evilbooyaa

Staff member
Volunteer Staff
7+ Year Member
Oct 10, 2011
7,021
7,304
Status (Visible)
  1. Attending Physician
Thread title is inflammatory, agree with @RadOncG and @Neuronix

Otherwise most others have said what I wanted to.

Love this field, love the day to day aspects, hate that the job market has cratered because of rampant expansion by greedy academic chairs. Hire more attendings to cover bought out/purposeful competition satellites, get more residents to give attendings resident coverage, hire those residents to staff more satellites, get more residents to staff those new attendings, rinse and repeat.

This is the first step in an extremely long and painful process in an attempt to bring the field back to heel.

Basic economics of supply and demand.
 
  • Like
Reactions: 3 users
Oct 25, 2020
1
3
Status (Visible)
  1. DO/PhD Student
This is very evident in the amplification of voices of residents on Twitter, with the academic Twitterati claiming they're "rising stars in the field" or "geniuses of radonc" or the ubiquitous FIRE FIRE FIRE emoji we see so much. When one looks into the actual research they've done, though, while admirable and more than I accomplished in training, it usually has zero clinical impact.

I'm all for supporting young trainees in the field, but overzealous promotion erodes the credibility of the poster/field.
Couldn't agree more. So many 'publications' under the names have no clinical value for radiation oncology as a medical field. Retrospectives, social economic studies will not rad onc great again. Hardcore research is the key for rad onc future. Otherwise, in next 10 years, we will see rad onc gradually take over by immunotherapies , targeted therapies, interventional treatment. So sad to look at 'leaders' publication lists and finding nothing really matter for rad onc.
 
  • Like
Reactions: 2 users

Phantom1

5+ Year Member
Mar 29, 2015
133
116
Status (Visible)
  1. Attending Physician
Thread title is inflammatory, agree with @RadOncG and @Neuronix

Otherwise most others have said what I wanted to.

Love this field, love the day to day aspects, hate that the job market has cratered because of rampant expansion by greedy academic chairs. Hire more attendings to cover bought out/purposeful competition satellites, get more residents to give attendings resident coverage, hire those residents to staff more satellites, get more residents to staff those new attendings, rinse and repeat.

This is the first step in an extremely long and painful process in an attempt to bring the field back to heel.

Basic economics of supply and demand.

For this issue of expanding residency programs to have more residents for attending coverage, Departments need to hire PAs or NPs to write the notes and have attendings do their damn contouring. I know this might cost more, but this is getting ridiculous.

Programs need to cut any residency slots they fund themselves this year and hire a PA or NP.
 
  • Like
Reactions: 2 users
About the Ads
May 30, 2019
58
204
Status (Visible)
  1. Resident [Any Field]
I don't think PAs and NPs are the answer for rad onc (or medicine in general for that matter). I think they are slowly but surely extending their autonomy in ways that are dangerous for patient care. If you are an academic radiation oncology and you can't go 6-9 months out of the year without resident coverage, what are you even doing still practicing? Hire an MD, do the work yourself, or retire and ride off into the sunset knowing you robbed an entire generation and got away with it.
 
  • Like
  • Love
Reactions: 9 users
Nov 2, 2019
1,104
4,317
I don't think PAs and NPs are the answer for rad onc (or medicine in general for that matter). I think they are slowly but surely extending their autonomy in ways that are dangerous for patient care. If you are an academic radiation oncology and you can't go 6-9 months out of the year without resident coverage, what are you even doing still practicing? Hire an MD, do the work yourself, or retire and ride off into the sunset knowing you robbed an entire generation and got away with it.

I've had junior academic faculty tell me they NEED a resident (or mid-level) because they just work so hard. This is just the zeitgeist of academic RadOnc right now, it's what they've been conditioned to believe.

In fairness to the person who said that to me recently, they are indeed very busy. Hilariously, it was said in the context of the claim that residents slow attendings down. I had a hard time reconciling those simultaneous arguments in my head...
 
  • Like
  • Haha
Reactions: 6 users
D

deleted605854

I've had junior academic faculty tell me they NEED a resident (or mid-level) because they just work so hard. This is just the zeitgeist of academic RadOnc right now, it's what they've been conditioned to believe.

In fairness to the person who said that to me recently, they are indeed very busy. Hilariously, it was said in the context of the claim that residents slow attendings down. I had a hard time reconciling those simultaneous arguments in my head...

How busy can they be? Rad Onc is not a surgical specialty

Sounds like that person wants a senior resident who's got the specialty down
 
  • Like
Reactions: 1 users

RSAOaky

7+ Year Member
Jul 1, 2012
146
396
Status (Visible)
  1. Medical Student
I've had junior academic faculty tell me they NEED a resident (or mid-level) because they just work so hard. This is just the zeitgeist of academic RadOnc right now, it's what they've been conditioned to believe.

In fairness to the person who said that to me recently, they are indeed very busy. Hilariously, it was said in the context of the claim that residents slow attendings down. I had a hard time reconciling those simultaneous arguments in my head...

I smell a fellowship opportunity
 
  • Like
Reactions: 1 users

GapCalc

2+ Year Member
Dec 21, 2018
131
462
I smell a fellowship opportunity

The University of Kentucky announces the creation of the Advanced Clinical Documentation Fellowship, a new, non-ACGME accredited fellowship for ABR-eligible RO graduates, beginning September 1, 2022. In this fellowship, recent RO graduates will develop innovative dot-phrases, dictation techniques, and billing methods. This training program may lead to employment at the PGY7 "instructor" level. Regrettably, visa sponsorship is not available.
 
  • Haha
  • Like
  • Love
Reactions: 13 users

sloh

10+ Year Member
Mar 31, 2008
534
665
Southern California
Status (Visible)
  1. Attending Physician
I've had junior academic faculty tell me they NEED a resident (or mid-level) because they just work so hard. This is just the zeitgeist of academic RadOnc right now, it's what they've been conditioned to believe.

In fairness to the person who said that to me recently, they are indeed very busy. Hilariously, it was said in the context of the claim that residents slow attendings down. I had a hard time reconciling those simultaneous arguments in my head...

Just watching how slow some of these attendings touch type fills me with doubt that residents slow them down.
 
  • Like
Reactions: 1 user

RickyScott

2+ Year Member
Oct 4, 2017
2,106
3,342
Status (Visible)
  1. Attending Physician
The University of Kentucky announces the creation of the Advanced Clinical Documentation Fellowship, a new, non-ACGME accredited fellowship for ABR-eligible RO graduates, beginning September 1, 2022. In this fellowship, recent RO graduates will develop innovative dot-phrases, dictation techniques, and billing methods. This training program may lead to employment at the PGY7 "instructor" level. Regrettably, visa sponsorship is not available.
The eagerness with which some of medstudents brown nose on twitter has me seriously considering creating this kind of opportunity for them in a few years.
 
  • Haha
  • Like
Reactions: 2 users

thecarbonionangle

5+ Year Member
Aug 23, 2014
1,983
3,023
Status (Visible)
  1. Attending Physician
Just watching how slow some of these attendings touch type fills me with doubt that residents slow them down.

i had an attending in residency who would routinely say this, “residents slow me down”. They typed with one finger looking at keyboard the entire time.
 
  • Like
Reactions: 1 user

thecarbonionangle

5+ Year Member
Aug 23, 2014
1,983
3,023
Status (Visible)
  1. Attending Physician
The University of Kentucky announces the creation of the Advanced Clinical Documentation Fellowship, a new, non-ACGME accredited fellowship for ABR-eligible RO graduates, beginning September 1, 2022. In this fellowship, recent RO graduates will develop innovative dot-phrases, dictation techniques, and billing methods. This training program may lead to employment at the PGY7 "instructor" level. Regrettably, visa sponsorship is not available.

please don’t give Randall any ideas. He is already in market for cheap warm bodies as it is.
 
About the Ads

RSAOaky

7+ Year Member
Jul 1, 2012
146
396
Status (Visible)
  1. Medical Student
i had an attending in residency who would routinely say this, “residents slow me down”. They typed with one finger looking at keyboard the entire time.

I bet this same attending also complained when he didn't have resident coverage...
 
  • Like
Reactions: 2 users

OTN

Member
15+ Year Member
Nov 6, 2003
1,331
2,703
I've had junior academic faculty tell me they NEED a resident (or mid-level) because they just work so hard. This is just the zeitgeist of academic RadOnc right now, it's what they've been conditioned to believe.

In fairness to the person who said that to me recently, they are indeed very busy. Hilariously, it was said in the context of the claim that residents slow attendings down. I had a hard time reconciling those simultaneous arguments in my head...

How busy was "very busy"? Just curious what that would entail in an academic setting.

Edit: If residents slow you down in the outpatient radonc setting, you're doing something wrong. I realize this is a bit of a hot take.
 
  • Like
Reactions: 1 users

thecarbonionangle

5+ Year Member
Aug 23, 2014
1,983
3,023
Status (Visible)
  1. Attending Physician
How busy was "very busy"? Just curious what that would entail in an academic setting.

Edit: If residents slow you down in the outpatient radonc setting, you're doing something wrong. I realize this is a bit of a hot take.
Especially in a program with zero education which is a majority of the places out there, attendings show up, resident sees consult and writes note and does all contours. Sure you have to “fix” them but that still saves you tons of time, generally. the idea that they mostly “slow” down the flow is total BS
 
  • Like
Reactions: 4 users

Ray D. Ayshun

SDN Bronze Donor
5+ Year Member
Sep 7, 2014
1,173
1,466
I've had junior academic faculty tell me they NEED a resident (or mid-level) because they just work so hard. This is just the zeitgeist of academic RadOnc right now, it's what they've been conditioned to believe.

In fairness to the person who said that to me recently, they are indeed very busy. Hilariously, it was said in the context of the claim that residents slow attendings down. I had a hard time reconciling those simultaneous arguments in my head...

Residents slow attendings down? Here and there, I'm sure, but I'm doubtful it's to the same degree attendings slow residents down, particularly those who first treated patients prior to "smells like teen spirit."
 
  • Like
Reactions: 1 user

RickyScott

2+ Year Member
Oct 4, 2017
2,106
3,342
Status (Visible)
  1. Attending Physician
How busy was "very busy"? Just curious what that would entail in an academic setting.

Edit: If residents slow you down in the outpatient radonc setting, you're doing something wrong. I realize this is a bit of a hot take.
the only "very busy" academic practice I have heard about is MSKCC (lee and zelefsky) where pt loads circa 2010 did not dip below 30. Dont know of other academic services right now where the census does not fall below 30. Sometimes a service will peak at 25 and doc/resident will state that this is common when in reality it is not... Somehow when you add up census of most academic centers, averages out 10-15 pts per doc.
 
  • Like
Reactions: 1 user

scarbrtj

I Don't Like To Bragg
5+ Year Member
Dec 18, 2015
3,216
4,903
Status (Visible)
  1. Attending Physician
the only "very busy" academic practice I have heard about is MSKCC (lee and zelefsky) where pt loads circa 2010 did not dip below 30. Dont know of other academic services right now where the census does not fall below 30. Sometimes a service will peak at 25 and doc/resident will state that this is common when in reality it is not... Somehow when you add up census of most academic centers, averages out 10-15 pts per doc.
For Zelefsky who was always 81/45 back in 2010, if he saw 4 new patients a week he’d average 36 under beam. Nowadays, with hypofx, 4 new patients a week equals about 15/day under beam. So makes sense.
 
  • Like
Reactions: 1 user

thecarbonionangle

5+ Year Member
Aug 23, 2014
1,983
3,023
Status (Visible)
  1. Attending Physician
Moving forward, i would think it is going to be difficult to have 30-40 under beam if new model eventually goes into effect when most prostates are being treated 5-20 fx, breast 5-16 fx etc etc. at least we still have the head and neck for 33-35 for definitive cases but could make argument that decreased smoking and increased gardasil may eventually drop these numbers significantly...
 
  • Like
Reactions: 1 user

Neuronix

Total nerd
Staff member
Administrator
Volunteer Staff
15+ Year Member
Mar 14, 2002
13,950
4,825
the beach
Status (Visible)
  1. Attending Physician
Number on beam is a garbage metric. I can do MGMA PP median wRVUs with 10 patients on beam. My practice is mostly SBRT and SRS with some hypofractionated palliatives and other cases thrown in. With APM this will become more common. Welcome to the future.

Yes I am in academics. My resident coverage fluctuates. I think I was up to 9 months at one point, 3 months this year. I think residents are a net neutral, but I kind of expect it to be that way. What gets saved in time should come back in teaching.

I never stray from controversy, and so I will be open and honest that I am afraid of residents. Any negative evals of me from residents are taken very seriously and can (and have) hurt me, while residents basically always move through to graduation at which time their evals are meaningless. So maybe less resident time is better for me in the end?
 
  • Like
Reactions: 8 users

RickyScott

2+ Year Member
Oct 4, 2017
2,106
3,342
Status (Visible)
  1. Attending Physician
Number on beam is a garbage metric. I can do MGMA PP median wRVUs with 10 patients on beam. My practice is mostly SBRT and SRS with some hypofractionated palliatives and other cases thrown in. With APM this will become more common. Welcome to the future.
exception if you are an srt service.
 
  • Like
Reactions: 1 user
D

deleted605854

Number on beam is a garbage metric. I can do MGMA PP median wRVUs with 10 patients on beam. My practice is mostly SBRT and SRS with some hypofractionated palliatives and other cases thrown in. With APM this will become more common. Welcome to the future.

Yes I am in academics. My resident coverage fluctuates. I think I was up to 9 months at one point, 3 months this year. I think residents are a net neutral, but I kind of expect it to be that way. What gets saved in time should come back in teaching.

I never stray from controversy, and so I will be open and honest that I am afraid of residents. Any negative evals of me from residents are taken very seriously and can (and have) hurt me, while residents basically always move through to graduation at which time their evals are meaningless. So maybe less resident time is better? I've gone back and forth with myself about this.

You mean welcome to Canada and UK rad onc practices

Trainees don't have such influence in Canada or the UK. Would they still continue to do so when the field is less competitive ?
 
About the Ads
D

deleted605854

i had an attending in residency who would routinely say this, “residents slow me down”. They typed with one finger looking at keyboard the entire time.

Note typing and contouring, the keyboard and the mouse. The two greatest enemies of any "glorious" rad onc attending. It's up to these brave residents to protect the weak and vulnerable attendings from them. Take heart future breadliners!
 
  • Like
Reactions: 1 user

RickyScott

2+ Year Member
Oct 4, 2017
2,106
3,342
Status (Visible)
  1. Attending Physician
Number on beam is a garbage metric. I can do MGMA PP median wRVUs with 10 patients on beam. My practice is mostly SBRT and SRS with some hypofractionated palliatives and other cases thrown in. With APM this will become more common. Welcome to the future.

Yes I am in academics. My resident coverage fluctuates. I think I was up to 9 months at one point, 3 months this year. I think residents are a net neutral, but I kind of expect it to be that way. What gets saved in time should come back in teaching.

I never stray from controversy, and so I will be open and honest that I am afraid of residents. Any negative evals of me from residents are taken very seriously and can (and have) hurt me, while residents basically always move through to graduation at which time their evals are meaningless. So maybe less resident time is better for me in the end?
A good resident makes your life much easier, but a bad one slows you down, especially if you are picky about contours.
 

OTN

Member
15+ Year Member
Nov 6, 2003
1,331
2,703
Number on beam is a garbage metric. I can do MGMA PP median wRVUs with 10 patients on beam. My practice is mostly SBRT and SRS with some hypofractionated palliatives and other cases thrown in. With APM this will become more common. Welcome to the future.

Yes I am in academics. My resident coverage fluctuates. I think I was up to 9 months at one point, 3 months this year. I think residents are a net neutral, but I kind of expect it to be that way. What gets saved in time should come back in teaching.

I never stray from controversy, and so I will be open and honest that I am afraid of residents. Any negative evals of me from residents are taken very seriously and can (and have) hurt me, while residents basically always move through to graduation at which time their evals are meaningless. So maybe less resident time is better for me in the end?

Thank you for doing this. It's not nearly as common as one would hope. The transaction has always been "I will do scut work and you will teach me stuff in return," but the number of attendings who didn't hold up their end of the bargain in my day was very high.
 
  • Like
Reactions: 8 users

Neuronix

Total nerd
Staff member
Administrator
Volunteer Staff
15+ Year Member
Mar 14, 2002
13,950
4,825
the beach
Status (Visible)
  1. Attending Physician
A good resident makes your life much easier, but a bad one slows you down, especially if you are picky about contours.

And I've learned the hard way that the more you press a bad resident to improve, the more they grow to hate you. There's something intrinsic about motivation and work ethic that I always assumed to be present in medical residents. I've had to learn it is not there in everyone.

Thank you for doing this. It's not nearly as common as one would hope. The transaction has always been "I will do scut work and you will teach me stuff in return," but the number of attendings who didn't hold up their end of the bargain in my day was very high.

I hope my trainees feel the same way as I do about the level of service to teaching when they work with me. I certainly agree--where I trained there were attendings who really taught, and there were others who did basically zero teaching. All through my training I was reading 1-2+ hours a day and asked a million questions, and that's how you get to be good at what you do, no matter where you train IMO. Those sorts of skills continue to be useful for the rest of your life I think.
 
  • Like
Reactions: 3 users

thecarbonionangle

5+ Year Member
Aug 23, 2014
1,983
3,023
Status (Visible)
  1. Attending Physician
And I've learned the hard way that the more you press a bad resident to improve, the more they grow to hate you. There's something intrinsic about motivation and work ethic that I always assumed to be present in medical residents. I've had to learn it is not there in everyone.



I hope my trainees feel the same way as I do about the level of service to teaching when they work with me. I certainly agree--where I trained there were attendings who really taught, and there were others who did basically zero teaching. All through my training I was reading 1-2+ hours a day and asked a million questions, and that's how you get to be good at what you do, no matter where you train IMO. Those sorts of skills continue to be useful for the rest of your life I think.

is a “bad resident” refelective of serious issues with the department? Or is this all on the resident?
 

evilbooyaa

Staff member
Volunteer Staff
7+ Year Member
Oct 10, 2011
7,021
7,304
Status (Visible)
  1. Attending Physician
And I've learned the hard way that the more you press a bad resident to improve, the more they grow to hate you. There's something intrinsic about motivation and work ethic that I always assumed to be present in medical residents. I've had to learn it is not there in everyone.



I hope my trainees feel the same way as I do about the level of service to teaching when they work with me. I certainly agree--where I trained there were attendings who really taught, and there were others who did basically zero teaching. All through my training I was reading 1-2+ hours a day and asked a million questions, and that's how you get to be good at what you do, no matter where you train IMO. Those sorts of skills continue to be useful for the rest of your life I think.

There will always be residents that complain about having to spend any amount of time learning.

Some situations where an attending (to me) was enthusiastic about teaching, and yeah we'd have long nights, but I felt really well trained - for another resident, that attending was evil and lead to complaints, etc.

Not rare to see a subpar resident 'shuffled through', and then when is a PGY-5, everyone goes "well just graduate him/her" regardless of how good clinically the attendings feel about his ability to practice (if this is the case, that PGY-5s chance of staying with the current department is obviously 0%).
 
  • Like
Reactions: 4 users

thecarbonionangle

5+ Year Member
Aug 23, 2014
1,983
3,023
Status (Visible)
  1. Attending Physician
These are independent in my opinion.

i guess it depends on how one defines it. Some people definitely have incorrigible personality issues and just bad attitudes and low work ethic but if definition of “bad resident” is that they lack knowledge/fail boards then the program failed them to an extent
 
About the Ads

Neuronix

Total nerd
Staff member
Administrator
Volunteer Staff
15+ Year Member
Mar 14, 2002
13,950
4,825
the beach
Status (Visible)
  1. Attending Physician
EB I agree with your post. Though I wonder, continuing our disagreement in the prior thread, what do you think should happen to the PGY-5 that filed complaints about having to stay late and has questionable competence when they go to look for a job? Should the attendings still give good recommendations externally? Should the attendings cold call or e-mail their friends looking for jobs for that resident? What does that do to your relationship and reputation with other attendings recommending someone that may not be very good in practice?

i guess it depends on how one defines it. Some people definitely have incorrigible personality issues and just bad attitudes and low work ethic but if definition of “bad resident” is that they lack knowledge/fail boards then the program failed them to an extent

It's hard to paint with a broad brush here. I'll just state that the skills to be a good rad onc are different than the skills needed to pass boards. However, I do think that anyone should be able to pass boards, especially if given opportunities to re-take. We'll ignore that one year where they ****ed up the exam, won't admit that they ****ed up the exam, and pretend like we're at our usual 90% pass rates.
 
  • Like
Reactions: 5 users

evilbooyaa

Staff member
Volunteer Staff
7+ Year Member
Oct 10, 2011
7,021
7,304
Status (Visible)
  1. Attending Physician
EB I agree with your post. Though I wonder, continuing our disagreement in the prior thread, what do you think should happen to the PGY-5 that filed complaints about having to stay late and has questionable competence when they go to look for a job? Should the attendings still give good recommendations externally? Should the attendings cold call or e-mail their friends looking for jobs for that resident? What does that do to your relationship and reputation with other attendings recommending someone that may not be very good in practice?

You should feel obligated to only help those residents who you think deserve it. I am fine with an attending not assisting a bad resident with his/her job seaerch. If you are only sometimes not making cold-calls on your residents' behalf, that means you are, sometimes, making cold-calls on your residents' behalf, which would make you better than 50-90% of academic attendings out there.
 

Neuronix

Total nerd
Staff member
Administrator
Volunteer Staff
15+ Year Member
Mar 14, 2002
13,950
4,825
the beach
Status (Visible)
  1. Attending Physician
If you are only sometimes not making cold-calls on your residents' behalf, that means you are, sometimes, making cold-calls on your residents' behalf, which would make you better than 50-90% of academic attendings out there.

:)

Now if only the replies weren't "Well we aren't hiring but we have this fellowship opportunity..."
 
  • Like
  • Sad
Reactions: 3 users

scarbrtj

I Don't Like To Bragg
5+ Year Member
Dec 18, 2015
3,216
4,903
Status (Visible)
  1. Attending Physician
Number on beam is a garbage metric.
I agree w/ you 99% of time, this is a 1%. Number on beam is one statistic, but it's very important... doesn't matter if you are running an SBRT service or not. It is still linked to how many new patients you're seeing on average (per day or week or whatever). And number of new patients you're seeing per unit of time is essentially equal to how busy any of us are. It's like wavelength (number on beam), frequency (number of new patients seen per unit of time), and energy (how busy a rad onc is)... they're all directly related.
 
  • Like
Reactions: 3 users

RollTideRadOnc

7+ Year Member
Jan 26, 2013
81
221
Status (Visible)
  1. Podiatrist
If you feel you can graduate a resident from your program, then you (or someone from the program) should help that person get a job in some way, shape or form.

If the program feels they cannot help the resident get a job, then the program needs to re-examine its educational structure and figure out how exactly they can best support their trainees.

everyone who’s graduated residency in the last 5 years is capable of being an attending. They are smart enough and work hard enough in the right environment.

don’t excuse essentially sabotaging someone’s job hunt by blaming the residents. These are capable people. Look to the systemic factors instead.

part of having a residency program is taking some responsibility for the people you are shepherding. Period. End of (an admittedly very opinionated) story.
 
  • Like
  • Love
Reactions: 6 users

thecarbonionangle

5+ Year Member
Aug 23, 2014
1,983
3,023
Status (Visible)
  1. Attending Physician
If you feel you can graduate a resident from your program, then you (or someone from the program) should help that person get a job in some way, shape or form.

If the program feels they cannot help the resident get a job, then the program needs to re-examine its educational structure and figure out how exactly they can best support their trainees.

everyone who’s graduated residency in the last 5 years is capable of being an attending. They are smart enough and work hard enough in the right environment.

don’t excuse essentially sabotaging someone’s job hunt by blaming the residents. These are capable people. Look to the systemic factors instead.

part of having a residency program is taking some responsibility for the people you are shepherding. Period. End of (an admittedly very opinionated) story.

absolutely agree. I recognize that theres an element of personal responsability, personality and attitude, but i do find it very frustrating to see the commonly held belief in our field that education is not important and that it is all on resident, residents teach themselves, they pick up what they can with clinic but the main determinant is themselves? Is this common in other fields?
The field over the past decade has recruited some of the highest qualified people and it is up to programs to promote, help and elevate people. Yes, personal responsibility matters but i certainly would not absolve programs from the responsibility of helping their own.
If this is not the right time to raise standards in education, career development and opportunities for existing programs and close those who cannot come close, then when is the right time? In my opinion, there are many subpar places, many are not newly established.
Never, of course. Too often, good change is delayed which means no change.
 
Last edited:
  • Like
  • Love
Reactions: 4 users

FrostyHammer

5+ Year Member
Aug 20, 2014
460
749
Status (Visible)
  1. Resident [Any Field]
I agree w/ you 99% of time, this is a 1%. Number on beam is one statistic, but it's very important... doesn't matter if you are running an SBRT service or not. It is still linked to how many new patients you're seeing on average (per day or week or whatever). And number of new patients you're seeing per unit of time is essentially equal to how busy any of us are. It's like wavelength (number on beam), frequency (number of new patients seen per unit of time), and energy (how busy a rad onc is)... they're all directly related.
I agree with Neuronix. If # on treat are being used to compare to oneself (like at different points in time) then it is OK as a measure, but if someone is comparing # on treat between two docs, it is a BS metric, since the SRS/SBRT services (or whatever higher proportion of those cases someone has on their service) will always be on the short end. Just can't compare an SBRT/SRS service to a head/neck service for instance, that is clearly apples & oranges. Maybe a fairer comparison is to generate hypothetical fractionated courses for each SRS/SBRT patient and then feel good about yourself for having an SRS/SBRT service with so few on-treats.
 
Nov 7, 2019
54
160
Status (Visible)
  1. Academic Administration
I agree with Neuronix. If # on treat are being used to compare to oneself (like at different points in time) then it is OK as a measure, but if someone is comparing # on treat between two docs, it is a BS metric, since the SRS/SBRT services (or whatever higher proportion of those cases someone has on their service) will always be on the short end. Just can't compare an SBRT/SRS service to a head/neck service for instance, that is clearly apples & oranges. Maybe a fairer comparison is to generate hypothetical fractionated courses for each SRS/SBRT patient and then feel good about yourself for having an SRS/SBRT service with so few on-treats.

Reviewing my numbers for 2020 - I have averaged 5 patients on treatment per week (range 2-10). I have simulated 204 patients this year (as of 10/29/20). Our stat board says I'm on track for 10,893 RVUs, with 10,000 being my target.

Employed GI practice, liver SBRT, pancreas adaptive, short course rectal; and palliative stuff.
 
Last edited:
  • Like
Reactions: 6 users

RadOncDoc21

10+ Year Member
Oct 24, 2010
1,958
2,534
Status (Visible)
  1. Attending Physician
Reviewing my numbers for 2020 - I have averaged 5 patients on treatment per week (range 2-10). I have simulated 204 patients this year (as of 10/29/20). Our stat board says I'm on track for 10,893 RVUs, with 10,000 being my target.

Employed GI practice, liver SBRT, pancreas adaptive, short course rectal; and palliative stuff.

I think these stats will be the future of the field.
 
  • Like
Reactions: 1 user

scarbrtj

I Don't Like To Bragg
5+ Year Member
Dec 18, 2015
3,216
4,903
Status (Visible)
  1. Attending Physician
I think these stats will be the future of the field.
The future is the present, or vice versa. Two hundred starts per year is the perfectly average rad onc in America... or maybe a Garrison Keillorian slightly above average. To restate some truisms: there are 1 million XRT patients/year*, of which ~600K will get XRT in the first year of their diagnosis. One million patients divides amongst 5500 (best 2020 estimate) to the tune of 180 new starts per rad onc per year. That's 3.5 new starts per week. If you're doing 4 per week, and the average length of treatment is 1.0 weeks (5 fractions), then you'll have on average 4 patients under beam per day for the year. And, on average, 1-2 of those patients will be "late in course" XRT patients (palliative 1y or more after dx, oligomets 1y or more after dx, etc.; a distinct subset but not altogether different perhaps than the "new dx" patients).

Math.

But who woulda thunk ~20y ago that a rad onc could be successful at 4 patients under beam per day. Did tech (and high tech's higher billing) rise up to meet cancer and/or economic realities, or did cancer and/or economic realities spurn use of more expensive tech and more billing. Who knows?! I do know this: rad onc is not really achieving greater cancer survival than 20y ago, but we sure are charging more per individual patient for that, um, privilege.


* There is reasonable data to show this number has declined over time. To wit, Nora Janjan in 2003: "Each year 1.2 million Americans receive radiation for the treatment of cancer"
 
Last edited:
  • Like
Reactions: 2 users

OTN

Member
15+ Year Member
Nov 6, 2003
1,331
2,703
The future is the present, or vice versa. Two hundred starts per year is the perfectly average rad onc in America... or maybe a Garrison Keillorian slightly above average. To restate some truisms: there are 1 million XRT patients/year*, of which ~600K will get XRT in the first year of their diagnosis. One million patients divides amongst 5500 (best 2020 estimate) to the tune of 180 new starts per rad onc per year. That's 3.5 new starts per week. If you're doing 4 per week, and the average length of treatment is 1.0 weeks (5 fractions), then you'll have on average 4 patients under beam per day for the year. And, on average, 1-2 of those patients will be "late in course" XRT patients (palliative 1y or more after dx, oligomets 1y or more after dx, etc.; a distinct subset but not altogether different perhaps than the "new dx" patients).

Math.

But who woulda thunk ~20y ago that a rad onc could be successful at 4 patients under beam per day. Did tech (and high tech's higher billing) rise up to meet cancer and/or economic realities, or did cancer and/or economic realities spurn use of more expensive tech and more billing. Who knows?! I do know this: rad onc is not really achieving greater cancer survival than 20y ago, but we sure are charging more per individual patient for that, um, privilege.


* There is reasonable data to show this number has declined over time. To wit, Nora Janjan in 2003: "Each year 1.2 million Americans receive radiation for the treatment of cancer"

I think you're being overly pessimistic re: radonc over the last 20 years. We're still doing very well in the HPV-mediated malignancies, with not much room to improve in early-enough stage H+N, cervical, anal. SBRT for early-stage lung cancers has undoubtedly increased survival compared with the old 70 Gy in 35 fx shotgun approach. SBRT for oligomets certainly does appear to improve survival based on Palma's data. I've treated a fair number of patients with Chris Crane's regimen for unresectable hepatobiliary cancers, and many of them are doing very well with NED several years out of their therapy.

Additionally, for those cancers where survival hasn't necessarily increased, side effect profiles of XRT have dramatically improved over the last two decades, which is also important.

Sure, medonc has made greater strides, but I would argue they were coming from further back. When I started residency metastatic solid tumors really had nothing for them that worked well, with the exception of testicular and maybe colorectal.

Also, I think you consistently overestimate the number of practicing radoncs, and I think ASTRO does as well. I know personally of two radoncs who graduated from training, passed boards, are board-certified, but are not practicing. They both graduated within the last 10-15 years. I also know personally of at least 5 academic radiation oncologists who see very few patients, and a few close to retiring docs locally who see very few as well. I'd be willing to bet the distribution of "patients treated per radonc" is somewhat bimodal, with lots of radoncs seeing a lot of patients (I treat ~350 per year), and lots of radoncs seeing very few. While I know anecdotal data is not data, I don't know THAT many radiation oncologists, but a decent proportion of them aren't seeing that many patients.
 
  • Like
Reactions: 1 users

RickyScott

2+ Year Member
Oct 4, 2017
2,106
3,342
Status (Visible)
  1. Attending Physician
I think you're being overly pessimistic re: radonc over the last 20 years. We're still doing very well in the HPV-mediated malignancies, with not much room to improve in early-enough stage H+N, cervical, anal. SBRT for early-stage lung cancers has undoubtedly increased survival compared with the old 70 Gy in 35 fx shotgun approach. SBRT for oligomets certainly does appear to improve survival based on Palma's data. I've treated a fair number of patients with Chris Crane's regimen for unresectable hepatobiliary cancers, and many of them are doing very well with NED several years out of their therapy.

Additionally, for those cancers where survival hasn't necessarily increased, side effect profiles of XRT have dramatically improved over the last two decades, which is also important.

Sure, medonc has made greater strides, but I would argue they were coming from further back. When I started residency metastatic solid tumors really had nothing for them that worked well, with the exception of testicular and maybe colorectal.

Also, I think you consistently overestimate the number of practicing radoncs, and I think ASTRO does as well. I know personally of two radoncs who graduated from training, passed boards, are board-certified, but are not practicing. They both graduated within the last 10-15 years. I also know personally of at least 5 academic radiation oncologists who see very few patients, and a few close to retiring docs locally who see very few as well. I'd be willing to bet the distribution of "patients treated per radonc" is somewhat bimodal, with lots of radoncs seeing a lot of patients (I treat ~350 per year), and lots of radoncs seeing very few. While I know anecdotal data is not data, I don't know THAT many radiation oncologists, but a decent proportion of them aren't seeing that many patients.
Why are the radoncs not practicing? Also,the system is going to evolve that if you want a radonc salary, you have to see patients. Some academic docs can see very few pts because the department is still highly profitable with 3-5 x negotiated prices of freestanding center. Price transparency is not going to be kind to this field. Nor will any type of national health care.
At the end of the day, no medical student should choose radonc with the notion that he can support himself seeing 3-4 pts per week or less.
 
Last edited:
  • Like
Reactions: 2 users

OTN

Member
15+ Year Member
Nov 6, 2003
1,331
2,703
Why are the radoncs not practicing? Also, system is going to evolve that if you want a radonc salary, you have to see patients. Some academic docs can see very few pts and because department is highly profitable with 3-5 x negotiated prices of freestanding center. Price transparency is not going to be kind to this field. Not will any type of national health care

Several of the academic radoncs have with big grants that I'm sure support their salaries and labs. Again, I graduated from training 11 years ago, when that kind of thing was achievable. A few, though, are of course taking advantage of the predatory/monopolistic/cronyism billing we all know so well.

Of the two clinically-oriented radoncs, one is not practicing because she could not find a job where her husband, who is also a specialized physician, could find one. The other practiced for awhile before she decided she wanted to go another way with things- I don't have the details there to be honest. The older retiring pp radoncs are petering along, seeing only a few patients here and there, but really don't have large volumes.

Price transparency will be great for those of us already in private practice, but would be overall bad for the health of the field, as it would eliminate the slack in the job market. National health care would destroy incomes throughout the entire healthcare sector via monopsonistic bargaining power, which is precisely what it would be designed to do. That's, of course, another topic entirely.
 
  • Like
Reactions: 1 user

scarbrtj

I Don't Like To Bragg
5+ Year Member
Dec 18, 2015
3,216
4,903
Status (Visible)
  1. Attending Physician
I think you're being overly pessimistic re: radonc over the last 20 years. We're still doing very well in the HPV-mediated malignancies, with not much room to improve in early-enough stage H+N, cervical, anal. SBRT for early-stage lung cancers has undoubtedly increased survival compared with the old 70 Gy in 35 fx shotgun approach. SBRT for oligomets certainly does appear to improve survival based on Palma's data. I've treated a fair number of patients with Chris Crane's regimen for unresectable hepatobiliary cancers, and many of them are doing very well with NED several years out of their therapy.

Additionally, for those cancers where survival hasn't necessarily increased, side effect profiles of XRT have dramatically improved over the last two decades, which is also important.

Sure, medonc has made greater strides, but I would argue they were coming from further back. When I started residency metastatic solid tumors really had nothing for them that worked well, with the exception of testicular and maybe colorectal.
My lack of optimism shouldn't be mistaken for pessimism; it's just: lack of optimism. "SBRT for early-stage lung cancers has undoubtedly increased survival compared with the old 70 Gy in 35 fx shotgun approach." Maybe. But you're talking such a tiny fraction of the ~1.8 million cancer patients/year pie (ie ~12,500 Stage I SBRT lung ca patients/year, and only a fraction are getting SBRT) the needle is not appreciably moving. All due respects to Chris Crane. The ability for rad onc, now, to move survival needles appreciably is ~zero; this being borne out by much data.


Also, I think you consistently overestimate the number of practicing radoncs, and I think ASTRO does as well.
I have three values from 2017 e.g.: one from a recent ASTRO poster (~4600), AAMC data (~5000), and a Bates analysis (~5300). Of the former two, the ASTRO poster showed ~4200 in 2012 and AAMC data showed ~4600 in 2012--upward slopes of about 70/yr. Looking at the three data points mentioned for 2017, the mean is 5000 and the 95% C.I. of the mean is 4600-5400. When I couple that with reasons to believe the Bates/Chowdhary/Amdur analysis is a more robust take, assuming 5300 rad oncs in 2017 is within reasonable bounds. If using an upward slope of 70 new rad oncs per year (which actually seems an UNDERestimate given 200 graduates/year) from 2017 onward, 5500 rad oncs for 2020 is a fair estimate within standard error bounds, neither over nor under.


I'd be willing to bet the distribution of "patients treated per radonc" is somewhat bimodal, with lots of radoncs seeing a lot of patients (I treat ~350 per year), and lots of radoncs seeing very few. While I know anecdotal data is not data, I don't know THAT many radiation oncologists, but a decent proportion of them aren't seeing that many patients.
It could be quadrimodal, who knows. But there are a finite number of new starts and rad oncs in America, and that forms a ratio which would average across the "population" of rad oncs. Getting into the distribution of work (chairmen, e.g., see few patients, and they don't have to see patients to support their salary... but somebody does) is a whole other discussion.
 
Last edited:
  • Like
Reactions: 1 users

medgator

Persona Non Grata
15+ Year Member
Sep 20, 2004
7,695
5,340
Status (Visible)
  1. Attending Physician
Price transparency will be great for those of us already in private practice, but would be overall bad for the health of the field, as it would eliminate the slack in the job market. National health care would destroy incomes throughout the entire healthcare sector via monopsonistic bargaining power, which is precisely what it would be designed to do. That's, of course, another topic entirely.
Medicare hasn't done that now. I am seeing evicore aim etc try to deny more and more services such as igrt 3dcrt IMRT etc in the name of saving insurance companies money and enriching their bottom line/shareholders however.

I see the current system vs what is in Canada as a pick your poison situation.

In some ways I'm hopeful that APM will put evicore and the like out of business and level the playing field for all RO providers in the country. Not holding my breath that the NCI centers will be included though
 

OTN

Member
15+ Year Member
Nov 6, 2003
1,331
2,703
Medicare hasn't done that now. I am seeing evicore aim etc try to deny more and more services such as igrt 3dcrt IMRT etc in the name of saving insurance companies money and enriching their bottom line/shareholders however.

I see the current system vs what is in Canada as a pick your poison situation.

In some ways I'm hopeful that APM will put evicore and the like out of business and level the playing field for all RO providers in the country. Not holding my breath that the NCI centers will be included though

Medicare isn't a monopsony right now. Medicare 4 All would turn it into one, as it bans private insurance (no other countries with 'single payer' have done this). Makes all the difference in the world.

Scarb, I think the data about the work distribution would be very interesting, but probably unattainable unfortunately. I hear what you're saying re: optimism, and I get it. When do we get to hear you pontificate about FLASH? :laugh:
 

RickyScott

2+ Year Member
Oct 4, 2017
2,106
3,342
Status (Visible)
  1. Attending Physician
Several of the academic radoncs have with big grants that I'm sure support their salaries and labs. Again, I graduated from training 11 years ago, when that kind of thing was achievable. A few, though, are of course taking advantage of the predatory/monopolistic/cronyism billing we all know so well.

Of the two clinically-oriented radoncs, one is not practicing because she could not find a job where her husband, who is also a specialized physician, could find one. The other practiced for awhile before she decided she wanted to go another way with things- I don't have the details there to be honest. The older retiring pp radoncs are petering along, seeing only a few patients here and there, but really don't have large volumes.

Price transparency will be great for those of us already in private practice, but would be overall bad for the health of the field, as it would eliminate the slack in the job market. National health care would destroy incomes throughout the entire healthcare sector via monopsonistic bargaining power, which is precisely what it would be designed to do. That's, of course, another topic entirely.
Basically continued employment where docs see 3-4 new patients a week and salaried at 300k+ is dependent on monopolistic academic systems charging 3-5x Medicare prices. Nobody should count on this in 10 years.
 
  • Like
Reactions: 2 users
About the Ads

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.