to consolidation. Now there is no way to pressure academics, old PP groups sold out or hospitals got bought, academics can bill more and more due to technology and hire someone that sees barely any patients even though they are "clinical faculty", and they will still make decent money, at least currently. Do I think this lasts? Do you?

To stay on topic with this thread, I think we are in a ridiculous moment currently, because people are trying to introduce widespread midlevel encroachment when many RadOncs aren't that busy.

 

[randomname2018]

Sometimes it's hard to know if there's something wrong with you or if it's just that you're not faculty at one of the favored academic institutions. I imagine they're still looking heavily at diversity as well. I have been told multiple times in private that I was not picked for committees or speaking engagements because I am a white man.

I volunteered for ASTRO committees every year for nearly a decade. I am an academic radiation oncologist practicing in a narrow disease site. I also have considerable expertise in other domains, which is very rare in radiation oncology. Additionally, I know APEX cold, cover to cover as well as ACR accreditation.

I was never chosen. I emailed multiple times to follow up. I never once received a return email. ASTRO has spoken and I've listened. I resigned my membership 3 years ago.

 

[RadOncDoc21]

Sometimes it's hard to know if there's something wrong with you or if it's just that you're not faculty at one of the favored academic institutions. I imagine they're still looking heavily at diversity as well. I have been told multiple times in private that I was not picked for committees or speaking engagements because I am a white man.

You should have told them you identify as a black woman, then you would at least be the front runner for a chief diversity officer position. I have never seen any other demographic for this position.

 

[randomname2018]

I'll add two more:
1) Not accommodating a young mother who needed to pump during her boards
2) Allowing lifetime accreditation

 

[Neuronix]

I volunteered for ASTRO committees every year for nearly a decade. I am an academic radiation oncologist practicing in a narrow disease site. I also have considerable expertise in other domains, which is very rare in radiation oncology. Additionally, I know APEX cold, cover to cover as well as ACR accreditation.

I was never chosen. I emailed multiple times to follow up. I never once received a return email. ASTRO has spoken and I've listened. I resigned my membership 3 years ago.

Thanks for sharing. It's nice to know that it's not just me.

I don't know if it's just my imagination, but it seemed like the ASTRO meeting was more sparsely populated this year.

This is what happens if you don't engage your membership.

I'll add two more:
1) Not accommodating a young mother who needed to pump during her boards
2) Allowing lifetime accreditation

I’m not opposed to lifetime accreditation. They make a lot of money off this maintenance of certification with no strong rationale for it.

What I do mind is that we have plenty of older rad oncs grandfathered into it, while junior rad oncs cannot opt out.

 

[RickyScott]

https://applink.instagram.com/p/CEp...16A0D&utm_source=igweb&fall_back_to_web=false

 

[TheWallnerus]

Wonder what happened with that dude he used to be all the rage

The only time we will see the word “race” at another ASTRO talk in the future is if it’s accompanied by “to the bottom”

 

[RickyScott]

Still around and spreading hate.

 

[A_DeMichele]

If ROCR or something starts to show signs of life in the Congress, this is the flyer to forward your representative 🙂

 

[randomname2018]

... it seemed like the ASTRO meeting was more sparsely populated this year.

As a conference, it isn't appealing. Locations have varied significantly in quality over the years. San Diego is a reasonable location, yet San Antonio is not. Additionally, spanning a weekend is poor form. Spending my exceedingly limited personal time and money doesn't exactly represent value to me.

What I do mind is that we have plenty of older rad oncs grandfathered into it, while junior rad oncs cannot opt out.

In my opinion, the fact that older rad oncs are grandfathered into lifelong certification undermines any potential argument for maintenance of certification. What it does demonstrate is that maintenance of certification is simply a means for certifying bodies to generate revenue.

 

[Gfunk6]

Looks like ASTRO is trying to stem the hemorrhage of lapsed memberships. Just got the following mass email:

Time is running out to take advantage of the ASTRO Membership reinstatement campaign. Have you considered reinstating your membership? Do you need a little more information about why now is the right time to be a member of the world’s leading society for radiation oncology?

If your answer is yes, please watch this video of my address during the recent ASTRO Annual Meeting where I spoke about the many exciting changes, renewed focus and new initiatives that have taken place since my becoming ASTRO CEO last November 1.

🎥 Watch the Video

As you heard, there are many good reasons to renew your membership. Here are the details of the reinstatement campaign:

• Reinstate your membership before November 6 and your past ASTRO membership dues and reinstatement fees will be waived.
• Pay 2025 ASTRO membership dues online at www.astro.org/paynow. Include this invoice number XXXXX. (Note you will be invoiced for 2026 membership dues separately.)
• You will immediately begin receiving membership benefits.

My commitment to the ASTRO Board of Directors and to ASTRO members is to ensure that ASTRO is transparent about processes and decisions before they are finalized and to make ASTRO the best possible organization for you. I have a standing invitation to all members, if you have a question or concern about ASTRO, please email me directly.

I hope to welcome you back as an ASTRO member before November 6. If you need assistance with reinstating your membership, please contact the membership team.

You have my commitment to do my best to serve you and the field of radiation oncology.

Who knew there were re-instatment fees to waive?