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We are running out of time to save our field before it permanently goes the way of the most undesirable of medical specialties. We need to show students and trainees that we hear their concerns and are actually taking concrete actions to address it. Make no mistake, we are in a war for the very survival of our field. While we may always match students, that was and will never be the question. There will always be those desperate enough to apply and those greedy enough to continue to take advantage of those poor souls. It is beneficial to us all to attract the most talented, bright young minds to our once proud and honorable field that is now a wasteland of terrible job opportunities and “leaders” looking out for their own personal interests rather than the field as a whole.

The current situation in rad onc is not what we want, to quote what so many have already said on SDN. We want our specialty to grow with new RT indications and techniques being pushed from academic centers to the community. We want to be able to look students in the eye and tell them truthfully that good jobs await them at the end of our long training and 4 board exams, the most in any specialty. To expect a non-predatory job where the rad onc collects their professional fees (in academics or private practice) in a geographic region near family is not entitlement, it is a noble aspiration that should be within reach of every rad onc graduate. While there are many threats to our field such as decreasing reimbursement through the idiotic APM and increasingly ridiculous hypofrac trials (stop all RT breast omission trials until you run at least a couple of biomarker stratified hypofrac RT vs 5 years endocrine therapy trials), what hurts the most is that much of the damage to our field is self-inflicted by our so-called “leaders”.

The massive residency overexpansion over the last many years is a huge issue that ASTRO can help solve, anti-trust concerns be damned. Take Louis Potters and Geraldine Jacobson into a side room and tell them, just close your horrible residency program, it is not needed nor wanted and we all know it. We all know the pressure that can be applied if those in power want to put the screws to someone – we have all seen it happen to someone else or felt it personally. For ASTRO leadership to use “anti-trust” concerns as a shield against doing anything such as applying real, back-room pressure on chairs and PDs is one of the largest abdications of responsibility by a professional organization facing a crisis in the history of modern medicine. To continue down this path is exploitative to trainees and hypocritical to the public messaging you have more recently espoused on “job market concerns” of the field. And guess what, it’s ok to make a mistake, just admit and move on. Don’t pull a Lisa Kachnic and Paul Wallner by doubling down on an indefensible position and victim shame residents who are working hard and studying for inane board exams (I still don’t know what TFIIH is, what it does, and how it is really relevant to the clinical practice of oncology). And what about the hospital systems and private equity firms doing the exact same thing as academic chairs by expanding, consolidating and then offering horrible job terms to rad oncs by skimming 30-50% of professional fees on top of taking all the technical fees? You do not blame the lion for slaying sheep for that is its nature. Sure, if those community hospital presidents or MBAs were rad oncs, we would blame them just as harshly too but they are not (don't worry we still blame them). Chairs, PDs, ASTRO leadership - you guys are all rad oncs and supposed to be on our team and that’s why your betrayal of the field for personal gain cuts so deep.

I do not completely blame our so-called “leaders” for their initial response by blaming “cyberspace” and SDN. It is human nature to seek out the “guilty party” in a time of tragedy when our field is attracting less competitive applicants with each passing year and seeing programs SOAP indiscriminately. It is a sign of strength to cry out against the declining prospects of rad onc and waning interest in our field, rather than to bow one's head and simply admit defeat. Inevitably, many have and will continue to fault us “doomsayers”, the hermits of SDN.

But we on SDN merely perform our duty. To fear us is redundant; to hate us, just dumb because we are not the root of the problem. Those more sensible will place responsibility with those who forced our hands to tell the ugly truth to students and residents everywhere. With some fortune, rad onc “leaders” may foster their SDN hatred into purpose and further rule their own fate, and the fate of rad onc, by joining us in the common goal of saving our field that we all love so much and know can be great again.

We all hope we can have more productive conversations going forward. You think we want to be on here trying to argue that metastatic disease is not a new disease site and actually metastatic disease exists on a spectrum of every disease site we already treat? You think I want to tell the International Code of Zoological Sciences I found a new species called “monke” in Penn’s basement that was calling for a palliative RT certification for rad oncs who had already been board certified and then published by a rad onc journal?

We want to stand united and fight the patient-killing apes at the satanic temple of eviCore and battle the ignorant bureaucratic demon chimpanzees at CMS pushing the APM because even if it isn’t affecting our dept or practice now, it will in 5 years when it is rolled out nationally. Let us come together and fight the real war against the true enemies of rad onc. But first, let us fix our goddamn field because it is a f*cking dumpster fire.

A tribute, with sound of course, to a true leader in our field, Simul the Great. Anyone can be a leader. You do not need to be a chair, sit on one of the 43 NRG subcommittees, or have 138 retrospective chart reviews all done by students and residents on your CV. You need willpower and courage to tell the truth and stand up for what you truly believe. If only more of us, myself included, could have half of his courage, we would all be in a much more beautiful place. Welcome to the war to save rad onc.

 
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ramsesthenice

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If we are going to bring GOT into this, I think the precipitous decline in story telling when they progressed passed the books (ie season 5) is highly analogous to our standing as a field overall since the early 2000s. I don't have time for photoshop, so i will let this speak for its self as is

1614034658962.png
 
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RickyScott

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To be honest, there is no escaping the fact that if all residencies were shut down (and current classes graduated), we would still be oversupplied in the 2030s. All we can do is warn the medstudents.
 
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RadsWFA1900

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We are running out of time to save our field before it permanently goes the way of the most undesirable of medical specialties. We need to show students and trainees that we hear their concerns and are actually taking concrete actions to address it. Make no mistake, we are in a war for the very survival of our field. While we may always match students, that was and will never be the question. There will always be those desperate enough to apply and those greedy enough to continue to take advantage of those poor souls. It is beneficial to us all to attract the most talented, bright young minds to our once proud and honorable field that is now a wasteland of terrible job opportunities and “leaders” looking out for their own personal interests rather than the field as a whole.

The current situation in rad onc is not what we want, to quote what so many have already said on SDN. We want our specialty to grow with new RT indications and techniques being pushed from academic centers to the community. We want to be able to look students in the eye and tell them truthfully that good jobs await them at the end of our long training and 4 board exams, the most in any specialty. To expect a non-predatory job where the rad onc collects their professional fees (in academics or private practice) in a geographic region near family is not entitlement, it is a noble aspiration that should be within reach of every rad onc graduate. While there are many threats to our field such as decreasing reimbursement through the idiotic APM and increasingly ridiculous hypofrac trials (stop all RT breast omission trials until you run at least a couple of biomarker stratified hypofrac RT vs 5 years endocrine therapy trials), what hurts the most is that much of the damage to our field is self-inflicted by our so-called “leaders”.

The massive residency overexpansion over the last many years is a huge issue that ASTRO can help solve, anti-trust concerns be damned. Take Louis Potters and Geraldine Jacobson into a side room and tell them, just close your horrible residency program, it is not needed nor wanted and we all know it. We all know the pressure that can be applied if those in power want to put the screws to someone – we have all seen it happen to someone else or felt it personally. For ASTRO leadership to use “anti-trust” concerns as a shield against doing anything such as applying real, back-room pressure on chairs and PDs is one of the largest abdications of responsibility by a professional organization facing a crisis in the history of modern medicine. To continue down this path is exploitative to trainees and hypocritical to the public messaging you have more recently espoused on “job market concerns” of the field. And guess what, it’s ok to make a mistake, just admit and move on. Don’t pull a Lisa Kachnic and Paul Wallner by doubling down on an indefensible position and victim shame residents who are working hard and studying for inane board exams (I still don’t know what TFIIH is, what it does, and how it is really relevant to the clinical practice of oncology). And what about the hospital systems and private equity firms doing the exact same thing as academic chairs by expanding, consolidating and then offering horrible job terms to rad oncs by skimming 30-50% of professional fees on top of taking all the technical fees? You do not blame the lion for slaying sheep for that is its nature. Sure, if those community hospital presidents or MBAs were rad oncs, we would blame them too but they are not. Chairs, PDs, ASTRO leadership - you guys are all rad oncs and supposed to be on our team and that’s why your betrayal of the field for personal gain cuts so deep.

I don’t completely blame our so-called “leaders” for their initial response by blaming “cyberspace” and SDN. It is human nature to seek out the “guilty party” in a time of tragedy when our field is attracting less competitive applicants with each passing year and seeing programs SOAPing indiscriminately. It is a sign of strength to cry out against the declining prospects of rad onc and waning interest in our field, rather than to bow one's head and simply surrender. Inevitably many have and will continue to fault us “doomsayers”, the autists of SDN.

But we on SDN merely perform our duty. To fear us is redundant; to hate us, just dumb because we aren’t the root of the problem. Those more sensible will place responsibility with those who forced our hands to tell the ugly truth to students and residents everywhere. With some fortune, rad onc “leaders” may foster their SDN hatred into purpose and further rule their own fate, and the fate of rad onc, by joining us in the common goal of saving our field that we all love so much. We all hope we can have more productive conversations going forward.

You think we want to be on here trying to argue that metastatic disease is not a new disease site and actually an extension of normal oncologic care? You think I want to tell the International Code of Zoological Sciences I found a new species called “monke” in Penn’s basement that was calling for a palliative RT certification for rad oncs who had already been board certified and then published by a rad onc journal? We want to stand united and fight the patient-killing apes at the satanic temple of eviCore and battle the ignorant bureaucratic jokers at CMS pushing the APM because even if it isn’t affecting our practice now, it will in 5 years when it is rolled out nationally. Let’s come together and fight the real war against the true enemies of rad onc. But first, let’s fix our goddamn field because it is a f*cking dumpster fire.

A video (turn your sound on) tribute to a true leader in our field, Simul the Great. Anyone can be a leader. You don’t need to be a chair, sit on one of the 43 NRG subcommittees, or have 138 retrospective chart reviews all done by students and residents on your CV. You need willpower and courage to tell the truth and stand up for what you truly believe. If only more of us, myself included, could have half of his courage, we would all be in a much more beautiful place. Welcome to the war to save rad onc.


Its a war alright...Think Germany 1944.
 
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evilbooyaa

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Derogatory names for SDN members will not be tolerated. The editors at SDN require major revisions to allow such a GIF to be in place, one that does not insult the SDN membership by using a derogatory term towards them.

Thanks for your submission to SDN. We will give you 30 days for a revision, please. Please let us know if, during this challenging time of COVID-19, you require a time extension.
 
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I've been reading the threads on residency spots and hell pit programs being commented on and trying to hold my tongue.

To everyone, with emphasis on those of us in academics with more face time with students and residents, do your damn duty. We are in a war to save our field. Do whatever you can to discourage students from going into the field and advocate at your own program for taking less residents/closing a spot. This is regardless of which program you are in. EVERY program needs to cut spots, not just the many hell pit programs out there.


Rad onc chair greed.JPG
 
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RadOncMegatron

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Here is my post from 2019 that is relevant to this thread.


BDC19263-350D-4760-9C3E-411A00CEBEEE.jpeg

Edit: Showing meme here so you don't have to expand below. Basically "SDN war" verbiage has been on this site for a while now...

I didn’t really think this day would come, but it appears what we’ve been saying here for years has finally come to the attention of the academic elite and have their full attention. SDN has spread the truth I believe, yes there has been some hyperbole, trolling, and yes frustration that could’ve been better said nonetheless I side with SDN far more than with the academic side.

I am hoping that when the next paper is published it will not be 10 authors from high powered institutions or else it will have no credibility.

One thing is for sure SDN folks, you didn’t think we would cause this kind of change, piss off the most important people in our field and not expect some major push back did ya? They blame you (me?) so brace yourself!

BDC19263-350D-4760-9C3E-411A00CEBEEE.jpeg
 
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fiji128

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I've been reading the threads on residency spots and hell pit programs being commented on and trying to hold my tongue.

To everyone, with emphasis on those of us in academics with more face time with students and residents, do your damn duty. We are in a war to save our field. Do whatever you can to discourage students from going into the field and advocate at your own program for taking less residents/closing a spot. This is regardless of which program you are in. EVERY program needs to cut spots, not just the many hell pit programs out there.


View attachment 331142

I ran the numbers. No one is actually closing spots permanently. Louisville was the only program to actually close spots from 8 to 6 and that probably has more to do with a decline in patient volume there then a desire to do good but I have no real insider info on it. Other programs unbelievably continued to expanded spots 2019 to 2021. On a plus many programs look to have open spots that they are actively not filling. However, they still aren’t officially contracting the program’s size so that could just be a temporary thing. It seems the only way forward to decrease spots permanently is program closure. Plenty of sub sub par programs out there that could be closed and no one would miss and the speciality would be better off for.
 
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metallica81788

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I wish there could just be a moratorium on RadOnc spots for two years - zero new residents. It would limit the "who should close or drop spots" talk and probably go a long way to solving things.

Even that wouldn't fix the hundreds of new grads already in the pipeline.
 
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medgator

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I wish there could just be a moratorium on RadOnc spots for two years - zero new residents. It would limit the "who should close or drop spots" talk and probably go a long way to solving things.

Even that wouldn't fix the hundreds of new grads already in the pipeline.
There's zero appetite to do anything substantive. At least a few decades ago, they closed down a number of spots and increased the residency length. Now they are just exploiting the situation with unaccredited fellowships
 
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fiji128

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I wish there could just be a moratorium on RadOnc spots for two years - zero new residents. It would limit the "who should close or drop spots" talk and probably go a long way to solving things.

Even that wouldn't fix the hundreds of new grads already in the pipelin
Maybe academics needs a choosing residents wisely campaign.
 
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RadOncMegatron

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Maybe academics needs a choosing residents wisely campaign.
ice cube friday movie GIF
 
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evilbooyaa

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Rad onc has an aging workforce, they just don't know when to quit

And they don't need to quit. Some to many large academic depts have an attending that is DANGEROUS without residents, who ensure that attending has 100% resident coverage to avoid real harm to patients.

The alternative are super old people in PP who get their ass kissed by junior partners, who also can't tell that person that they're practicing outdated medicine.

Nobody is eating the old in our field and aggressively pushing the fraction of old timers who have not kept up with the times (not every old attending as many are quite well read) out to pasture.
 
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metallica81788

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And they don't need to quit. Some to many large academic depts have an attending that is DANGEROUS without residents, who ensure that attending has 100% resident coverage to avoid real harm to patients.

The alternative are super old people in PP who get their ass kissed by junior partners, who also can't tell that person that they're practicing outdated medicine.

Nobody is eating the old in our field and aggressively pushing the fraction of old timers who have not kept up with the times (not every old attending as many are quite well read) out to pasture.

This problem is almost as big of a threat our field as the oversupply of residents.

Natural selection will eventually solve it, but probably 15-20 years too late in most cases.
 
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