What is the problem...can one define it? Let your voice be heard...

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RickyScott said:
If there is a just risk of oversupply (and 100% will agree that exists), who would even consider the specialty given alternatives like medonc.
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Exactly why you don't go ramping up your oil well construction when a barrel of oil is going for rock bottom prices. I don't know where my analogy is exactly going now but rad onc hit and passed Peak Oil a while back 😉
 
Dan Spratt said:
As promised happy to share my slides from SCAROP meeting and discuss with anyone how the convo went and things I learned. Says pptx is not supported when I try to attach. Happy to share them
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@Neuronix @evilbooyaa

Any way for Dan to email to you guys and you upload to SDN for a public downloadable link
 
Lol, what’s the point? I’m sure the final conclusion is the same.

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TheWallnerus said:
Exactly why you don't go ramping up your oil well construction when a barrel of oil is going for rock bottom prices. I don't know where my analogy is exactly going now but rad onc hit and passed Peak Oil a while back 😉
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The issue is that producers of oil get paid for their product which follows laws of supply and demand, while producers of residents get "paid" for making the product regardless of if the product sells.
 
Dan Spratt said:
As promised happy to share my slides from SCAROP meeting and discuss with anyone how the convo went and things I learned. Says pptx is not supported when I try to attach. Happy to share them
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Sure email them to me at [email protected], I'll get it uploaded one way or another.
 
Dan Spratt said:
Changes

Challenge accepted.

PowerPoint slides.
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Dan strikes me as a man who finds 3-button suits inefficient and is actively trying to find a way to put his pants on two legs at a time.

I would love to commission his brother to create a retro movie poster featuring Chairman Spratt battling prostate cancer - and ketchup, and anonymous internet misanthropes - but, after reviewing his portfolio and past clients, I'm 100% sure I can't afford it, because I'm an attending Radiation Oncologist in 2022, not 2002.
 
Dan Spratt said:
State what was presented in 1 short sentence, please. Thanks!

Challenge accepted.

PowerPoint slides.
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(this joke only works for 1970s and earlier when technology didn't exist to trace calls to a location)

Man uses phone...
MAN: "Hello, fire department... my house is on fire! Please send help!"
FIREMAN: "Yes sir! How do we get there?!"
MAN: "Well hell ain't you all still got them red fire trucks?!"
 
RealSimulD said:
😂

I’ve seen the slides.

Don’t expect a panacea or catharsis. Dan is one person and he has his own constituency there to satisfy. “Anti - trust” keeps coming up as the biggest cock-block.
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Sounds like ASTRO will let you give a PowerPoint presentation, but not an illegal PowerPoint presentation.

CONSTITUTION: All speech is free.
ASTRO: Yes. Except if you're speaking about how many rad oncs there should be... then, you're a criminal.

HixhLem.png
 
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RealSimulD said:
😂

I’ve seen the slides.

Don’t expect a panacea or catharsis. Dan is one person and he has his own constituency there to satisfy. “Anti - trust” keeps coming up as the biggest cock-block.
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let’s see them!
 
TheWallnerus said:
Sounds like ASTRO will let you give a PowerPoint presentation, but not an illegal PowerPoint presentation.

CONSTITUTION: All speech is free.
ASTRO: Yes. Except if you're speaking about how many rad oncs there should be... then, you're a criminal.

HixhLem.png
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Lock ‘em up!!
 
Anti-trust as bogus as it gets. I cannot imagine anti-trust applying to a "recommendation" from an entity such as SCAROP to reduce spots, made publicly and impacting individual institutions not by mandate but by culture.

SCAROP could address this with a couple sentences.

"SCAROP recommends a marked reduction in residency training positions nationally. The most equitable path forward is for each department to consider a 50% reduction in trainees to be accomplished over a 3 year period."

Maybe that's in one of the slides?
 
communitydoc13 said:
Anti-trust as bogus as it gets. I cannot imagine anti-trust applying to a "recommendation" from an entity such as SCAROP to reduce spots, made publicly and impacting individual institutions not by mandate but by culture.

SCAROP could address this with a couple sentences.

"SCAROP recommends a marked reduction in residency training positions nationally. The most equitable path forward is for each department to consider a 50% reduction in trainees to be accomplished over a 3 year period."

Maybe that's in one of the slides?
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I think that quote was represented by the boy in the slide. The PM represented trial lawyers.
 
OTN said:
"And as far as I can tell, all the research is being done by docs at nci centers and suggests worse care at non-nci centers."

My wealthiest and healthiest patients are the ones who make it to tertiary care centers. The sicker and poorer ones are those who cannot travel and stay in the community for care. In my opinion the difference in outcome between NCI centers and non-NCI centers is fully explained by socioeconomic factors.
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I love hypofractionation, but I’ll be the first to admit that in my rural patients (of which I have many), I sometimes have no other choice but to use suboptimal hypofractionated regimens when the alternative is no treatment. Can’t do low-toxicity, curative intent 5 fr for everything even if you want.
 
What exactly are the damages and who are the parties that would bring a suit in an anti trust case?

There is no army of med students just dying to get into rad onc and can't do so. Who is being harmed by training less rad oncs? There is now loads of data showing a disconnect between training more doctors and filling rural positions, so it's not like if you cut spots you make it harder to fill Rhinelander.

I contend their biggest threat of lawsuit is a group of disgruntled residents or early career rad oncs that were lied to regarding career opportunities and/or can show collaboration from chairs to intentionally flood the market to drive down costs.
 
BobbyHeenan said:
I contend their biggest threat of lawsuit is a group of disgruntled residents or early career rad oncs that were lied to regarding career opportunities and/or can show collaboration from chairs to intentionally flood the market to drive down costs.
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Yup.
 
BobbyHeenan said:
I contend their biggest threat of lawsuit
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Nah. The biggest threat is one of the SCAROP members themselves initiating a lawsuit on behalf of their own institution. It would be frivolous of course, but I think its the threat of frivolous chairs that is now the real "cock-block" to change.
 
communitydoc13 said:
Nah. The biggest threat is one of the SCAROP members themselves initiating a lawsuit on behalf of their own institution. It would be frivolous of course, but I think its the threat of frivolous chairs that is now the real "cock-block" to change.
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I didn't even think of that.
So one of the chairs that wants to expand ("just look at our volumes, we NEED more residents, we DESERVE more residents") but is "blocked" and so files anti-trust?

That makes sense.
 
Dan Spratt said:
Great points. I think radonc needs to expand more like how clinical oncologists have done in the UK to give systemic therapies, and at minimum radiopharm. I may be fortunate, but have spoken to many private practice radoncs who do the same, but I write for all oral ARSIs and are getting our hot lab up in radonc to deliver 177Lu-PSMA. I am also lucky, but lead many drug trials and work with pharma to help inform future work with combination drug-RT, and radoncs are uniquely suited for many of these roles given our vast knowledge of cancers across the body and various treatments. We also have more and more biomarkers being developed and play important roles at tumor boards.

I just worked with our newest faculty recruit who is amazing to put out 2 papers in PRO on how to use radiopharm and stressed the importance of radonc being involved. Hope they come online soon.
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Great to hear you write all oral ARSIs. What differentiates US RadOncs from clinical oncologists the world over is not knowledge but prescribing drugs and managing potential after effects.
We stage the diseases and know the next lines of treatment and it takes nothing to prescribe these medications or treat their side effects. We are physicians for God’s sake! ER physicians and GPs manage these SE in most climes.

MedOnc + Heme training takes 3 years while sole Med Onc training used to be available for 1 year. Can we give residents the option of using the “research year” to do medical oncology and become trained clinical oncologists?

We don’t need permission from ABIM to do this just like dermatologists didn’t get ABR certification to use LINACs and GyneOncs didn’t need permission from anywhere to give chemotherapy. We can and should have options. This will make us well rounded oncologists (Clinical Oncs are recognized as the leaders of tumor boards) and we don’t even have to bother much about inpatients in this era of hospitalists doing everything and just asking for recommendations.
 
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DrAdonis said:
Great to hear you write all oral ARSIs. What differentiates US RadOncs from clinical oncologist the world over is not knowledge but prescribing drugs and managing potential after effects.
We stage the diseases and know the next line of treatment and it takes nothing to prescribe these medications or treat their side effects. We are physicians for God’s sake! ER physicians and GPs manage these SE in most climes.

MedOnc + Heme training takes 3 years. Med Onc only training used to be available for 1 year. Can we give residents the option of using the “research year” to do medical oncology and become trained clinical oncologist?

We don’t need permission of ABIM to do this. Dermatologist didn’t get ABR certification to use LINACs, GyneOnc didn’t need permission from anywhere to give chemotherapy. We can and should have options. This will make us well rounded oncologists and we don’t even have to bother much about inpatients in this era of hospitalists doing everything and just asking for recommendations.
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Couldn’t agree with you more. Problem is not fixable just by cutting spots.
 
DrAdonis said:
Great to hear you write all oral ARSIs. What differentiates US RadOncs from clinical oncologist the world over is not knowledge but prescribing drugs and managing potential after effects.
We stage the diseases and know the next line of treatment and it takes nothing to prescribe these medications or treat their side effects. We are physicians for God’s sake! ER physicians and GPs manage these SE in most climes.

MedOnc + Heme training takes 3 years. Med Onc only training used to be available for 1 year. Can we give residents the option of using the “research year” to do medical oncology and become trained clinical oncologist?

We don’t need permission of ABIM to do this. Dermatologist didn’t get ABR certification to use LINACs, GyneOnc didn’t need permission from anywhere to give chemotherapy. We can and should have options. This will make us well rounded oncologists and we don’t even have to bother much about inpatients in this era of hospitalists doing everything and just asking for recommendations.
Click to expand...

If SCAROP/ASTRO/WHATEVER BAG OF LETTERS keeps on bringing up the asinine "anti-trust" argument, then moving to creating "clinical oncologists" rather than purely radiation oncologists is realistically the only thing that can be done to save the specialty.
 
CurbYourExpectations said:
"Anti-trust" could be the one sentence to describe the problem and why students are less interested, they see the oversupply and have lost trust.
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I am not a lawyer..but it strikes me that "anti-trust" goes both ways

Scenario #1-Entities collude to fix prices
Scenario #2-Entities collude to fix labor
 
Chartreuse Wombat said:
I am not a lawyer..but it strikes me that "anti-trust" goes both ways

Scenario #1-Entities collude to fix prices
Scenario #2-Entities collude to fix labor
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The issue is that for the ASTRO honchos like Harari and Hallahan etc it only goes in one direction
 
jondunn said:
I'm sure our med onc colleagues will be HAPPY and THRILLED and won't say a PEEP!
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MedOnc and Clinical Onc coexist is most climes. They’ll continue their job as it is, our expansion won’t affect them significantly as demand is high. They’ll exclusively manage benign hematology and hematologic malignancies, both specialties can prescribe systemics for solid tumors and we will continue to irradiate.

For a RadOnc majorly treating prostate and already prescribing ARSIs, adding Docetaxel to the list will more or less make one a clinical oncologist for that site - those are the common drugs for PCa. It will take people like Dan Spratt not so much to take such single steps, we can start from there and make it not unusual to be a clinical oncologist in the US.

I can also think of many scenarios without putting in much thought e.g inviting renowned clinical oncs from Europe to spend 2-3 months in our departments as exchange scholars if MedOnc tries to make the 1 year rotation difficult.
There’s no doubt that MedOncs will grumble at the beginning but that’s not unexpected. We will all be fine at the end and our patients will most likely be better for it.
 
OTN said:
If SCAROP/ASTRO/WHATEVER BAG OF LETTERS keeps on bringing up the asinine "anti-trust" argument, then moving to creating "clinical oncologists" rather than purely radiation oncologists is realistically the only thing that can be done to save the specialty.
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I think you are right but changes will be painful in the short term. Training will require structural revision down to the intern year. No more cush TYs…all will have to do IM. Is the specialty ready for this?!?!🤔
 
I would argue that attracting the kind of applicant who would not want to do an IM year might have been what bit us in ass. We basically hyper selected people who wanted to make tons of money, have a light schedule and wanna live within a 30 mile circle of manhattan otherwise the horror! Wait until the pitchforks come.
 
Imagine if 50 pgy-2 rad onc residents, if on July 1 they were pulled aside and told they’d be doing IM and med onc fellowships instead. It would be good for rad onc, med onc, and those 50 residents.

The med onc job market is “great, actually, it’s incredible.” It’s actually believable when a 1st year fellow on a J-1 visa says this.

Someone should make a survey asking if rad onc residents and attendings would be willing to do a 2 year fellowship to prescribe and manage systemic therapy for solid tumors.

If acgme and the other acronym time lords were okay with it, I’d bet some med onc programs would happily take a highly motivated golden era rad onc who did an IM internship. It could even be partly enfolded into residency in lieu of 12 months (up to 18-21 months) of research.

So many academic rad onc research careers built on combined modality therapy, odd that no one gives combined modality in practice.
 
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I personally would rather be a subspecialty of radiology/ IR. I did a prelim IM year at a major medical center/ university- no thanks.
The whole "DEI" thing really makes me angry- I managed to score 95%+ on my physics section of the boards- and I'm not a white male. Don't insult women/ URM- condescending to assume "math is too hard" ...
 
Manatee3 said:
I personally would rather be a subspecialty of radiology/ IR. I did a prelim IM year at a major medical center/ university- no thanks.
The whole "DEI" thing really makes me angry- I managed to score 95%+ on my physics section of the boards- and I'm not a white male. Don't insult women/ URM- condescending to assume "math is too hard" ...
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Being part of radiology does nothing to make us "oncologists" - it's going backwards. Meanwhile there is a high need for systemic therapy - no reason we shouldn't broaden our field to include concurrent ct and IO. Will be more convenient for patients as well - esp those who go to different clinics for chemo vs. RT.
 
goodkerma said:
Being part of radiology does nothing to make us "oncologists" - it's going backwards. Meanwhile there is a high need for systemic therapy - no reason we shouldn't broaden our field to include concurrent ct and IO. Will be more convenient for patients as well - esp those who go to different clinics for chemo vs. RT.
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100%. It should also be optional. It’s okay to do RadOnc alone.
 
goodkerma said:
Being part of radiology does nothing to make us "oncologists" - it's going backwards. Meanwhile there is a high need for systemic therapy - no reason we shouldn't broaden our field to include concurrent ct and IO. Will be more convenient for patients as well - esp those who go to different clinics for chemo vs. RT.
Click to expand...
The advantages of going back to being under radiology include
1. Historical precedent
2. Don’t have Medonc fighting against you. I doubt they want to train someone to subsequently take a portion of their business
3. Extend the training. 5 years radiology plus 2 year fellowship in radonc means nobody entering job market for 2 years
4. Radiology has been much smarter about residency expansion over last 20 years ( they are near the bottom of list In terms of percentage increase in positions)
5. Take the power away from radonc chairs who have demonstrated (as a generalization) no interest in serving as caretakers for the field
 
RadRadRad said:
The advantages of going back to being under radiology include
1. Historical precedent
2. Don’t have Medonc fighting against you. I doubt they want to train someone to subsequently take a portion of their business
3. Extend the training. 5 years radiology plus 2 year fellowship in radonc means nobody entering job market for 2 years
4. Radiology has been much smarter about residency expansion over last 20 years ( they are near the bottom of list In terms of percentage increase in positions)
5. Take the power away from radonc chairs who have demonstrated (as a generalization) no interest in serving as caretakers for the field
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You make some very good points, but for me personally, it would be a much easier transition to oncology than radiology, although I don’t know how representative that is. In the end, I don’t see us having much of a choice just as the specialty focused on treating syphilis folded into ID per Zeitman.
 
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RadRadRad said:
The advantages of going back to being under radiology include
1. Historical precedent
2. Don’t have Medonc fighting against you. I doubt they want to train someone to subsequently take a portion of their business
3. Extend the training. 5 years radiology plus 2 year fellowship in radonc means nobody entering job market for 2 years
4. Radiology has been much smarter about residency expansion over last 20 years ( they are near the bottom of list In terms of percentage increase in positions)
5. Take the power away from radonc chairs who have demonstrated (as a generalization) no interest in serving as caretakers for the field
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re #2 -- that's the good thing about academic med onc -- they don't give s--t as long as someone is doing their notes.
 
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