SCAROP Presentation

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
D

deleted1111261

Hi - I have the slides. I have communicated with @Dan Spratt - and he thinks that without context of the presentation, the slides alone don't tell the whole story. I don't disagree, so out of respect to him - we should let him give his 2 cents at some point. There is one slide I really take issue with and I strongly doubt the presentation would change anything.

Here is my review of it and I posted a few slides that I think are informative.

Slide 6 - 25% of graduates DID NOT get a job in preferred region. Not city. REGION. We knew this. Glad he brought this up.

Slide 7 - 2015 - 2025 - demand of RT was projected to increase by 19%. Based on 2016 reference. There is so much out there that shows far lower increase, or decrease when you look at it per capita. This to me is where Dan is not looking at all the data. He has his reasons with not having faith in Todd's analysis, but there are others. I think this slide is faulty and should include a much larger range. This is where you could have reached out to many of us.

Slide 16 - Expansion of programs has not occurred in the areas of need. DUHHHH. Do you know we have 10 first year positions in metro Detroit + Ann Arbor? I love my Mitten people, but is this necessary?

Several slides are informative about poor quality of residencies. Many don't have GK, protons, prostate brachy, gyn brachy, IORT, Adaptive, etc). Many programs have double/triple coverage - heavy on service, not education

This next slide I cut and paste I really take issue with. False dichotomy. Who is this "Fringe" that says Radiation Oncology is not amazing as a specialty? I think we have 100% agreement that we love what we do day to day. Also, how did the Fringe contribute to the problem? Seriously? Neither are to blame? I don't think the Fringe expanded. Contributing to solution? Chirag, me, Todd, Mudit, Beckta, McFarlane, Rahul T, Jimmy Bates, Johnnie Verma, so many of us doing everything we can to raise awareness. (I have only named men, because I don't see any women talking about the issue currently, but Chelain and Shauna did in the past, so I'm not ignoring their contributions. We are writing papers. We are finding the data. We are risking our necks. This is an unfair slide and I bet this essentially leads the chairs to say we are the problem.

1653061215621.png



This is a money slide here - I think he did a very good job of defining the problem. Great job, Dan!! This is perfect.

1653061003101.png


This is conclusion. He says ACTION IS REQUIRED. What is this action? This is the key part, I think. He said via communication that the recommendation to contract has anti-trust implications. I think that is terrible argument. I want to see who would have standing, I want to see who is harmed, I want to see precedent showing that contraction is legally risky. I call BS.


1653061116158.png


I would have loved to hear how this was actually presented, because it depends on how you synthesize it to the crowd.

I would bet that this doesn't move the needle one bit, it could have been far stronger.

Members don't see this ad.
 
  • Like
  • Love
Reactions: 14 users
At the end of the day, no field expanded more than radonc. Total outlier. yet somehow those who oppose it are fringe.

1653063627227.jpeg
 
  • Like
  • Love
Reactions: 3 users
At least they are talking about it and objectively put a number on what compensation for rad oncs should be (>650k - kudos).

With regards to "antitrust" concerns as a reason for not contracting, this needs to be rigorously explained with a precise argument, which I have never heard. Not just discussed in generalities with hand-waving. Otherwise it is a cop-out. I suspect the reality is they just don't want to have to jump through that hoop and worry about it. Easier to keep status quo and brush it off with "oh we can't that we will totally get sued cause I watched a movie one time"
 
  • Like
Reactions: 2 users
Members don't see this ad :)
At least they are talking about it and objectively put a number on what compensation for rad oncs should be (>650k - kudos).

With regards to "antitrust" concerns as a reason for not contracting, this needs to be rigorously explained with a precise argument, which I have never heard. Not just discussed in generalities with hand-waving. Otherwise it is a cop-out. I suspect the reality is they just don't want to have to jump through that hoop and worry about it. Easier to keep status quo and brush it off with "oh we can't that we will totally get sued cause I watched a movie one time"
How did “antitrust” not stop the contraction of the 1990s? There were many places that closed. Places like howard, university of new mexico, east carolina, george washington, georgia had programs. Many others closed and contracted. Are any of the leadership from back then still alive to tell us about this? It was clearly done so it should not be surprising that this is so frustrating to many of us
 
  • Like
Reactions: 4 users
The "problem" isn't that med students aren't applying to residencies like they used to. Nay, that's the ****ing solution.

It's unbelievable to have missed the point so entirely.
 
  • Like
  • Love
Reactions: 4 users
Stop SOAPing. Close terrible programs by raising standards. Let supply of docs decrease to meet demand.

This isn't rocket science.
 
  • Like
Reactions: 4 users
I also take issue with 'Denies many amazing aspects of our field' - I think the vast majority of SDN realizes what a good job a Rad Onc is, but would like to have a good job market along with said job. This is true anytime somebody comes to ask about the field "Yes, it's a great job, you work with patients, use cool tech, work weekdays, minimal night/weekends, this is all great... BUT the concern is if you can get a job that doesn't massively exploit your labor in a specific REGION of the US, 25% of the time, RIGHT now, with that only going to get worse over the next 5 years"


That being said, besides that... I think it's a reasonable first step (for Chairmen/women). Most Chairs wouldn't have even brought this up. Multiple old chairs say there is no problem. Replace "Old Guard" with "Boomer Chairs" and you have the SDN talking point. I have to believe this is the first time SCAROP has had this discussion in a candid way with the conclusion being "do something, godamnit"

Dan Spratt may be the chair at Case, but he's like the PGY-2/3 in SCAROP. As much as a lot of SDN 'turned' on him in his thread, he's not going to be able to unilaterally get things done while keeping the cabal that is SCAROP happy.
 
  • Like
  • Love
Reactions: 11 users
I also take issue with 'Denies many amazing aspects of our field' - I think the vast majority of SDN realizes what a good job a Rad Onc is

Exactly. What are the mental gymnastics to come up with such a ridiculous statement? Most people here seem to be early/mid career, meaning they were top of their class and could have gone into anything. Why do you think we chose rad onc? It's not like we had no other choice and don't appreciate what this field has to offer. We knew the work was awesome. At the time, the pay and job opportunities were also awesome. We recognize the aspects of our field that are awesome that led us to apply to it above everything else that are still awesome. Something else in the calculus changed. We lament that which has changed. It's not like we suddenly started working weekends and taking call. What has changed is that the pay and job opportunities are no longer awesome.
 
  • Like
  • Love
Reactions: 3 users
Exactly. What are the mental gymnastics to come up with such a ridiculous statement? Most people here seem to be early/mid career, meaning they were top of their class and could have gone into anything. Why do you think we chose rad onc? It's not like we had no other choice and don't appreciate what this field has to offer. We knew the work was awesome. At the time, the pay and job opportunities were also awesome. We recognize the aspects of our field that are awesome that led us to apply to it above everything else that are still awesome. Something else in the calculus changed. We lament that which has changed. It's not like we suddenly started working weekends and taking call. What has changed is that the pay and job opportunities are no longer awesome.


Maybe SCaRoP are like these guys
 
  • Like
Reactions: 2 users
Members don't see this ad :)
Exactly. What are the mental gymnastics to come up with such a ridiculous statement? Most people here seem to be early/mid career, meaning they were top of their class and could have gone into anything. Why do you think we chose rad onc? It's not like we had no other choice and don't appreciate what this field has to offer. We knew the work was awesome. At the time, the pay and job opportunities were also awesome. We recognize the aspects of our field that are awesome that led us to apply to it above everything else that are still awesome. Something else in the calculus changed. We lament that which has changed. It's not like we suddenly started working weekends and taking call. What has changed is that the pay and job opportunities are no longer awesome.
Objectively, the pay is still pretty awesome. It may not be as awesome as it used to be... but we are WELL above the median salary for most physicians. As you said, it is reasonable to lament how things have changed (and worry how things will be), but it is hard to lament how things are.
 
  • Like
  • Dislike
Reactions: 3 users
Objectively, the pay is still pretty awesome. It may not be as awesome as it used to be... but we are WELL above the median salary for most physicians. As you said, it is reasonable to lament how things have changed (and worry how things will be), but it is hard to lament how things are.
I have never heard a CEO say “I’m paid enough,”
 
  • Like
Reactions: 2 users
Objectively, the pay is still pretty awesome. It may not be as awesome as it used to be... but we are WELL above the median salary for most physicians. As you said, it is reasonable to lament how things have changed (and worry how things will be), but it is hard to lament how things are.
Eh...
1653072398546.png

Iowa City disagrees.
 
  • Like
Reactions: 3 users
I have never heard a CEO say “I’m paid enough,”
For a lot of people and certain jobs, worth = salary. As doctors, we have the alleviating suffering (and saving the occasional life) thing to get us out of bed in the morning.
 
For a lot of people and certain jobs, worth = salary. As doctors, we have the alleviating suffering (and saving the occasional life) thing to get us out of bed in the morning.

Arrested Development Eye Roll GIF
 
  • Haha
  • Like
  • Care
Reactions: 6 users
For a lot of people and certain jobs, worth = salary. As doctors, we have the alleviating suffering (and saving the occasional life) thing to get us out of bed in the morning.
Would you do it as a volunteer work ?

If not, then it’s just that your number is different than another person’s number, right?
 
I'm just surprised that in these SCAROP meetings there is no talk of XRT being constantly re-contextualized to rapidly developing systemic therapy and personalized medicine. Did the whole indications thing come up at all?

If this does not resonate strongly with SCAROP folks, it's because they are neither treating or discussing in tumor board: breast, GI malignancies, lung, lymphoma, skin, GYN, or sarcoma
 
  • Like
Reactions: 2 users
Would you do it as a volunteer work ?

If not, then it’s just that your number is different than another person’s number, right?
The "medicine is a calling" trope needs to die. It's a job. An incredibly important/difficult/frustrating/satisfying one, that should be very well compensated.

It's immature thinking like this, that allows the MBAs to walk all over us.
 
  • Like
Reactions: 13 users

Maybe SCaRoP are like these guys

and we beat out er in percentage expansion!​

The Residency Gravy Train​

There’s an obvious reason for the doctors’ unique lack of labor market leverage: The emergency medicine specialty is bringing in nearly twice as many med school grads as it did a decade ago, and almost triple the number it attracted in 1998.
 
  • Like
Reactions: 1 users
The "medicine is a calling" trope needs to die. It's a job. An incredibly important/difficult/frustrating/satisfying one, that should be very well compensated.

It's immature thinking like this, that allows the MBAs to walk all over us.
And the ones making the truly important decisions but benefit the most are not accountable for any of the risks or went through the rigorous training to be in our position.

If some of you guys believe you are making too much, please contact me and I’ll share my crypto wallet.
 
  • Like
Reactions: 1 user
Objectively, the pay is still pretty awesome. It may not be as awesome as it used to be... but we are WELL above the median salary for most physicians.

Med onc grads from average, community training programs get offers well into 7 figures as newly employed physicians for decent locations.

But yeah, keep comparing us to primary care physicians with a totally different skillset and patient population rather than our med onc, IR, or surgical colleagues.
 
  • Like
Reactions: 5 users
And the ones making the truly important decisions but benefit the most are not accountable for any of the risks or went through the rigorous training to be in our position.

If some of you guys believe you are making too much, please contact me and I’ll share my crypto wallet.
Maybe @OTN can share since he has way too much money, supposedly!
 
  • Haha
Reactions: 1 users

What problem are we referring to? What problem has the "fringe" caused, exactly?


Know anyone offering 500k+ for <50 hours a week? Maybe some rural places? Dan's own ad on ASTRO Career site does not mention a salary.

I still think rad onc is a good specialty. You just can't be picky about the job you take. Of location, lifestyle, and pay, getting above average (for rad onc) on any one of those is a big deal.
 
  • Like
Reactions: 4 users
What problem are we referring to? What problem has the "fringe" caused, exactly?
The problem (as stated in presentation) is "Not enough med student interest."

I'd posit SDN has indeed lowered med student interest by providing some degree of informational symmetry. Fringe idea, I know.
 
  • Like
Reactions: 4 users
The problem (as stated in presentation) is "Not enough med student interest."

I'd posit SDN has indeed lowered med student interest by providing some degree of informational symmetry. Fringe idea, I know.

I don't understand how having a totally open discussion for anyone to contribute to is considered fringe.

It is true that we hide behind pen names. Does the "old guard" ever consider why practicing radiation oncologists would not want to be open about their identities when discussing things openly and honestly?

I have also seen declines in rad onc competitiveness portrayed as a good thing repeatedly in many environments. So is this even a problem?

Regardless, this is all a distraction. The problem is that there are too many residency positions and too many radiation oncologists. The specialty overexpanded. Period. Full stop. The problem is not us writing about it, no matter how Dan wants to assign a false equivalency that "both sides are the problem".
 
  • Like
Reactions: 10 users

Maybe SCaRoP are like these guys
Total effing bee ess to think this won't happen in rad onc

bkaAy6y.png



These are assumptions; I am not savvy to ER but clearly they're making some forecast assumptions which is all many of us have ever tried to do. If they're expecting "just" a 19% oversupply of ER docs to cause this much chaos in 2030, one can calculate that by 2030 we may have...

... a ~100-200% oversupply of rad onc residents.

There is no amount of low-balling or invokable conservativism to make rad onc's over-supply get as low as 19%.
 
Last edited:
  • Like
Reactions: 3 users
For a lot of people and certain jobs, worth = salary. As doctors, we have the alleviating suffering (and saving the occasional life) thing to get us out of bed in the morning.
Get out of bed Monday, sim to alleviate suffering Tuesday, denial on Wednesday, P2P on Thursday, file an appeal on Friday, save a life a few weeks later.
 
  • Like
Reactions: 2 users
Med onc grads from average, community training programs get offers well into 7 figures as newly employed physicians for decent locations.

But yeah, keep comparing us to primary care physicians with a totally different skillset and patient population rather than our med onc, IR, or surgical colleagues.
Well into the seven figures? lol

I am sorry, but this one is going to require a little bit more data than an anectdote. I can tell you that at the large academic center where I work, salaries are public, and my colleagues in medical oncology with similar experience are making less than I do.
 
I'm just surprised that in these SCAROP meetings there is no talk of XRT being constantly re-contextualized to rapidly developing systemic therapy and personalized medicine. Did the whole indications thing come up at all?

If this does not resonate strongly with SCAROP folks, it's because they are neither treating or discussing in tumor board: breast, GI malignancies, lung, lymphoma, skin, GYN, or sarcoma

I don't know what most of the chairmen and women do anything besides prostate cancer a day or two a week. And that's if they're any percentage clinical at all.
 
  • Like
Reactions: 1 user
WAY MORE

I reserved the font and color choice for just this moment in time.
To be fair, ER docs are also being replaced by NP/PA, and we are not (**knocks on wood**)
 
  • Like
Reactions: 1 user
Well into the seven figures? lol

I am sorry, but this one is going to require a little bit more data than an anectdote. I can tell you that at the large academic center where I work, salaries are public, and my colleagues in medical oncology with similar experience are making less than I do.

I'm surprised. They're being hired here for double what I made last year. That data is not public here though.
 
  • Like
Reactions: 1 user
Well into the seven figures? lol

I am sorry, but this one is going to require a little bit more data than an anectdote. I can tell you that at the large academic center where I work, salaries are public, and my colleagues in medical oncology with similar experience are making less than I do.
"I don't need anecdotes..." (Gives anecdote.)

I kid.

Anecdotally I feel like academic med onc turnover is getting pretty high. Agree, disagree?

Did the whole indications thing come up at all?
No. And even if it did academic rad oncs think rad onc utilization is forever on the upswing (see Liu's SCAROP letter). So it's best it didn't come up because they would get the data all wrong anyways.
 
I can tell you that at the large academic center where I work, salaries are public, and my colleagues in medical oncology with similar experience are making less than I do.
What isn't listed publicly is how much they're making in suffering relief.
 
  • Love
Reactions: 1 user
I'm surprised. They're being hired here for double what I made last year. That data is not public here though.
I like the med oncs I work with, so I hope that they don't find out about the salaries at your hospital haha
 
  • Like
Reactions: 1 user
I like the med oncs I work with, so I hope that they don't find out about the salaries at your hospital haha

We had to increase med onc salaries quite a bit over the past few years since it was the only way to recruit and retain med oncs. Otherwise they just go to any of many neighboring health systems. If they are unhappy they have four hospital systems courting them at any given time and will just jump ship. I think we're still hiring, let me know if any are interested and I'll forward their info.

Rad onc does not have recruiting and retention issues. It's very rare that positions open up in this area in radiation oncology, and those that do have many applicants.

PS: Haven't been offered more than $6,000/week for a rad onc locums gig in at least five years.
 
  • Like
Reactions: 5 users
PS: Haven't been offered more than $6,000/week for a rad onc locums gig in at least five years.
Dude. I just got offered (the equivalent of) $8000/week two days ago! Only $17,000 or more a week on top of that and we will be making med onc money!

en26eGW.png
 
  • Wow
  • Haha
  • Dislike
Reactions: 2 users
Academic centers are the definition of vertical integration:

- labor force recruitment (students)
- labor force training (residents)
- employment of labor (satellite and main site attendings)
- certification of labor and labor units (ABR, APEx)
- superior payor rates
- superior political lobbying
- cherry-picking affluent communities across the country to drop a cobranded sign next to the hospital lawn gnome

Like HCA controls the EM residencies and employs EM grads, you see that dynamic in rad onc as well.

Who is playing oligopolist/monopolist here?
 
Last edited:
  • Like
Reactions: 3 users
Top