The Declining Residency Applicant Pool: A multi-institutional medical student survey to identify precipitating factors

[elementaryschooleconomics]

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Simul just posted this paper on Twitter, out today:

The Declining Residency Applicant Pool: A multi-institutional medical student survey to identify precipitating factors

Co-authored by some of our favorite people!

Abstract:

Purpose
To better understand and identify concerns that may be responsible for the declining radiation oncology residency applicant pool.

Methods and materials
All RO residency programs affiliated with a US medical school were asked to participate in the study survey. An optional and anonymous survey consisting of twelve questions was emailed to all graduating medical students in 2020 at the twelve allopathic medical schools that agreed to survey administration. Survey responses were collected from March to May 2020.

Results
The study consisted of 265 survey responses out of 1766 distributed to eligible medical students, resulting in a response rate of 15.0%. The majority of students reported no exposure to RO (60.8%) and never considered it as a career option (63.8%). Neutral perceptions of the field were more common (54.3%) than positive (39.6%) and negative (6.0%). The top factors attracting medical students to RO were perceptions of high salary, favorable lifestyle and workload, and technological focus. The top negative factors were the field’s interplay with physics, competitive USMLE board scores for matched applicants, and the focus placed on research during medical school. In the subgroup of students who were interested in RO but ultimately applied to another specialty, the job market was the most salient concern.

Conclusions
Finding a place for RO in medical school curricula remains to be a challenge with most surveyed students reporting no exposure during their education. Concern over the job market was the primary deterrent for medical students interested in pursuing RO. For disinterested students who had not considered RO as a career option, the required physics knowledge was the main deterrent.

They again beat the dead horse that we need to expose medical students to RadOnc (which I agree with, in the context that it's good for future physicians to know when to explore radiation as a treatment option for patients, but I disagree with in the context of recruiting students into the field).

The real kicker is the last line in the last paragraph:

"Misperceptions"? What misperceptions? The misperception by elderly academic faculty who graduated medical school in the 1970s that the job market is fine?

The best part is that this survey was conducted and paper written before the APM announcement. Since APM dropped, I have heard faculty in my ivory tower department very negative about the future, something which is totally new from them.

 

[Gfunk6]

This article and its laughable conclusions make about as much sense as telling a patient with a gangrenous infection of the leg to simply take Tylenol to reduce his fever.

If you want to fix the problem (without killing the patient) - YOU"VE GOTTA AMPUTATE!

EDIT - Ok, I read the proof. The authors conclude that for medical students who have had RO exposure, the job market concerns remain "salient." (Well at least they've finally admitted this)

Rather than coming up with the logical conclusion to fix the job market via residency expansion, they instead want to include more RO exposure in the medical school curriculum. The idea is that if you have enough people exposed to RO, a few will be stupid enough to actually train in RO (e.g. if you increase the denominator, the numerator will necessarily increase).

EDIT2 - They, of course, make it a special point to say that recruitment of women and URMs is vital.

EDIT3 - I wonder if this article can be considered "hate speech." You are taking historically under-represented groups and deliberately putting them in a field which has no future. You are excluding white males who will potentially not share a similar fate.

 

[OTN]

The first author is a PGY-2 who just did her first GBM contours last month, per her Twitter. Let me reiterate that: a PGY-2 resident wrote, as a first author, in a national journal, that concerns about the post-training job market are misperceptions. Given that the paper was just published, this suggests the paper was written while she was still an intern and had not yet even begun PGY-2 training.

While I know how "mentorship" works in academia, and I have no doubt she was pressured/outright told to write that, she now gets to own such a ridiculous statement.

Come ON, Wallner and Steinberg. At least write the propaganda yourself.

 

[MegaVoltagePhoton]

The author list includes Mike Steinberg (lol) and Paul Wallner (double lol). Senior author Raldow I don’t know personally but this is not very insightful if it’s what she can do as an “academic”.

feel very bad for the first author. if she really is a brand new pgy-2 like otn said....Yikes probably not the best introduction.

 

[deleted605854]

I hope the author of this...err....drivel documents her journey through rad onc more extensively on twitter. I anticipate a fellowship in "the future of radiation oncology" followed by a "head and neck IORT" fellowship in the years to come.

 

[elementaryschooleconomics]

Hmm, what do the authors suggest here? Given the top concerns:

1) Job market: either spin the truth (ahem, lie) and tell them everything is alright, or confirm their concerns and affirm their decision to go elsewhere

2) Physics: the ABR continues to inflict some of the most ridiculous board exams on its residents, shows no sign of change, and when there was a high failure rate in 2018 blamed the "poor quality of the residents"

3) USMLE scores: well, the specialty isn't competitive anymore and Step 1 is going pass/fail so...moot point

Actually this paper/survey confirms what we know: medical students are smart and understand the issues. Out of the three top concerns the only one to be "addressed" is the erroneous belief you need an outstanding Step 1 score - you don't. Terrible job market and archaic physics demands? Check and check.

 

[evilbooyaa]

It's unfortunate that this PGY-2 who has no direct knowledge of job market issues got pulled into this old gomer pissing contest. She is very bright and will likely come to regret publishing the wallner/steinberg/#radoncrocks talking points when she is a PGY-5 struggling to find a job. It's like being the white house press secretary - forced to be the mouthpiece for old white men.

UCLA (Radlow, McCloskey, and Steinberg) - do better.

@OTN I get it's a national journal, but I mean it is ADVANCES. Not IJROBP, not PRO. It's like the cureus of ASTRO - literally anything remotely rad onc related can get published there.

 

[Neuronix]

The job market is mostly controlled by academics. You want a job? Go to academic satellite. Want that job? Please your academic attendings. Even in private the biggest A is affability. To be agreeable and pleasant is the best policy for residents. We're breeding sheep in this specialty but in my opinion it's by design.

In other words:

Don't hate the player (the PGY-2), hate the game.

Also the paper's conclusions are a joke. They just totally dismiss job market concerns as "misconceptions". More CV padding for the authors who will do nothing to fix the real problems in this specialty of inconsistent and excessive board exams and overtraining.

 

[MegaVoltagePhoton]

I don't think anyone hates the first author. Clearly not her fault here.

 

[RickyScott]

The job market is mostly controlled by academics. You want a job? Go to academic satellite. Want that job? Please your academic attendings. Even in private the biggest A is affability. To be agreeable and pleasant is the best policy for residents. We're breeding sheep in this specialty but in my opinion it's by design.

In other words:

Don't hate the player (the PGY-2), hate the game.

Also the paper's conclusions are a joke. They just totally dismiss job market concerns as "misconceptions". More CV padding for the authors who will do nothing to fix the real problems in this specialty of inconsistent and excessive board exams and overtraining.

Steinberg earns 1 mill/year after having sold his practices for tens of millions. Almost no jobs in SoCal, but trying to con students into filling his residency for note taking and spewing out trash research.

 

[elementaryschooleconomics]

The job market is mostly controlled by academics. You want a job? Go to academic satellite. Want that job? Please your academic attendings. Even in private the biggest A is affability. To be agreeable and pleasant is the best policy for residents.

This is my survival policy. Sadly, this is how I find myself responsible for another textbook chapter after swearing up and down I wouldn't write anything else this year.

But when a senior faculty member asks you in-person in the middle of a sim to help them out...the only answers are "yes" or "definitely".

 

[MegaVoltagePhoton]

Steinberg earns 1 mill/year after having sold his practices for tens of millions. Almost no jobs in SoCal, but trying to con students into filling his residency for note taking and spewing out trash research.

while i definitely agree in general, there actually is good research coming out of UCLA rad onc. which is why i am disappointed to see this, but not surprised.

 

[Chartreuse Wombat]

This is my survival policy. Sadly, this is how I find myself responsible for another textbook chapter after swearing up and down I wouldn't write anything else this year.

But when a senior faculty member asks you in-person in the middle of a sim to help them out...the only answers are "yes" or "definitely".

You have moral agency. Just say no otherwise the nonsense is perpetuated.

 

[MegaVoltagePhoton]

Really hard to blame the resident here. As OTN said, if she's a PGY-2 now, she was literally an intern when doing this survey project (which seems pretty dumb to begin with, and had a crap response rate). Probably asked for an easy project to do. Blame is on the senior author and whoever else is in leadership. Wallner on it is just hilarious.

 

[Ray D. Ayshun]

You have moral agency. Just say no otherwise the nonsense is perpetuated.

Is having a resident write a chapter any more nonsensical than having an attending? Nobody is searching for state of the art from 2 years ago. We should all revolt against book chapters.

 

[elementaryschooleconomics]

You have moral agency. Just say no otherwise the nonsense is perpetuated.

True. I guess to drill down into my specific scenario, this is the one faculty member who has consistently had my back throughout all of residency and I'm happy to help out based on that fact alone...in addition to my general policy of trying to be affable.

But to the larger point, it's hard to say "no" when faculty directly ask for you to be involved in projects/writing (this obviously extends beyond RadOnc to all of medicine). There's always a line I feel like you need to walk to balance your perception in a department. Early in residency if you turn down things you'll potentially be seen as aloof/disinterested/not committed to your training etc, and opportunities might pass you by later on if faculty don't have positive vibes with you. If you turn things down late in residency you might be seen as "checked out"/"senioritis"/etc and attendings might respond in kind ("if he's not interested in scholarship then I'm not interested in teaching", "guess he didn't want a strong endorsement for that job").

I approach this as just one type of currency I have to spend in my political capital. Being affable/agreeing to work on projects that I might not want to do could help buffer me when I push back on something else or ask for references, etc.

Is having a resident write a chapter any more nonsensical than having an attending? Nobody is searching for state of the art from 2 years ago. We should all revolt against book chapters.

This is definitely true. I'm not sure what the point of these chapters are anymore. I have Twitter.

Really hard to blame the resident here. As OTN said, if she's a PGY-2 now, she was literally an intern when doing this survey project (which seems pretty dumb to begin with, and had a crap response rate). Probably asked for an easy project to do. Blame is on the senior author and whoever else is in leadership. Wallner on it is just hilarious.

I would bet a year's salary that this is the case. She was probably trying to get a jump on research and this is the result. Whether she asked for an easy project, or came up with this idea on her own, or was asked to do it by one of the senior authors - we'll probably never know. But now she's a published author for the party line of the ABR, on a paper with her chair, and her work is being discussed on the misanthropic SDN and Twitter. I'm sure UCLA has seen this thread, and Simul's thread on Twitter. They'll circle the wagons, and I'm sure someone will defend this somewhere (it's happening to a degree on Twitter right now).

 

[elementaryschooleconomics]

Here's my favorite argument, buried in Twitter, talking about the physics issue highlighted in the paper:

Obviously I'm with Mudit and Ashwin here.

 

[deleted941485]

Here's my favorite argument, buried in Twitter, talking about the physics issue highlighted in the paper:

View attachment 320984

View attachment 320985

View attachment 320986

Obviously I'm with Mudit and Ashwin here.

I mean look what happened to anesthesiology when they tried to emphasized the value of experience and training relative to their CRNA counterparts. Nothing! They got steamrolled over supervisions

Disease site or modality it doesn’t matter, if there’s one thing I’ve learned living in this country it’s that no one will ever let a lack of expertise get in the way of making another dollar. Ever

You can’t play by the rules of you want to get ahead.

 

[Krukenberg]

Here's my favorite argument, buried in Twitter, talking about the physics issue highlighted in the paper:

View attachment 320984

View attachment 320985

View attachment 320986

Obviously I'm with Mudit and Ashwin here.

Totally agree with Ward. SDN complains about all the ways rad onc is hurting itself, but you guys want to lower barriers to entry of other physicians prescribing radiation? Our only ownership is over a modality, not disease site. We need to do everything we can to justify our ownership over ionizing radiation. If regulators see us dropping standards then our board certification means less. We can’t own the modality just by knowing about clinical indications. ENT, urology, neurosurgery can certainly justify that they are knowledgeable about the indications for radiation in their disease sites. What they lack in the eyes of regulators is physics and rad bio training

 

[RickyScott]

No radonc wants to lower the barriers. There is just nothing we can do short of legislation which could never pass. (Never heard of any legislation in any area of medicine restricting practice to one specialty)

 

[deleted605854]

-The issue isn't board exams: Look at Canada.

it's not the board exam. It's legislation

Have the ABR certify graduates prior to them finishing residency, none of this sitting exams after residency nonsense.

Pass legislation that therapeutic ionizing radiation can only be given by a board-certified radiation oncologist. Done.

 

[Krukenberg]

No radonc wants to lower the barriers. There is just nothing we can do short of legislation which could never pass. (Never heard of any legislation in any area of medicine restricting practice to one specialty)

What! There are multiple people on here and on Twitter calling for ABR physics and rad bio to be abolished or substantially weakened. That is totally lowering the barriers

 

[Krukenberg]

-The issue isn't board exams: Look at Canada.

it's not the board exam. It's legislation

Have the ABR certify graduates prior to them finishing residency, none of this sitting exams after residency nonsense.

Pass legislation that therapeutic ionizing radiation can only be given by a board-certified radiation oncologist. Done.

Of course legislation is the gold standard, but how will lowering certification standards do anything to convince a legislator that you are arguing in good faith?

 

[elementaryschooleconomics]

What! There are multiple people on here and on Twitter calling for ABR physics and rad bio to be abolished or substantially weakened. That is totally lowering the barriers

The barrier is "Board Certification by the American Board of Radiology".

Currently, to surpass that barrier you must complete 5 years of ACGME-certified training in Radiation Oncology (well, 1+4), and pass four separate board exams.

Cutting out the 2 basic science exams does not lower the barrier in any meaningful way. The other specialties/non-RadOncs utilizing XRT (Derm) are not affected by this at all. The only ones affected by the basic science exams are the people who are already nearly done with the 5 years of training. If this was a common aspect of other specialties (some sort of basic science board exam 2/3rds of the way through training) then alright, whatever. However, to my knowledge, we're the only specialty which you can Match into directly from medical school with exams of this nature (please someone, correct me if I'm wrong on that).

When you're doing something no one else is doing just because that's the way it has always been done...at some point, you really need to examine why.

 

[OTN]

Physics exams make a ton of sense.

Bio exams never have and never will. All specialties in medicine deal with “biology”. None of them have to take a biology exam.

 

[RickyScott]

Of course legislation is the gold standard, but how will lowering certification standards do anything to convince a legislator that you are arguing in good faith?

There is less than zero chance of laws passing. Dermatologists could legitimately argue 1)they treat more skin cancer with radiation than radiation oncologists. 2) they have +10x training and experience managing skin cancer. I dont want to see testing abolished. We need it more than ever now that field is absolute bottom of the barrel specialty. There are some bona-fide *****s at the door.

 

[thecarbonionangle]

It is very funny to me that some people believe these bs exams are some “barrier” to others taking what we do. Such magical thinking! I got a real good bridge to sell. Everyone has a plan until reality has a way to punch you in the jaw

 

[medgator]

It is very funny to me that some people believe these bs exams are some “barrier” to others taking what we do. Such magical thinking! I got a real good bridge to sell. Everyone has a plan until reality has a way to punch you in the jaw

ASTRO thought board-certified radiation oncologists practicing radiation oncology with urologists was "taking" what they did. And we all know how that turned out

 

[Mandelin Rain]

Can you imagine surgeons praying that congress restricts the use of scalpels to board certified surgeons?

That's what is being argued here.

The linac is our scalpel. That is all. Hoping for some legislation to restrict it's use is insane and useless energy.

 

[RickyScott]

Can you imagine surgeons praying that congress restricts the use of scalpels to board certified surgeons?

That's what is being argued here.

The linac is our scalpel. That is all. Hoping for some legislation to restrict it's use is insane and useless energy.

dermatologists treat so much more skin cancer with radiation than we do. They would argue that radoncs should be banned! (I disagree but in a court of law etc they can make a better case to ban us than visa verse). a legislative monopoly is a delusion of power for a very weak and small interest group like Astro that can’t get its own house in order.
This is the problem with attaching our specialty to a modality. will be happening in urology in 10 years.

 

[radiaterMike]

There already is some limitation on who can utilize radiation. The NRC (and states that have their own regulations) control who can administer radiation to patients. Neurosurgeons cannot administer SRS without a radiation oncologist involved. As already mentioned, urologists cannot prescribe IMRT for prostate cancer (though they can own the machines if they want, as can medical oncologists, venture capitalists, shareholders of a publicly traded company ...). The superficial RT and electronic brachytherapy machines are outside of the purview of the NRC because the energy is so low. So there is a risk of radiation oncologists losing skin cancer cases (as is already happening) as well as breast cancer (with IORT with these machines). But I do not fear surgeons taking this on - they have enough other things to worry about than taking on a specialty with declining reimbursements.

EDIT- just saw that someone else posted this in another (more relevant) thread. I may be wrong about NRC (maybe their regulations just apply to brachy, unsealed sources and gamma knife ?) Found this on the web - Regulation and Radiation Medicine - Radiation In Medicine - NCBI Bookshelf and this NRC 10 CFR | Oncology Medical Physics

EDITS- as per above - yes I was wrong. NRC affords some protections, but newer technology (ZAPP instead of gamma knife, electronic brachy instead of 'real' brachy ....) circumvent these.

 

[Mandelin Rain]

Maybe I’m completely wrong, but What I seem to remember is that the NRC has absolutely nothing to do with linear accelerators. States oversee them.


What law states neurosurgeons can’t deliver SRS? There’s a whole machine developed to market direct to neurosurgeons called Zap.

 

[bergonieandtribondeau]

It is very funny to me that some people believe these bs exams are some “barrier” to others taking what we do. Such magical thinking! I got a real good bridge to sell. Everyone has a plan until reality has a way to punch you in the jaw

I completely agree with what's already been said here. There is little Rad Onc has done to defend itself from the encroachment of other medical specialties in the past, and I'm not terribly optimistic that they will suddenly stand firmer ground in the future. Exams are completely meaningless here and have absolutely no impact on "preventing" other fields like Derm, Uro, IR, NSGY and others from taking radiation treatments into their own hands as they already have. These have always been the dangers of a medical field based upon a treatment modality rather than a disease or anatomic site. If other people can figure out how to do it, can make money from it, and don't have to put up a huge fight to do so, they will take things into their own hands. I vaguely remember a Red Journal article from a few years ago that Anthony Zietman wrote basically talking about this exact thing, with mutterings of finding ways to re-combine Rad Onc with Radiology to broaden capacities in the future; the vast majority of polled Rad Onc residents being in favor of the expanded training change.

I see the major barrier to "usurping" types of RT as simply one of degree; in other words, if the treatment technique is sufficiently complex and requires a more advanced understanding of radiation/physics therein, then that will ultimately be left to Rad Onc. EBRT for non-skin, protons, carbon ions, will always be us. But who knows how wide of a net that is going to be in the future? And how many Rad Oncs will be needed to do carry out those treatments?

IMO, the gauntlet of board exams for Rad Onc are a vestige of a previous era, with dubious relevance to clinical practice or "ownership" of radiation treatment. This quantity, quality, and difficulty of these exams for residents would not fly in any other field.

 

[evilbooyaa]

Other fields used to have more 'basic science-y' exams. Radiology used to have dedicated physics boards IIRC? Now they've gotten rid of that. Don't think anybody sees Radiology eliminating that and the oral exam and thinks Radiologists are any less trained than they were.

Rad Onc is the only residency (not fellowship, as cards fellows for example do an inordinate amount of board exams as well, but not ALL are mandatory for each and every fellow) that has 4 board exams. What's the utility of squawking about "maintaining standards"?

 

[thecarbonionangle]

Maybe I’m completely wrong, but What I seem to remember is that the NRC has absolutely nothing to do with linear accelerators. States oversee them.


What law states neurosurgeons can’t deliver SRS? There’s a whole machine developed to market direct to neurosurgeons called Zap.

my understanding is there is nothing stopping neurosurgeons from getting a Zap. It is being directly marketed to them. it is only a matter of time. I’m sure our board exams will protect us folks!

 

[FrostyHammer]

my understanding is there is nothing stopping neurosurgeons from getting a Zap. It is being directly marketed to them. it is only a matter of time. I’m sure our board exams will protect us folks!

This is what we get for "being too nice" to involve other specialists for absolutely nothing. About 5 months ago we had a thread called "SRS and neurosurgery consults" where we touched on this issue. Part of the problem are viewpoints like those I pasted below from that discussion (no offense GFunk). If our specialty is bent on "reciprocity" and "being too nice" and "appeasement re-referrals" (which work just about as well as "appeasement politics"), we are just begging for these other specialities to take over our jobs and duties - then in that case we shouldn't really complain that machines are being directly marketed to neurosurgeons, because we literally shot ourselves in the foot.

There are really two issues at play in involving Neurosurgeons in SRS. The first is on the clinical side (this is much less relevant now then it was 20-30 years ago) and the second is on the camaraderie/teamwork/referral side.

On #1, to the extent that is possible I try to refer all of my SRS patients to a Neurosurgeon. I will freely admit that this can slow down the treatment planning process and is not always useful clinically. However, I find their input indispensable for functional SRS (TGN, AVM) and for resection cavity cases (no one can contour as well as the person who saw the region you are treating intraoperatively).

#2 is as critical if not more so. Neurosurgeons have their own unique billing codes which allows them to rightfully charge for their services. Also, it is human nature to want to reciprocate referrals to those who send patients to you. This is the most important. During supervision of potentially long SRS cases, there is a great opportunity to dialogue with the Neurosurgeon about any number of topics of mutual interest.

 

[thecarbonionangle]

This is what we get for "being too nice" to involve other specialists for absolutely nothing. About 5 months ago we had a thread called "SRS and neurosurgery consults" where we touched on this issue. Part of the problem are viewpoints like those I pasted below from that discussion (no offense GFunk). If our specialty is bent on "reciprocity" and "being too nice" and "appeasement re-referrals" (which work just about as well as "appeasement politics"), we are just begging for these other specialities to take over our jobs and duties - then in that case we shouldn't really complain that machines are being directly marketed to neurosurgeons, because we literally shot ourselves in the foot.

IR pioneered interventional cardiology as well as interventional vascular neurology. The cardiologists took it. The neurosurgeons have largely taken over interventional neuro (aneurysms, coils etc). This is what happens when we do not own anything and as you say, we are our worst enemies. We have involved the neurosurgeon for no clear reason, basically scratch my back and i scratch yours, for a majority of cases, and now they own the brain and are damn sure they can do what you do. not looking good folks! It is only a matter of time until zap systems are developed for other applications. Peripheral lung tumor that needs sbrt? Just zap it pulmonologist, draw a circle!

i have seen Adler’s comments in the radiosurgical society message boards. He speaks confidently in recs regarding dose and constraints and he is almost always right! Let’s not kid ourselves here, these people are sharp and can learn it.

 

[RickyScott]

Neurosurgeons invented gamma knife, cyberknife, zap, and from what I am told the original nomos imrt?

 

[Chartreuse Wombat]

Neurosurgeons invented gamma knife, cyberknife, zap, and from what I am told the original nomos imrt?

Mark P. Carol Inventions, Patents and Patent Applications - Justia Patents Search

USPTO patent applications submitted by and patents granted to Mark P. Carol

patents.justia.com

At least we gave him an honorary medal

Neurosurgeon Mark P. Carol Honored by ASTRO For Contributions to IMRT, IGRT

The American Society for Radiation Oncology (ASTRO) has named Mark P. Carol, M.D., a distinguished leader in the fields of intensity modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT), as its 2012 Honorary Member, which is the highest honor the society bestows upon...

www.itnonline.com

Maybe we should ask for the medal to be returned as he was(is) pushing HIFU

 

[deleted605854]

IR pioneered interventional cardiology as well as interventional vascular neurology. The cardiologists took it. The neurosurgeons have largely taken over interventional neuro (aneurysms, coils etc). This is what happens when we do not own anything and as you say, we are our worst enemies. We have involved the neurosurgeon for no clear reason, basically scratch my back and i scratch yours, for a majority of cases, and now they own the brain and are damn sure they can do what you do. not looking good folks! It is only a matter of time until zap systems are developed for other applications. Peripheral lung tumor that needs sbrt? Just zap it pulmonologist, draw a circle!

i have seen Adler’s comments in the radiosurgical society message boards. He speaks confidently in recs regarding dose and constraints and he is almost always right! Let’s not kid ourselves here, these people are sharp and can learn it.

Before the end times, back in Jan 2020. I sat down with a good Neurosurgeon buddy of mine. We had some beers and he told me that even though he does not like SRS, he wants to be good at it. I asked why? His response was something along the lines of it paying well and would be good to do when he wants to lower his OR time as he gets older. He said he might be on his 4th marriage at the time and the money would be nice.

 

[Gfunk6]

Neurosurgeons invented gamma knife, cyberknife, zap, and from what I am told the original nomos imrt?

This, a million times, this.

We can pontificate all day about Neurosurgeons but they invented the ****ing platform that we use.

 

[thecarbonionangle]

Neurosurgeons invented gamma knife, cyberknife, zap, and from what I am told the original nomos imrt?

yes an embarrassment for our field is that all of this was pioneered by them

 

[deleted605854]

This, a million times, this.

We can pontificate all day about Neurosurgeons but they invented the ****ing platform that we use.

Maybe rad onc departments should encourage these pursuits?

 

[MegaVoltagePhoton]

Yes. Let's please try our best not to **** on new technologies.

 

[scarbrtj]

i have seen Adler’s comments in the radiosurgical society message boards. He speaks confidently in recs regarding dose and constraints and he is almost always right! Let’s not kid ourselves here, these people are sharp and can learn it.

We can pontificate all day about Neurosurgeons but they invented the ****ing platform that we use.

Dudes. Just because Adler invented a radiosurgery device and did a fellowship under Lars Leksell, the neurosurgeon who literally invented stereotactic radiosurgery (and thus by virtue SBRT), doesn't mean he knows the first thing about radiation oncology. Wah.

 

[FrostyHammer]

This, a million times, this.

We can pontificate all day about Neurosurgeons but they invented the ****ing platform that we use.

Yup...that is consistent with many other devices such as the stent, which was invented by a radiologist (Julio Palmaz) and yet is probably not used by a single radiologist/IR in the world.

 

[thecarbonionangle]

Dudes. Just because Adler invented a radiosurgery device and did a fellowship under Lars Leksell, the neurosurgeon who literally invented stereotactic radiosurgery (and thus by virtue SBRT), doesn't mean he knows the first thing about radiation oncology. Wah.

ya man i mean he doesn’t have those very important “biology” and “physics” boards. Clearly does not know much!

 

[Mandelin Rain]

ya man i mean he doesn’t have those very important “biology” and “physics” boards. Clearly does not know much!

The thing is, he doesn't need to know nodal stations to cover for a T2 unilateral tonsil or when to treat endometrial cancer with cylinder vs EBRT. He just needs to be able to identify structures on a brain MRI, circle them, and allow a standardized dose constraint sheet to guide thought process on treatment.

Similar to what he'd do with a knife, but like a thousand times easier and less acute.