Canadian patients coming to US for RT

[deleted1111261]

I like to think of this incarnation of Simul as the "Joe Pera" version. Not quite UP and not quite a music teacher, but close. Of course, the world needs more Joe Peras.

View attachment 372429

I’m gonna listen!

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Members don't see this ad.

 

[seper]

Wow. Is this for male physicians, female physicians or both ?

In an economic sense, we can use the Law of Comparative Advantage to sort this out.

It means a very fast typing lawyer should still hire a secretary. Or, a high earning physician outsources cleaning the house and lawn care.

Currently, I’m working full time and my wife doesn’t work outside the house. She is far busier than me.

Cleaning and mowing grass is easy to outsource! Think providing elderly care and simultaneously being a colorectal surgeon

 

[deleted1111261]

Cleaning and mowing grass is easy to outsource! Think providing elderly care and simultaneously being a colorectal surgeon

Okay, but that has little do with doctoring

Like any job in the world that requires outside of the home work that gives you a food income requires the same thought process of whether both people work. I don’t see how lawyer, tech, i banker/finance, management consultant or the other sexy post-Ivy jobs are different

 

[seper]

Okay, but that has little do with doctoring

Like any job in the world that requires outside of the home work that gives you a food income requires the same thought process of whether both people work. I don’t see how lawyer, tech, i banker/finance, management consultant or the other sexy post-Ivy jobs are different

I think they are very different! Many of these well compensated jobs are still fully remote. Tons of people I know are doing hybrid - 2 days in the office Full time back to the office for bankers is either 3 or 4 days in the building, 8 hours tops. You can run a solo household with these types of arrangements.

 

[deleted1111261]

I think they are very different! Many of these well compensated jobs are still fully remote. Tons of people I know are doing hybrid - 2 days in the office Full time back to the office for bankers is either 3 or 4 days in the building, 8 hours tops. You can run a solo household with these types of arrangements.

Mckinsey consultant working from home… Goldman Sachs analyst in PJs in a Jersey city condo…

I take that maybe these people aren’t in your social circle?

 

[Fpg1245]

Mckinsey consultant working from home… Goldman Sachs analyst in PJs in a Jersey city condo…

Oh I know them well. A special kind of insufferable. I’d rather get dragged behind a dumpster and executed than listen to them talk about their trip to Mykonos and how busy they are wfh.

 

[thecarbonionangle]

LOL pulling two separate residents because the service cant go uncovered for even a day...

when i read this my thought was yeah i dont think drew realizes how bad of a look this is for his program. Students if you are listening pay attention! Steinberg loves a good slave. I have said this before on here and been attacked. UCLA culture has always had plenty of “scut”.

 

[medgator]

Mckinsey consultant working from home… Goldman Sachs analyst in PJs in a Jersey city condo…

I take that maybe these people aren’t in your social circle?

Starting at the bottom, their hours in house have to rival any surgical internship

 

[TheWallnerus]

Starting at the bottom, their hours in house have to rival any surgical internship

I think no business is ballsy enough to work people this many crazy hours. Glad to be proven wrong.

 

[deleted1111261]

If you share a Manhattan apartment with a first year I-banker it’s like living alone for half the price

 

[radoncftw]

when i read this my thought was yeah i dont think drew realizes how bad of a look this is for his program. Students if you are listening pay attention! Steinberg loves a good slave. I have said this before on here and been attacked. UCLA culture has always had plenty of “scut”.

you shouldnt even need to have an out of office email or have people "cross-cover" for 2 days. you are a resident with an attending rad onc.
so happy i ran from academia when i finished

 

[NotMattSpraker]

you shouldnt even need to have an out of office email or have people "cross-cover" for 2 days. you are a resident with an attending rad onc.
so happy i ran from academia when i finished

Academics needs an intervention. Im sure this is not new, but sitting here at 5 years out it is surprising how many of my peers have left their academic job. Almost all of them have left because they were treated like a workhorse or trash or both.

Editors constantly complain about the lack of people willing to work for free and then shame them when they wont. (Always hilarious)

Yesterday there was a viral video of a trainee's husband slapping an OBGYN at an academic conference for assaulting his wife.

You have to wonder if these people will ever reflect and realize they are the problem.

 

[Fpg1245]

Academics needs an intervention. Im sure this is not new, but sitting here at 5 years out it is surprising how many of my peers have left their academic job. Almost all of them have left because they were treated like a workhorse or trash or both.

Editors constantly complain about the lack of people willing to work for free and then shame them when they wont. (Always hilarious)

Yesterday there was a viral video of a trainee's husband slapping an OBGYN at an academic conference for assaulting his wife.

You have to wonder if these people will ever reflect and realize they are the problem.

They’re too wrapped up in their own personal narratives to do anything of substance.

 

[RickyScott]

you shouldnt even need to have an out of office email or have people "cross-cover" for 2 days. you are a resident with an attending rad onc.
so happy i ran from academia when i finished

It wouldn’t surprise me if Mikey has close to zero clinical knowledge so needs a babysitter at all times. The guy sold a bunch of practices to 21c for tens millions and posed as a policy expert. Drew should come over from the va and cover him.

 

[medgator]

Academics needs an intervention. Im sure this is not new, but sitting here at 5 years out it is surprising how many of my peers have left their academic job.

Feel grateful i left the cesspool as quickly as possible

 

[CaesarRO]

It wouldn’t surprise me if Mikey has close to zero clinical knowledge so needs a babysitter at all times. The guys sold a bunch of practices to 21c for tens millions and posed as a policy expert. Drew should come over from the va and cover him.

Have been told by chair during residency "Do you really want Dr. *** to go uncovered? That wouldn't be safe..." with an aghast expression on his face. To which I thought "... my point exactly..." Why is that dinosaur still in practice?

 

[IonsAreOurFuture]

It wouldn’t surprise me if Mikey has close to zero clinical knowledge so needs a babysitter at all times. The guy sold a bunch of practices to 21c for tens millions and posed as a policy expert. Drew should come over from the va and cover him.

Steinberg knows his clinical stuff, or at least did back in the day that he was my examiner for the mock oral boards that UCLA put on. I think his real talent is for business, at least among rad oncs.

 

[deleted1111261]

I know I’m the minority and Steinberg is by no means perfect, I like the idea of successful builders rather than only lab people being department leaders

 

[OTN]

I know I’m the minority and Steinberg is by no means perfect, I like the idea of successful builders rather than only lab people being department leaders

I agree, but what have the academic leaders of our field built over the last 20 years?

 

[NotMattSpraker]

I know I’m the minority and Steinberg is by no means perfect, I like the idea of successful builders rather than only lab people being department leaders

I agree and had a good experience rotating at UCLA as a med student. He also seems to put in some effort promoting the residents and his junior faculty on Twitter and in media. Would be great if there was more of that out there.

I know the business-forward Rad Onc leaders have not been great stewards, so I understand the varied opinions though.

 

[medgator]

I know I’m the minority and Steinberg is by no means perfect, I like the idea of successful builders rather than only lab people being department leaders

Unfortunately they only cared about building their own academic centers and careers, not about the specialty at large once their grads went out into the real world and community practice, leading to what i suspect is the most toxic dichotomy in any specialty between community/private practice folks and academic/training center ones

 

[RickyScott]

I know I’m the minority and Steinberg is by no means perfect, I like the idea of successful builders rather than only lab people being department leaders

My beef with Steinberg is his "let them eat cake" take on the specialty, which he tries to sell URM.

 

[deleted1111261]

My beef with Steinberg is his "let them eat cake" take on the specialty, which he tries to sell URM.

100% reasonable

But they all, literally all, do it. He’s just more public facing

 

[RickyScott]

100% reasonable

But they all, literally all, do it. He’s just more public facing

True, but he is in the worst job market in the country and pays faculty bottom dollar, despite his own million+ salary, and tens of millions in the bank. New faculty cant afford housing within 30 miles of UCLA without family help.

 

[NotMattSpraker]

Unfortunately they only cared about building their own academic centers and careers, not about the specialty at large once their grads went out into the real world and community practice, leading to what i suspect is the most toxic dichotomy in any specialty between community/private practice folks and academic/training center ones

Ive noticed that too. Academic med oncs are way more kind to their community colleagues than Rad Oncs. Surgeons too. Most of them proudly talk about their community colleagues, especially if they trained them.

Not sure why. I suspect this is long standing and started before I was around.

 

[Lamount]

Ive noticed that too. Academic med oncs are way more kind to their community colleagues than Rad Oncs. Surgeons too. Most of them proudly talk about their community colleagues, especially if they trained them.

Not sure why. I suspect this is long standing and started before I was around.

I think it goes both ways… and that is the problem. Pride precludes both sides from respecting those who don’t show any. No way out.

 

[sirspamalot]

Community radoncs didn't flood training programs for cheap labor. Most 'good' community radoncs can outrun any academic site specific radonc because just think about it:

Your average "site specific" academic radonc does nothing but that. Imagine again you are a GU and do 90% prostate related care. You're telling me this clinician is outrunning the community doc who has to deal with everything?

Or, as my (now 'famous' academic radonc) former co-resident put it so well "If I do anything but X, I'd be committing malpractice"

There is no "both sides" here... academic physician leadership has harmed our specialty in ways the old greedy community docs couldn't have imagined.

 

[Neuronix]

There is no "both sides" here... academic physician leadership has harmed our specialty in ways the old greedy community docs couldn't have imagined.

There are absolutely both sides.

As a new grad my choices were no partnership track employed physician vs. academics. What's the difference?

Sure there were plenty of nebulous partnership tracks nobody would put in writing that didn't exist. Or also the fake partnership tracks that they call "partner" but is just the same salary/bonus structure as anywhere and with "senior partners" making the big bucks that I was never going to join.

Not to say there aren't issues with academics. There absolutely are. But to paint this as one sided is crazy. Everyone is out to get junior rad oncs. I think equitable went out the window a decade ago.

Regarding the private world, I'm sick of seeing antiquated equipment being used incorrectly to bill modern treatment codes. Or private guys that treat rare stuff that they should refer out that they won't because they "treat everything that walks in the door" and immediately retreat to "well I'm just a lowly community doc" the second you question them. Or how about the docs that treat IMRT by having their dosimetrists contour everything? I get RT-DICOMs whenever possible from prior treatment courses, and I see some scary stuff, disease missed, OARs not contoured and overdosed, targets drawn improperly, etc.

But yeah what do I know, I specialize in one disease site at the mothership with all the latest and greatest equipment, see more of it than just about anyone else, write trials and papers on it, know and accrue for all the clinical trials, know what my colleagues are doing in that site, etc... Guess that makes me a bad doc since I don't treat everything.

The academic bashing on here gets to a ridiculous level sometimes. We should all respect one another as physicians who have different circumstances.

 

[Fpg1245]

There are absolutely both sides.

As a new grad my choices were no partnership track employed physician vs. academics. What's the difference?

Sure there were plenty of nebulous partnership tracks nobody would put in writing that didn't exist. Or also the fake partnership tracks that they call "partner" but is just the same salary/bonus structure as anywhere and with "senior partners" making the big bucks that I was never going to join.

Not to say there aren't issues with academics. There absolutely are. But to paint this as one sided is crazy. Everyone is out to get junior rad oncs. I think equitable went out the window a decade ago.

Regarding the private world, I'm sick of seeing antiquated equipment being used incorrectly to bill modern treatment codes. Or private guys that treat rare stuff that they should refer out that they won't because they "treat everything that walks in the door" and immediately retreat to "well I'm just a lowly community doc" the second you question them. Or how about the docs that treat IMRT by having their dosimetrists contour everything? I get RT-DICOMs whenever possible from prior treatment courses, and I see some scary stuff, disease missed, OARs not contoured and overdosed, targets drawn improperly, etc.

But yeah what do I know, I specialize in one disease site at the mothership with all the latest and greatest equipment, see more of it than just about anyone else, write trials and papers on it, know and accrue for all the clinical trials, know what my colleagues are doing in that site, etc... Guess that makes me a bad doc since I don't treat everything.

The academic bashing on here gets to a ridiculous level sometimes. We should all respect one another as physicians who have different circumstances.

This is a nice sentiment. We need to respect each other. But we won’t.

 

[Lamount]

Community radoncs didn't flood training programs for cheap labor. Most 'good' community radoncs can outrun any academic site specific radonc because just think about it:

Your average "site specific" academic radonc does nothing but that. Imagine again you are a GU and do 90% prostate related care. You're telling me this clinician is outrunning the community doc who has to deal with everything?

Or, as my (now 'famous' academic radonc) former co-resident put it so well "If I do anything but X, I'd be committing malpractice"

There is no "both sides" here... academic physician leadership has harmed our specialty in ways the old greedy community docs couldn't have imagined.

You are making my point… and I think you agree with me. Do you disagree that academic rad oncs don’t respect community rad oncs? Do you disagree that community rad oncs don’t respect academics?

The fact that you, as a community rad onc, think your disrespect is justified only further supports my argument.

 

[sirspamalot]

You are making my point… and I think you agree with me. Do you disagree that academic rad oncs don’t respect community rad oncs? Do you disagree that community rad oncs don’t respect academics?

The fact that you, as a community rad onc, think your disrespect is justified only further supports my argument.

Its not disrespect, its a reality. Nothing I said is factually incorrect, even if it is not politically correct.

Highly focused radonc academic specialists could not survive one week of busy practice.

And, while greed was (and still is, in some private groups) a factor in community practice, the academic/residency kerfuffle proved greed wasn't just in the community.

So the way I see it it ain't the same. Disagreement isn't disrespect.

Whatboutism may be for sale but...

 

[RickyScott]

Academic leadership not academics have screwed this specialty. Average academic is equally impacted by oversupply and the toxic radonc milieu as those in community practice. I don’t know anyone in academics who thinks the field is headed in a good direction.

 

[medgator]

The academic bashing on here gets to a ridiculous level sometimes. We should all respect one another as physicians who have different circumstances.

You missed his point completely. Academics ruined the job market, not the community guys by ramping up slots while simultaneously doing research to reduce fractions, indications etc

 

[Lamount]

Its not disrespect, its a reality. Nothing I said is factually incorrect, even if it is not politically correct.

Highly focused radonc academic specialists could not survive one week of busy practice.

And, while greed was (and still is, in some private groups) a factor in community practice, the academic/residency kerfuffle proved greed wasn't just in the community.

So the way I see it it ain't the same. Disagreement isn't disrespect.

Whatboutism may be for sale but...

I am pretty sure I do my job today better than you would at first and you do your job today better than I would at first…

In terms of efficiency, from many of the complaints I have seen on this forum about declining numbers in the community, this lowly lung cancer specialist has more patients on beam with 3 days in clinic than PPs in clinic 5 days a week.

Maybe I am wrong… maybe you guys in PP really are on a different level

 

[medgator]

I am pretty sure I do my job today better than you would at first and you do your job today better than I would at first…

In terms of efficiency, from many of the complaints I have seen on this forum about declining numbers in the community, this lowly lung cancer specialist has more patients on beam with 3 days in clinic than PPs in clinic 5 days a week.

Maybe I am wrong… maybe you guys in PP really are on a different level

View attachment 372584

I've heard multiple people say they couldn't go back to treating everything after they have been site specific for awhile, even some pretty big names

 

[Lamount]

I've heard multiple people say they couldn't go back to treating everything after they have been site specific for awhile, even some pretty big names

Wouldn’t ever want to do gyn, Peds or brachytherapy again… but I understand a lot of generalists avoid these as well.

As for everything else, i think I would be confident approaching with econtour and a few months of running cases by colleagues. I imagine most specialists from my generation would feel similarly

 

[Neuronix]

You missed his point completely. Academics ruined the job market, not the community guys by ramping up slots while simultaneously doing research to reduce fractions, indications etc

I don't see all these private practices opening their arms with quality partnership track positions. All I see are no more partnership track or ridiculous times and low salaries to partner.

The residencies are controlled by academics, which makes them an easy scapegoat. But, all sides take advantage. Few in hiring positions are innocent here, and that was my point.

 

[medgator]

I don't see all these private practices opening their arms with quality partnership track positions. All I see are no more partnership track or ridiculous times and low salaries to partner.

If there wasn't such an oversupply of grads via expansion with simultaneous increase in observation/hypofx for many indications, things might be different now.

Again, is it the private practices fault that all these extra programs opened up unnecessarily over the last 10-15 years and created such a supply-demand mismatch/imbalance? That's @sirspamalot 's point that you seem to be missing

 

[medgator]

Wouldn’t ever want to do gyn, Peds or brachytherapy again… but I understand a lot of generalists avoid these as well.

As for everything else, i think I would be confident approaching with econtour and a few months of running cases by colleagues. I imagine most specialists from my generation would feel similarly

Yeah probably less of a problem now.

Better quality of trainees, i heard that mainly from boomer professors/chairs who got in when all you needed was a pulse and clean background check (kinda like 2020+!!)

 

[TheWallnerus]

I've heard multiple people say they couldn't go back to treating everything after they have been site specific for awhile, even some pretty big names

This is always so interesting to me. Maybe because these people didn’t have a good wide generalist foundation on which to build. I could not treat a single prostate or breast for the next ten years but still be able, even ten years later, to treat a breast and prostate just great. I feel we are all smart cookies. Surely… absent dementia or brain injury… all of our residency teachings, residency clinical experience, and generalist board certifications are worth something/not worth anything.

 

[communitydoc13]

I'm calling dumb on the PP vs academics conflict here. SDN is lucky to have significant input from academic attendings. There is no way I will have the depth of knowledge about a given site as a good academic doc. Whether this is clinically meaningful is a different question, and the answer is probably no for most patients.

While academics has its own intrinsic pathologies, PP is prone to greed, greed, greed. We all know it. We don't all practice it.

Just hoping the academic docs out there have time and support to do academics. Of course, what the community wants from academics are new indications or new therapeutics that they can themselves participate in. Most folks in the community are better staffed regarding docs than their colleagues in other fields. They are not clamoring for new trainees.

The academic docs who say they couldn't go back to treating everything are probably old and likely disproportionately notable. I'd have no problem hiring an academic ten or less years out from training, or even longer if they were doing stuff like H&N, GYN and lung. If you were just doing breast? Maybe no. At this point, there should be very few breast only attendings.

 

[OTN]

I'm calling dumb on the PP vs academics conflict here. SDN is lucky to have significant input from academic attendings. There is no way I will have the depth of knowledge about a given site as a good academic doc. Whether this is clinically meaningful is a different question, and the answer is probably no for most patients.

While academics has its own intrinsic pathologies, PP is prone to greed, greed, greed. We all know it. We don't all practice it.

Just hoping the academic docs out there have time and support to do academics. Of course, what the community wants from academics are new indications or new therapeutics that they can themselves participate in. Most folks in the community are better staffed regarding docs than their colleagues in other fields. They are not clamoring for new trainees.

The academic docs who say they couldn't go back to treating everything are probably old and likely disproportionately notable. I'd have no problem hiring an academic ten or less years out from training, or even longer if they were doing stuff like H&N, GYN and lung. If you were just doing breast? Maybe no. At this point, there should be very few breast only attendings.

Greed is a universal human trait and by no means confined to pp docs.

 

[deleted1111261]

I like to think of this incarnation of Simul as the "Joe Pera" version. Not quite UP and not quite a music teacher, but close. Of course, the world needs more Joe Peras.

View attachment 372429

So, I watched the first episode on you tube.

So weird!! Do I come off like that?

You do have to honor the for sale sign, tho

 

[communitydoc13]

So, I watched the first episode on you tube.

So weird!! Do I come off like that?

You do have to honor the for sale sign, tho

Ha! Of course you are nothing like Joe Pera.

But, Joe is high quality and earnest and mid-western and definitely not interested in having "the best". He doesn't have a view of himself as someone of historical importance.

Basically the opposite of a cynical Miami plastic surgeon....or Tom Wamsgams....or...

 

[IonsAreOurFuture]

I've heard multiple people say they couldn't go back to treating everything after they have been site specific for awhile, even some pretty big names

I'm starting to wonder if it isn't time for me to specialize down into a few organ sites. Currently I'm doing everything except prostate implants in a group of 5 docs. I think we have some room to focus down and still be able to cross cover.

Maybe not a single organ site like Dan Spratt is to prostate, but I find it's a little challenging to treat everyone from age 4 to 104 and every cancer under the sun.

Plus arthritis...

 

[dieABRdie]

Academics needs an intervention. Im sure this is not new, but sitting here at 5 years out it is surprising how many of my peers have left their academic job. Almost all of them have left because they were treated like a workhorse or trash or both.

Editors constantly complain about the lack of people willing to work for free and then shame them when they wont. (Always hilarious)

Yesterday there was a viral video of a trainee's husband slapping an OBGYN at an academic conference for assaulting his wife.

You have to wonder if these people will ever reflect and realize they are the problem.

 

[sirspamalot]

Trainee or patient's husband?

 

[SneakyBooger]

targets drawn improperly, etc.

We should all respect one another as physicians who have different circumstances.

I love the majority of my academic counterparts as much as I love the majority of my community counterparts. And some academics I don't love at all just as with my community counterparts.

OOOOOOO - CONTOURING!

Looks like community docs contour just as poorly as expert academics:

"Conclusion: Multi-generalist-generated consensus ROIs met or exceeded expert-derived acceptability thresholds."

Interobserver agreement among multiple generalists or ...https://www.redjournal.org › article › fulltext

 

[deleted1111261]

I love the majority of my academic counterparts as much as I love the majority of my community counterparts. And some academics I don't love at all just as with my community counterparts.

OOOOOOO - CONTOURING!

Looks like community docs contour just as poorly as expert academics:

"Conclusion: Multi-generalist-generated consensus ROIs met or exceeded expert-derived acceptability thresholds."

Interobserver agreement among multiple generalists or ...https://www.redjournal.org › article › fulltext

Does this say it takes 5 generalists to equal 1 expert? Maybe this explains the oversupply!

 

[NotMattSpraker]

I'm calling dumb on the PP vs academics conflict here. SDN is lucky to have significant input from academic attendings. There is no way I will have the depth of knowledge about a given site as a good academic doc. Whether this is clinically meaningful is a different question, and the answer is probably no for most patients.

While academics has its own intrinsic pathologies, PP is prone to greed, greed, greed. We all know it. We don't all practice it.

Just hoping the academic docs out there have time and support to do academics. Of course, what the community wants from academics are new indications or new therapeutics that they can themselves participate in. Most folks in the community are better staffed regarding docs than their colleagues in other fields. They are not clamoring for new trainees.

The academic docs who say they couldn't go back to treating everything are probably old and likely disproportionately notable. I'd have no problem hiring an academic ten or less years out from training, or even longer if they were doing stuff like H&N, GYN and lung. If you were just doing breast? Maybe no. At this point, there should be very few breast only attendings.

These are good points. Of all the "bad bosses" I've heard about from friends, the absolute worst one was in a well known community practice. People do abuse juniors in both settings.

Just for your consideration though... there is a power imbalance and in my opinion, this seems to be leveraged more in RO than other fields. Academic affiliated people exert a lot of control over collective issues in this field; they do all the training, credentialing, and hold the vast majority of the society board positions. They also now hire >50% of new grads. In this position, they often model bad behavior.

I've seen so many academic ROs point to the greedy community RO doing 37.5 in 15 for palliation then turn around and treat a G6 prostate on protons or boost a 100 year old lady with breast cancer. Maybe I just feel this way because I have yet to be accepted to the Penn Palliative Network, I'm really trying. Or maybe Im just a little salty that more than one person told me "leaving academics" for a really great job was ruining my career.

I stand by my original post that they need an intervention. With great power comes great responsibility right?