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granted, (apparently one of their fellow is clinical) but it is improbable that 2 programs make up almost all the fellows.
RO-APM Podcast Episode (from The Accelerators)
- Thread starter elementaryschooleconomics
- Start date
I did a fellowship (on purpose)... and ended up with a pretty sweet gig because of it. I wanted to do something very specific in my career and didn't have the credentials to do it graduating from a -fairly reputable- residency. The fellowship I chose had a long track record of prior fellows who ended up with good jobs in this field, so it's not like I just got lucky. I know that fellowships are dirty word here... but consider the possibility that they aren't universally bad. For some (like me), they open doors that wouldn't otherwise be open. The key is to go into it with your eyes open and a specific/realistic goal in mind.
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10 -15 years ago, nobody from mskcc or Stanford did fellowships, and if you went to a good program, you did not need a fellowship for brachy or peds position.
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people who are interested in pure science careers (the MSKCC example) have ALWAYS have this avenue open to them, and people have always (small minority of course) taken this.
this is simply not true.
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I think the farther away we get from training, the more out of touch some us become. I am 5 years out and a certifiable geezer at this point, but I still know some people in training, through friends of friends.
it is laughable to think that someone graduating from stanford or sloan is taking a fellowship because they HAVE to. it just doesn't pass the smell test, and you lose immediate credibility to suggest it.
some people truly want to become career scientists, and an extra year in your lab can be incredibly fruitful grant-wise
this is a territory that is foreign to most of us, but yes, like i said, some people actually WANT to do this stuff and make it their lives/career.
it is laughable to think that someone graduating from stanford or sloan is taking a fellowship because they HAVE to. it just doesn't pass the smell test, and you lose immediate credibility to suggest it.
some people truly want to become career scientists, and an extra year in your lab can be incredibly fruitful grant-wise
this is a territory that is foreign to most of us, but yes, like i said, some people actually WANT to do this stuff and make it their lives/career.
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First off, one of the mskcc residents is apparently doing a clinical fellowship. 10-15 years ago, lab oriented residents just didn’t do fellowships. After spending 18 months in the lab at mskcc during residency, you usually got a good research gig. Back then 9/10 residents from these places went into cush private practices like the Princeton group so anyone going into academics was very sought after.
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It's because the job market was tough back then, same reason many do it now, there's just been a proliferation of them in the last several years because of.....
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Exactly. In the past lamount would not have had to a fellowship. I am assuming he is an academic and if he went to a good training program in the past, most of his colleagues would be shooting for high paying private practices in good locations and he would have had his pick of academic positions. When I graduated mskcc faculty were peeved that none of their grads had chosen academics for years.
I’m happy with my lot in life so it’s easy for me to feel like things happened for a reason
Perhaps, if I were applying 10 years ago, I would have had three 10/10 job offers to chose from and would never have considered a fellowship. Who knows? What I CAN tell you speaking for myself and several other colleagues, in the current environment, SOME fellowships are quite helpful to getting great jobs. I think it is reasonable to lament the need for fellowships, but (not directed at you personally) I wouldn’t presume they are all garbage or predatory.
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It’s great you got the job you wanted, but it’s also clear that the door is closing.
"I interned at the Chicago Osteopathic Hospital and performed my residency at the Memorial Sloan-Kettering Cancer Center. As a part of my formal medical and residency training, I spent time at the Massachusetts Eye and Ear Infirmary in Boston and Curie Institute in Paris. In the latter part of my residency training, I was awarded a fellowship and spent time at the Joint Center for Radiation Therapy and Children’s Hospital Boston."
Thomas E. Merchant, DO, PhD
Thomas Merchant, DO, PhD, St. Jude Faculty, Department of Radiological Sciences, Chair, Department of Radiation Oncology, St. Jude Children's Research Hospital
www.stjude.org
"Dr. Camphausen received his M.D. from Georgetown University in 1996. He completed his internship at Georgetown in 1997 and a residency in radiation oncology at the Joint Center for Radiation Therapy at Harvard Medical School in 2001. Dr. Camphausen spent two years working in the laboratory of Dr. Judah Folkman studying the interaction of angiogenesis inhibitors and radiotherapy. He joined the National Cancer Institute in July 2001 as a tenure-track investigator."
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Anecdotal evidence from decades ago. The best kind. And so up to date!"I interned at the Chicago Osteopathic Hospital and performed my residency at the Memorial Sloan-Kettering Cancer Center. As a part of my formal medical and residency training, I spent time at the Massachusetts Eye and Ear Infirmary in Boston and Curie Institute in Paris. In the latter part of my residency training, I was awarded a fellowship and spent time at the Joint Center for Radiation Therapy and Children’s Hospital Boston."
Thomas E. Merchant, DO, PhD
Thomas Merchant, DO, PhD, St. Jude Faculty, Department of Radiological Sciences, Chair, Department of Radiation Oncology, St. Jude Children's Research Hospital
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i mean SDN does live on anecdote. but agree a different era. early 90s may as well be the 50s for rad onc.
but anecdotally, I certainly know US grads who did fellowships who graduated in the 2008-20112 period.
but anecdotally, I certainly know US grads who did fellowships who graduated in the 2008-20112 period.
Dr. Kimmelman earned a dual MD/PhD degree from the Medical Scientist Training Program at Icahn School of Medicine at Mount Sinai. He completed his residency in radiation oncology at the Harvard Medical School Combined Program, as well as a postdoctoral fellowship in the laboratory of Ronald A. DePinho, MD, current President of The University of Texas MD Anderson Cancer Center.
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probably not where they thought...
thankfully made the 10-15 year cutoff... rad onc had a great 5 year run it seems
Nadia N. Laack, M.D.
www.mayoclinic.org
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It was rare in the past, and maybe worth it for a postdoc in the best lab in the world. Certainly not half the graduating class. Let’s see if it happens again this year.
Dr. Kimmelman earned a dual MD/PhD degree from the Medical Scientist Training Program at Icahn School of Medicine at Mount Sinai. He completed his residency in radiation oncology at the Harvard Medical School Combined Program, as well as a postdoctoral fellowship in the laboratory of Ronald A. DePinho, MD, current President of The University of Texas MD Anderson Cancer Center.
this is like the PSP=3D guy... if you make a comment that says "nobody did xxxx" and that is easily refutable, someone will probably call out you out. there were < 10 fellows last year, nobody reasonable is arguing we should have half a class take a fellowship
But it is ironic how often people complain about the quality of basic research that rad onc has, but then will talk down on people who would actually try to improve that by doing a lab fellowship/post doc/instructor position. I'm all for clowning on the palliative/SRS/IGRT fellowships, but not sure it makes sense to denigrate the lab folks
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The bottom line is, we are seeing more garbage ones getting posted every year. Probably not happening for kicks. Institutions/people are preying on what they see as an opportunity from residency expansion
Using the ACR link from RickyScott, if you look there is a table (in the first column for "600 or more patients" that's facility workload stratum and "275" is number of new patients per rad onc per year on average in that facility), and we can use the Zaorsky data to infer:
@jondunn this data is published...
The thing about the Zaorsky data was that it was from 2004-2013. How many rad oncs were complaining that time about seeing <3 consults per week? Wasn't this the golden era where nobody from MSKCC or Harvard did fellowships or post docs?
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Mayo not a big peds programthankfully made the 10-15 year cutoff... rad onc had a great 5 year run it seems
Nadia N. Laack, M.D.
View attachment 345552
so mskcc and Stanford produced 6 of the 7 fellows in the survey?
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Roughly the same number of people saying smoking causes cancer in the 1960s, complaining about rising atmospheric CO2 in the 1980s, or warning over Bin Laden in the 1990s. They existed. But very few people believed them when they said that things were getting problematic. Just like a person dying of COVID in the ICU saying the virus is a hoax, we will have people gainsaying any negative rad onc data, well, forever I guess.
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Someone told me at ASTRO that sdn was basically evil and a hoax. I smiled and did’t give much of an idea of an opinion. My smile said “ i hear you”. Little did they know!
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w
I mean by definition the bottom line is the number of fellows, not the number of fellowships.
I mean by definition the bottom line is the number of fellows, not the number of fellowships.
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But we can all agree that the number of radoncs and residents have increased?
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Yes of course. Needs to be reversed
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The last ARRO survey showed what I would call angst and agita (YMMV) and that on average people got two job offers coming out of residency (a difference that's p<<0.05 versus any other residency). Half of American rad oncs get less than $150K a year from Medicare. Salaries for the whole of rad onc can't be that great. ASTRO claims Medicare has cut payments to rad onc 25% the last ~10 years. It's thus tough to claim "both are true" re: declining reimbursements and salaries saying stable or rising over time. And with ever more ROs present to divvy up the shrinking pie.
Because if employment is great and salaries are good in rad onc, we should all shut up. I keep trying to believe they are but these niggling facts keep bubbling up to the surface. And the trends are not improving.
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I mean we shouldn’t all shut up. It’s just my take is the future is the worry, and the present is mostly still okay, when it comes to the market. Just because the present is reasonably okay is not a reason to not be worried, I just acknowledge that fact, personally.
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D
deleted1111261
Hence climate change analogies …
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I generally agree, but I also agree that the interest in radonc by med students is right now about what it should be. I strongly disagree with maintaining resident complements at current levels.
IMO, the market today is OK by the following standards:
1. You can get a job
2. You cannot with high confidence determine where you are going to get a job
3. The type of job you get is likely to be incommensurate with your credentials (may change as credentials of applicants decrease)
4. Your lateral mobility will be close to zero
How do I know this? Because I've hired someone in the past several years. All national applicants for a job that was a regional job for me and that I thought I was too good for years ago. Every applicant we interviewed had multiple real publications and some affiliation (either undergrad, medical school, residency or faculty) with one of the most prestigious institutions on earth (IVY or Big 3 type cancer center). It was easy to hire someone excellent at a cancer center where all medical oncologists are IMGs.
It's completely silly to denigrate people who do fellowships to enhance their academic credentials or do meaningful research. Now I admit, when my chair recommended that my 38 year old, children having, PhD having self "consider a fellowship" if I wanted to "do something serious" I was appalled and realized that my academic career was over. However, the "most serious" people have always been willing to do this sort of thing, even go back to residency and get double boarded. They have always been willing to do a national job search. Like most community docs, I have come to terms that within my field, I am not "serious". I do believe that this dichotomy is less severe in many other fields.
As I've said before, radonc will remain for the foreseeable future an option that provides low intensity clinical practice with above average academic pay for "truly, truly elite" research types. We are talking the Tim Chans and Max Diehns of the world. (Who of course could do whatever they wanted in any field and study whatever they want now).
I am skeptical of the details of Wallnerus' data. (not his analysis or integrity). The main issue I have is that the total number of "working" radoncs is not well defined. Heck, there are docs that show up on regional "top docs" lists that haven't practiced in years. When you go to part time or essentially retire, nobody takes your license away.
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I could be off by up to a factor of two on "total number of 'working' radoncs" and you would have a calculation that shows 20 years of stagnation in rad onc; but even then we could all agree fractions have dropped. Even this massive of a mistake would be best case scenario for making a case that things are only a little oversupplied in rad onc.
And trust me. I am skeptical of the details of my data too. It only takes one piece of falsifying evidence to invalidate a whole theory. I welcome invalidation.
An MD-PhD RadOnc attending managing inpatients consults alongside the IMG MedOnc fellows. That is a common situation.
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Hilarious timing:
So CMS can hike its costs because of the pandemic, but when we ask to delay APM for the same reason, we're told to buzz off?
I love that our own internal politicking and careerism have funneled us into arguing about fractions and Palliative Care Networks, while those grifters over at Biogen somehow got Aduhelm through FDA approval. I wonder...how could that have happened...
So CMS can hike its costs because of the pandemic, but when we ask to delay APM for the same reason, we're told to buzz off?
I love that our own internal politicking and careerism have funneled us into arguing about fractions and Palliative Care Networks, while those grifters over at Biogen somehow got Aduhelm through FDA approval. I wonder...how could that have happened...
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Good thing we are saving the system a ton of money through hypofrac and APM? I guess big pharma doesn't have the same alignment in values? I'm shocked, i tell you
D
deleted1111261
The separating to me always confuses.
If everyone’s prices were the same, hypofractionation will save money. They are two components and do not have to be mutually exclusive.
That being said, hypoFX not be paid out so much less. If it’s an equivalent treatment to the conventional treatment, it should be paid out the same, or some amount more that isn’t enough to justify additional treatments (when the two treatments are equal).
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- MD Anderson, Oncora Medical team up to fight cancer with precision medicine alliance
- Oncora Medical and MD Anderson embark on personalized radiation oncology study
- When we started Oncora back in 2014, we formed a strategic partnership with MD Anderson to help guide our engineers in building a technology platform capable of capturing structured data in radiation oncology, while simultaneously integrating with EMRs, oncology information systems, and cancer registries. We became obsessed with reducing redundant clicks and inefficient data entry. Physician leaders have collaborated with us during the whole process to ensure our system doesn’t create unnecessary burden on the doctors and care team. Because of this attention to workflow, our software actually reduces the time physicians spend documenting by 67%.Our software has been used to process hundreds of thousands of notes at MD Anderson, and is currently in use by over 100 physicians.
In this blog post, my goal is to provide a resource to practices selected for the RO Model. This post will discuss the “7 Requirements.” I will write additional posts to clarify other points of the RO Model and look forward to feedback from readers. Here are 7 requirements that apply to practices in the RO Model.
Goals of Care: physicians must engage the patient with a goals of care discussion and document the radiation course as either curative or palliative.
Pathways: Physicians must adhere to evidence based pathway (such as an NCCN pathway) or otherwise document and justify their deviation.
Staging: A TNM Stage must be documented by the radiation oncologist at the start of treatment
Performance Status: Physicians must assess and document a quantitative performance status (KPS, ECOG, etc) before treatment
Treatment Summary: Physicians must send referring physician a treatment summary
RO Model Discussion: Physicians must discuss the RO Model with the patient and inform the patient that their cancer center is included in the model
Peer Review: The physician/care team must perform and document peer review on 50% of episodes year 1, increasing every year.
All of the 7 requirements listed above are satisfied by using the Oncora Patient Care and Analytics software to track and organize your cancer center’s data. In fact, a study performed by MD Anderson demonstrated that our tool captured stage 92% of the time and allowed peer review 96% of the time. Because of interoperability with major players in both the EMR and RadOnc software space, we can easily get your practice onboard by the end of the year in time for the program launch on Jan 1, 2021. If you are interested in a demo or wondering if your practice is included in the RO Model, check out our RO Model page for more information.
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Disgusting
- MD Anderson, Oncora Medical team up to fight cancer with precision medicine alliance
- Oncora Medical and MD Anderson embark on personalized radiation oncology study
- When we started Oncora back in 2014, we formed a strategic partnership with MD Anderson to help guide our engineers in building a technology platform capable of capturing structured data in radiation oncology, while simultaneously integrating with EMRs, oncology information systems, and cancer registries. We became obsessed with reducing redundant clicks and inefficient data entry. Physician leaders have collaborated with us during the whole process to ensure our system doesn’t create unnecessary burden on the doctors and care team. Because of this attention to workflow, our software actually reduces the time physicians spend documenting by 67%.Our software has been used to process hundreds of thousands of notes at MD Anderson, and is currently in use by over 100 physicians.
In this blog post, my goal is to provide a resource to practices selected for the RO Model. This post will discuss the “7 Requirements.” I will write additional posts to clarify other points of the RO Model and look forward to feedback from readers. Here are 7 requirements that apply to practices in the RO Model.
Goals of Care: physicians must engage the patient with a goals of care discussion and document the radiation course as either curative or palliative.
Pathways: Physicians must adhere to evidence based pathway (such as an NCCN pathway) or otherwise document and justify their deviation.
Staging: A TNM Stage must be documented by the radiation oncologist at the start of treatment
Performance Status: Physicians must assess and document a quantitative performance status (KPS, ECOG, etc) before treatment
Treatment Summary: Physicians must send referring physician a treatment summary
RO Model Discussion: Physicians must discuss the RO Model with the patient and inform the patient that their cancer center is included in the model
Peer Review: The physician/care team must perform and document peer review on 50% of episodes year 1, increasing every year.
All of the 7 requirements listed above are satisfied by using the Oncora Patient Care and Analytics software to track and organize your cancer center’s data. In fact, a study performed by MD Anderson demonstrated that our tool captured stage 92% of the time and allowed peer review 96% of the time. Because of interoperability with major players in both the EMR and RadOnc software space, we can easily get your practice onboard by the end of the year in time for the program launch on Jan 1, 2021. If you are interested in a demo or wondering if your practice is included in the RO Model, check out our RO Model page for more information.
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good gravy
EDIT: All EMR systems like this main purpose is to make it look like you did a lot of work when you didn't. Because billing. Because money.
Why is it every time there's a horrible situation in radonc this guy's name is right smack in the middle of it?
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If BS, great initials btw, is involved in any “projections”, or “project” or “meeting” or anything substantive, you can most certainly assume that some grift or badness will come out of it. This is a very imprecise gentleman.
Dr. Benjamin Smith has done more damage to this field than anyone else in its entire history, and it's not even close. Given all that he's "accomplished", it's very likely he will be able to hold the crown for all of eternity.
