Physics & Radbio

[deleted947887]

Young whippersnappers.

I never said any of that and you need to re-read my post and adjust your tone. I have never been personal and have stressed on multiple occasions that trainees should not be punished. Nor have I ever said the exam should be a solution to a different problem. Ever.

And I doubt Wallner cares 1 bit about the job situation. You really think the path that someone with a great gig who went into private practice to make money is to cause himself more headache over an issue that has no bearing on his career or life?

What I said was, it is reasonable to hold some factors outside content, review material, and changing exam focus accountable for physics. Until the rates were posted, there was maybe one post complaining our physics by the examinees here. And white knighting the people who are actively contributing to a bigger problem is real but that is all it is. Not a stealth way to solve a market problem that will not change based on a single year.

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[Mandelin Rain]

I know that we love to turn every thread into a discussion of the current and future job market, but that is completely unrelated to this issue.

If anything, Wallner stands to benefit from cheap labor as his bankrupt empire attempts a comeback.

Who knows what the true motivations are/were. My guess is he felt that there was complacency among programs and residents regarding residency teaching, culminating in the Amdur letter. I'm sure during his time at ARRO he heard all the same complaints that have been posted here about just being scut monkeys for attendings (which is true, BTW). He might have viewed this as a wake up call. Or maybe he just felt his position in the ABR was threatened by the Amdur article, as I'm sure the ABR wouldn't be thrilled with losing testing fees, and sought to tamp down resistance via this move. I doubt though, that a near retirement age private practice owner who relies on a steady stream of rad oncs cared too much about declining pay and overstauration of the job market in the future. But, maybe? Obviously an overstep any way you look at it. And it ended up hurting a bunch of (presumably) good, smart, young doctors who had no hand in creating these issues.

If his move truly was somewhat altruistic, the response probably wouldn't have been so severe and angry. He may have even offered a mid-year make up given the test was a statistical outlier. But that's not what happened. He wanted to make it hurt.

 

[scarbrtj]

Wallner stands to benefit from cheap labor as his bankrupt empire attempts a comeback

A non-board certified, fully residency-trained radiation oncologist is the cheapest radiation oncologist money can buy.

 

[Mandelin Rain]

A non-board certified, fully residency-trained radiation oncologist is the cheapest radiation oncologist money can buy.

This is a good point.

However, I'd say "good luck" to Paul Wallner if trying to get any of the current non-boarded PGY-5s to come work for him.

 

[mikezab]

Debtrising,

The issue people have with your post is that you do seem to call out the current PGY-5's for not trying, and that being lackadaisical is what was behind the lower exam scores. Your words were 'Maybe there was some component of sleeping at the wheel on part of the trainees'. Which is being interpreted as 'the residents didn't try and overlooked the exam'.

You keep coming back to physics saying that there were no issues with the exam. There were issues with the physics exam, it is just that the issue was different. You are correct that the exam content was the same (similar to Raphex exams etc). If you look back on this thread you will see the complaints from people that failed physics-- their issue is that they were doing very well on Raphex exams, read all the normal study materials and conventional wisdom said that when scoring 80%+ on Raphex you would easily pass physics. But many of these people failed. The issue with physics was on the scoring of the exam.

To point out specific areas where your thought process is incorrect:

1. 'if all the tenets of a “corrupt” exam offered for rad bio have no application nor were they even brought up for physics, at what point does that theory need to be re-evaluated?'. The exam was still corrupt, just in a different way. Dr. Wallner and the ABR increased the percentage of questions you needed to get right in order to pass. They have not been forthcoming with any information regarding raw scores.

2. You said: 'a percent correct cut off the exact same as at least one previous year, is it really so outrageous to examine the education programs or the preparation for the exam??'.

-The percent correct cut off was NOT THE SAME as prior years. The only information provided from Dr. Wallner had to do the with 'Passing Standard'. The Passing Standard is the cumulative point total you must reach in order to pass the exam. Each question is individually graded, and given a point value based on how easy/difficult the ABR (and Dr. Wallner) determine it is. THEY make this call. THEY CHANGE THESE VALUES EVERY YEAR. So if he had an agenda, he could easily have made each question worth less which would affect how many people passed. We DO NOT KNOW THE RAW SCORES. And Dr. Wallner hasn't gone back to evaluate questions from previous years to be able to prove/say 'hey these idiots were 4 standard deviations off from prior years on the same exact questions...'. This would be an easy thing to do and would prove his point that the issue had to do with trainees. He has taken the time to analyze that data based on program size instead of trying to figure out what went wrong with the test when something was very clearly wrong.
-The 'Passing Standard' this year was 71%. The only information Dr. Wallner was willing to provide was the last 5 years passing standards. These ranged from 63-71%. In other words, this is the highest the passing standard has ever been in at least 5 years (and likely much much longer but Dr. Wallner is unwilling to give us this information). Yet they didn't take a second look at it or adjust it when the pass rates were lower than ever before by 3-5 standard deviations-- odd...right? To beat this point home, this is the HIGHEST PASSING STANDARD EVER in the last 5 years. That's all we know.

 

[RadOncDoc21]

To be fair... Wallner appears to be the exact same person I remember a couple of years ago when he replied back to an email with a very condescending snarky undertone. My first reaction was to respond back, but I decided to let it go and to be honest, I immediately stopped caring the very next day.

I know there are going to be responses in how this year was different and that it wasn't fair to many more residents, but I do understand how you feel because I was in the same situation. We can even argue on the subject manner and how it's changed or how much the bar has shifted, which I'm sure it did. All I'm saying is at the end of the day, you are all on track to become board-certified radiation oncologist and will go on to have great careers. I'm not telling you to let it go but definitely don't let this setback define your career.

I hope this will at least create some positive energy as this forum has become gravely depressing.

 

[thecarbonionangle]

The Wallner well-meaning for the greater good theory is quite funny. Some people are blind like eyeless moles. If you walked in and a guy was walking out with your belongings, your reaction would not be expected to be “that looks uncomfortable, let me help you out with that”. Apparently some would react exactly like that.

 

[deleted947887]

If you go back far enough you'll see those people just like it when bad things happen to their colleagues. No one is blind.

Anyway, I think suing the ABR should be the plan. He shouldn't be on the board if he has a conflict of interest in having less (or more) board certified physicians. When he was originally put on the board he wasn't at 21st Century. He should've stepped down when he took that job.

The Wallner well-meaning for the greater good theory is quite funny. Some people are blind like eyeless moles. If you walked in and a guy was walking out with your belongings, your reaction would not be expected to be “that looks uncomfortable, let me help you out with that”. Apparently some would react exactly like that.

 

[RadOncDoc21]

The Wallner well-meaning for the greater good theory is quite funny. Some people are blind like eyeless moles. If you walked in and a guy was walking out with your belongings, your reaction would not be expected to be “that looks uncomfortable, let me help you out with that”. Apparently some would react exactly like that.

Not sure if this was in response to my post or not. If it was, nowhere did I say Wallner is well-meaning or even a good person. I personally don’t think he’s worth the time and energy, but feel free to do whatever you want.

 

[KHE88]

I'm struggling to not respond to yet another attempt by DebtRising to derail this thread by whining about the job market and bask in the schadenfreude of watching us fail. I'm seriously starting to wonder if this is an ABR troll account because he is essentially repeating the absurd Wallner/Kachnic party line. Sadly, a number of our own peers from larger programs are also agreeing and have been commenting elsewhere that this was a fair exam and it was right to fail so many. This number is small though, and I think most of those who passed appreciate the absurdity of this situation. These are likely the future academic leaders of tomorrow who will be filling Wallner's shoes.

Although, I will say this: DebtRising does have a point about residents this year not studying enough (hear me out...).
The reason is that Wallner simply raised the bar. He had the power to do so, and he did.

"The lady doth protest too much, methinks" - Wallner's curiously overly aggressive defense on the reliability of their methods and consistency of the exam (despite strong evidence to the contrary presented by ARRO) is fairly self-evident that the exam was anything but. Repeating over and over that the exam is "legally defensible" suggests that there was worry about being challenged in court. So maybe we need to do that. Would be awesome to have a court force them to turn over exams and records to prove their wild claims.

I do not know what is driving Wallner's personal scorn and agenda to harm small programs, I just know that it exists. I don't know why he hates these programs and wants to harm them, I just know he did. I find it unlikely that he did this to try and improve the job market because I promise he doesn't care about whether the next generation of radiation oncologists is gainfully employed and fairly paid. Yes locums rates for radiation oncology suck and probably will continue to decline, and non-board certified rad oncs essentially have to do locums, but he will probably be dead before he sees a cent from this fallout. He just wants to shut down the small programs for some unclear reason. There's something else fueling him. I don't get it. If someone wants to fill me in on what this caustic man is thinking, feel free.

DebtRising, the physics exam was a hard exam. You didn't take it, so shut up already. The content was more surprising on bio, yes. A comparable content change on the physics exam would have been asking us something like solving an integral equation. The issue with the physics exam was that the passing score was so high, not that the content was so tangential. Your attempt to use the physics pass rate as evidence for Wallner's claim that the class of 2019 is abnormally complacent (Wallner's favorite word to describe us) is asinine. They adjusted physics to correlate with bio. Period.

The reality is that, being an ultra-competitive sub-specialty (at least up until now as we are rapidly trying to go the way of pathology), a fair numbers of gunners get into our field. And what programs do the gunners "gun" for? I think what happened was this: Wallner looked back at quartile and raw scores for people from the big programs vs. small programs. It would not be surprising to think that people with 260-270 step scores also neurotically over-studied for all additional tests in residency. If Wallner wanted to hurt the small programs, he could simply look at those raw scores on physics and bio from the big programs. Probably a lot more top quartile scores there because of the gunners there studying every weeknight and 12 hours a day every weekend throughout the spring of PGY-4 then taking 2 weeks of vacation prior to the exam to study. So Wallner simply raised the bar. He had a bone to pick with bio (go back and look at the bio task force linked earlier in this thread), and introduced a lot of questions that would only be picked up by somebody with a PhD in cancer biology or someone who seriously overstudied with many other resources beyond Hall (which he has repeatedly hinted is "out-dated" based on who-knows-what). The cut score for physics was simply adjusted so the second quartile who normally would have passed failed. Is that new group of second quartile failures who otherwise would have passed any other year besides this one really not competent to practice?

I personally thought I way overstudied for physics because I found it much more interesting than bio and went very in depth because I enjoyed learning the material. It turned out this was barely enough for me to pass.

The gunners/compulsive over-studiers and PhDs were the people that passed the exam. If you studied the way most people have in the past to the point where you felt you had reasonable competency in bio and physics, you failed.

So yeah, maybe we didn't study enough. But we would have passed in any other year. Do we as clinicians really need to study to the level for a PhD candidate in cancer biology or medical physics needs to for his/her qualifying exam to go for dissertation? Doesn't this distract from clinical education?

Maybe this really was retaliation for Lee/Amdur claiming that boards were an irrelevant distraction from more important education. The new reality is that the amount of preparation needed for these tests just went up exponentially and the stakes just got a lot higher for departments as ACGME accreditation is now tied to first-time pass rates on them. Thanks guys!

Med students, you are entering into one of the most volatile, inbred, and corrupt fields with odd pathologic personalities in leadership that eat their young. Going into radiation oncology at the moment is an enormous risk. If there is literally any other field in medicine you think you might have a semi-decent chance of being content (not even happy) in, then do that.

 

[RadOncLazers]

I’m still actively discussing a lawsuit. It’s completey viable from what I’ve been told. The exam pass rates, trends, and communications are extremely convincing. There are several lareger firms who would likely work with the case. I think it’s fair to allow a response at the upcoming meetings, but we should not lose sight of what happened this year.


QUOTE="sphinx2019, post: 20374415, member: 947887"]If you go back far enough you'll see those people just like it when bad things happen to their colleagues. No one is blind.

Anyway, I think suing the ABR should be the plan. He shouldn't be on the board if he has a conflict of interest in having less (or more) board certified physicians. When he was originally put on the board he wasn't at 21st Century. He should've stepped down when he took that job.[/QUOTE]

 

[thecarbonionangle]

In what other place are people posting hinting that people deserved it that you are referencing?

Our field attracts a lot of pathological personalities due to the size of the field. Many people do not retire when they should and hold on to power. Wallner is old enough to have done a residency in radiology then do a fellowship in Drexel in rad onc (funny that he has a bias against small programs). Lots of dinosaurs like that still in practice in the academic and private practice world. Someone mentioned the Upenn chair warning about the perils of IMRT back in the day and saying immunotherapy was crap. These people are not the future of our field. Some of them are refusing to hand the power over to the newer generetion and hold on to power in a sickening way. These slimeballs must be retired one way or another. The meeting at ASTRO is an opportunity to begin this change.

A broken clock is right at times. There are many programs out there, of all sizes, where residents only do scut and education is minimal to none. This must he addressed but this is not how you do it.

Although absolutely unrelated, if we are going to address our oversupply problem we will not do so with our “leaders”.

 

[KHE88]

In what other place are people posting hinting that people deserved it that you are referencing?

People are talking about this in other setting other than online. Seen it. You're naive if you think our generation is immune from a few nasty power hungry sociopaths eager to climb the ranks into a leadership role. Look at the current narcissistic sociopaths filling these spots. These positions don't exactly attract normal well balanced kind people.

 

[Vandalia]

I’m still actively discussing a lawsuit. It’s completey viable from what I’ve been told. The exam pass rates, trends, and communications are extremely convincing. There are several lareger firms who would likely work with the case. I think it’s fair to allow a response at the upcoming meetings, but we should not lose sight of what happened this year.

Anyway, I think suing the ABR should be the plan. He shouldn't be on the board if he has a conflict of interest in having less (or more) board certified physicians. When he was originally put on the board he wasn't at 21st Century. He should've stepped down when he took that job.

I am not a lawyer and this is not my specialty. However, after the decades I have picked up a fair amount of legal knowledge by osmosis while practicing medicine. Sure, you need to talk to an actual attorney, but you also need to know the questions to ask and know that if you are paying by the hour, and aren't legally sophisticated there is a good chance you are being scammed.

(Note, you need to talk to an attorney. Don't trust me. Don't listen to your cousin who is a paralegal, or your fellow resident who took a law course as an undergrad. Don't talk to your uncle who does wills and deeds. You need to talk to a lawyer who does this type of contract work.)

The first problem is that it is very likely that you will never be able to get to court. Almost any agreement these days has a provision that requires any dispute be handled in arbitration. The US Supreme Court in a series of rulings over the years has made these provisions ironclad, so you are not going to get out of it. If an attorney tells you he can contest the arbitration provision in court, you are being taken to the cleaners. What is arbitration? Ever see or hear of Judge Judy? That is arbitration, an extreme example of arbitration, but arbitration none the less. The most important point is that there are no "class actions" in arbitration. So every case would have to be filed separately. Arbitration is also final - there are no appeals; unless the arbitrator literally flipped a coin to make a decision or was given a cartoon bag of money with a dollar sign on it by one of the parties. Now I have no idea if any agreement you signed with the ABR has an arbitration provision, but I would be shocked if it did not.

The second problem is if you get to court (or arbitration). For the sake of argument, lets say there is no arbitration provision. You file a complaint. The ABR will file almost certainly a motion to dismiss. The important point is that this happens before any discovery. The motion to dismiss will almost certainly include "failure to state a claim." This means that even if everything that the plaintiff (you) says is true, they (you) still cannot win. You have to come up with a legal theory in order to win. "It wan't fair" does not cut it. The simplest way is if there was breach of contract. If the agreement you signed with the ABR says that they must provide an accurate study guide, or all the questions in physics must come from X, then you have a chance. I would be surprised if this is the case. If the legal basis is outside of the agreement there is a very low chance of success and a very high chance the attorney is scamming you.

If an attorney insists you pay him hourly fess (retainer) in a case like this, you should be concerned. An attorney will file any case you like as long as you are paying the bills, even if it has no chance of success. If he is willing to take it on a contingency basis - he puts his resources on the line - then you have a chance. If you ask him to do it on a contingency basis and he laughs, that is all you need to know. The most immediate question you need to answer is arbitration. If there is an arbitration provision you are not getting to court, which means basically no discovery or class action, which basically means your legal options are nil.

I believe the ABMS board are in need of serious reform, but the chances of being able to do this through a legal process are small. If your faculty members will support a revolt, you have a good chance. That should be your focus.

 

[thecarbonionangle]

People are talking about this in other setting other than online. Seen it. You're naive if you think our generation is immune from a few nasty power hungry sociopaths eager to climb the ranks into a leadership role. Look at the current narcissistic sociopaths filling these spots. These positions don't exactly attract normal well balanced kind people.

Trust me i am not blind to the level of sociopathy found even amongst our coresident colleagues. There have been some crazy posts even defending the ABR on this post earlier by supposed fellow resident sycophants. I found out earlier in my training and have posted before that i found the people the field attracts generally dissapointing. I find weirdos and narcissist gunners, non-teamplayers are abound these days. I have very little friends in the field. I mostly tolerate my co-residents and some are not good people and lack empathy. However, this is not the issue at hand and my coresidents are not peeing on me and telling me it is raining with a colourful rainbow at the present time.

 

[thecarbonionangle]

I am not a lawyer and this is not my specialty. However, after the decades I have picked up a fair amount of legal knowledge by osmosis while practicing medicine. Sure, you need to talk to an actual attorney, but you also need to know the questions to ask and know that if you are paying by the hour, and aren't legally sophisticated there is a good chance you are being scammed.

(Note, you need to talk to an attorney. Don't trust me. Don't listen to your cousin who is a paralegal, or your fellow resident who took a law course as an undergrad. Don't talk to your uncle who does wills and deeds. You need to talk to a lawyer who does this type of contract work.)

The first problem is that it is very likely that you will never be able to get to court. Almost any agreement these days has a provision that requires any dispute be handled in arbitration. The US Supreme Court in a series of rulings over the years has made these provisions ironclad, so you are not going to get out of it. If an attorney tells you he can contest the arbitration provision in court, you are being taken to the cleaners. What is arbitration? Ever see or hear of Judge Judy? That is arbitration, an extreme example of arbitration, but arbitration none the less. The most important point is that there are no "class actions" in arbitration. So every case would have to be filed separately. Arbitration is also final - there are no appeals; unless the arbitrator literally flipped a coin to make a decision or was given a cartoon bag of money with a dollar sign on it by one of the parties. Now I have no idea if any agreement you signed with the ABR has an arbitration provision, but I would be shocked if it did not.

The second problem is if you get to court (or arbitration). For the sake of argument, lets say there is no arbitration provision. You file a complaint. The ABR will file almost certainly a motion to dismiss. The important point is that this happens before any discovery. The motion to dismiss will almost certainly include "failure to state a claim." This means that even if everything that the plaintiff (you) says is true, they (you) still cannot win. You have to come up with a legal theory in order to win. "It wan't fair" does not cut it. The simplest way is if there was breach of contract. If the agreement you signed with the ABR says that they must provide an accurate study guide, or all the questions in physics must come from X, then you have a chance. I would be surprised if this is the case. If the legal basis is outside of the agreement there is a very low chance of success and a very high chance the attorney is scamming you.

If an attorney insists you pay him hourly fess (retainer) in a case like this, you should be concerned. An attorney will file any case you like as long as you are paying the bills, even if it has no chance of success. If he is willing to take it on a contingency basis - he puts his resources on the line - then you have a chance. If you ask him to do it on a contingency basis and he laughs, that is all you need to know. The most immediate question you need to answer is arbitration. If there is an arbitration provision you are not getting to court, which means basically no discovery or class action, which basically means your legal options are nil.

I believe the ABMS board are in need of serious reform, but the chances of being able to do this through a legal process are small. If your faculty members will support a revolt, you have a good chance. That should be your focus.

The legal system is broken because it allows the party with most money to almost always win. Most cases are settled for this reason and many rich companies and people violate the law knowing they can play the system. Its like playing poker against someone with a much larger amount of chips, they can always bully you with large bets and force you to go all in. Rich people commonly use the legal system by suing and bankrupting people through court fees and lawyers. This was a common Trump tactic. Suing the ABR is lkely a dead end because of the lack of money. The ABR is rich from decades of charging us money for a largely irrelevant test, a true failure of leadership in our field for MANY years. Amdur and Lee simply expressed what many already believed. The lawyers wanting to work for free to get their names out there are looking for cases with larger societal impact ( civil rights etc) not residents vs ABR

 

[deleted947887]

https://www.jacr.org/article/S1546-1440(03)00007-3/fulltext

In 2002, Paul Jung, MD, and two other physicians filed a class action antitrust lawsuit against the National Resident Matching Program (NRMP) or the “The Match.” They alleged that the NRMP is “a computerized processing system that assigns graduating medical students a single, non-negotiable employment opportunity. A rider, sponsored by Senators Edward M. Kennedy (D-Mass.) and Judd Gregg (R-N.H.), was attached to a pension act, the Pension Funding Equity Act, which President George W. Bush signed into law in April 2004

If you truly believe you're in the right, go for it. If you're angry about an exam, don't. Nothing comes without risks, that's why you have to do it for the right reasons. If you lose, you have no regrets. Those guys won.

My opinion is that you can not have a person who is undoubtedly interested in the market of radiation oncologists (i.e. involved in hiring and likely negotiating new hires) involved in a process that ultimately amounts to market regulation. Particularly when said individual has in the past expressed a great interest in diminishing (reasonable) government oversight. That creates a conflict. I do not see how this is allowed. Either put an end to board certification or make the process fair. As it currently stands, it is operating like a trust.

 

[RadOncLazers]

Thank you for the insight. Fortunately, I have pretty good relationships with lawyers at larger firms, and have spoken with them about the matter. Again, it seems very feasible, but I do think it’s fair to allow these upcoming meetings to unfold.

QUOTE="Vandalia, post: 20374839, member: 599406"]I am not a lawyer and this is not my specialty. However, after the decades I have picked up a fair amount of legal knowledge by osmosis while practicing medicine. Sure, you need to talk to an actual attorney, but you also need to know the questions to ask and know that if you are paying by the hour, and aren't legally sophisticated there is a good chance you are being scammed.

(Note, you need to talk to an attorney. Don't trust me. Don't listen to your cousin who is a paralegal, or your fellow resident who took a law course as an undergrad. Don't talk to your uncle who does wills and deeds. You need to talk to a lawyer who does this type of contract work.)

The first problem is that it is very likely that you will never be able to get to court. Almost any agreement these days has a provision that requires any dispute be handled in arbitration. The US Supreme Court in a series of rulings over the years has made these provisions ironclad, so you are not going to get out of it. If an attorney tells you he can contest the arbitration provision in court, you are being taken to the cleaners. What is arbitration? Ever see or hear of Judge Judy? That is arbitration, an extreme example of arbitration, but arbitration none the less. The most important point is that there are no "class actions" in arbitration. So every case would have to be filed separately. Arbitration is also final - there are no appeals; unless the arbitrator literally flipped a coin to make a decision or was given a cartoon bag of money with a dollar sign on it by one of the parties. Now I have no idea if any agreement you signed with the ABR has an arbitration provision, but I would be shocked if it did not.

The second problem is if you get to court (or arbitration). For the sake of argument, lets say there is no arbitration provision. You file a complaint. The ABR will file almost certainly a motion to dismiss. The important point is that this happens before any discovery. The motion to dismiss will almost certainly include "failure to state a claim." This means that even if everything that the plaintiff (you) says is true, they (you) still cannot win. You have to come up with a legal theory in order to win. "It wan't fair" does not cut it. The simplest way is if there was breach of contract. If the agreement you signed with the ABR says that they must provide an accurate study guide, or all the questions in physics must come from X, then you have a chance. I would be surprised if this is the case. If the legal basis is outside of the agreement there is a very low chance of success and a very high chance the attorney is scamming you.

If an attorney insists you pay him hourly fess (retainer) in a case like this, you should be concerned. An attorney will file any case you like as long as you are paying the bills, even if it has no chance of success. If he is willing to take it on a contingency basis - he puts his resources on the line - then you have a chance. If you ask him to do it on a contingency basis and he laughs, that is all you need to know. The most immediate question you need to answer is arbitration. If there is an arbitration provision you are not getting to court, which means basically no discovery or class action, which basically means your legal options are nil.

I believe the ABMS board are in need of serious reform, but the chances of being able to do this through a legal process are small. If your faculty members will support a revolt, you have a good chance. That should be your focus.[/QUOTE]

 

[RadOncLazers]

That’s why it helps to know people, and not just the aspiring newly minted lawyer.

The legal system is broken because it allows the party with most money to almost always win. Most cases are settled for this reason and many rich companies and people violate the law knowing they can play the system. Its like playing poker against someone with a much larger amount of chips, they can always bully you with large bets and force you to go all in. Rich people commonly use the legal system by suing and bankrupting people through court fees and lawyers. This was a common Trump tactic. Suing the ABR is lkely a dead end because of the lack of money. The ABR is rich from decades of charging us money for a largely irrelevant test, a true failure of leadership in our field for MANY years. Amdur and Lee simply expressed what many already believed. The lawyers wanting to work for free to get their names out there are looking for cases with larger societal impact ( civil rights etc) not residents vs ABR

 

[RickyScott]

Thank you for the insight. Fortunately, I have pretty good relationships with lawyers at larger firms, and have spoken with them about the matter. Again, it seems very feasible, but I do think it’s fair to allow these upcoming meetings to unfold.

QUOTE="Vandalia, post: 20374839, member: 599406"]I am not a lawyer and this is not my specialty. However, after the decades I have picked up a fair amount of legal knowledge by osmosis while practicing medicine. Sure, you need to talk to an actual attorney, but you also need to know the questions to ask and know that if you are paying by the hour, and aren't legally sophisticated there is a good chance you are being scammed.

(Note, you need to talk to an attorney. Don't trust me. Don't listen to your cousin who is a paralegal, or your fellow resident who took a law course as an undergrad. Don't talk to your uncle who does wills and deeds. You need to talk to a lawyer who does this type of contract work.)

The first problem is that it is very likely that you will never be able to get to court. Almost any agreement these days has a provision that requires any dispute be handled in arbitration. The US Supreme Court in a series of rulings over the years has made these provisions ironclad, so you are not going to get out of it. If an attorney tells you he can contest the arbitration provision in court, you are being taken to the cleaners. What is arbitration? Ever see or hear of Judge Judy? That is arbitration, an extreme example of arbitration, but arbitration none the less. The most important point is that there are no "class actions" in arbitration. So every case would have to be filed separately. Arbitration is also final - there are no appeals; unless the arbitrator literally flipped a coin to make a decision or was given a cartoon bag of money with a dollar sign on it by one of the parties. Now I have no idea if any agreement you signed with the ABR has an arbitration provision, but I would be shocked if it did not.

The second problem is if you get to court (or arbitration). For the sake of argument, lets say there is no arbitration provision. You file a complaint. The ABR will file almost certainly a motion to dismiss. The important point is that this happens before any discovery. The motion to dismiss will almost certainly include "failure to state a claim." This means that even if everything that the plaintiff (you) says is true, they (you) still cannot win. You have to come up with a legal theory in order to win. "It wan't fair" does not cut it. The simplest way is if there was breach of contract. If the agreement you signed with the ABR says that they must provide an accurate study guide, or all the questions in physics must come from X, then you have a chance. I would be surprised if this is the case. If the legal basis is outside of the agreement there is a very low chance of success and a very high chance the attorney is scamming you.

If an attorney insists you pay him hourly fess (retainer) in a case like this, you should be concerned. An attorney will file any case you like as long as you are paying the bills, even if it has no chance of success. If he is willing to take it on a contingency basis - he puts his resources on the line - then you have a chance. If you ask him to do it on a contingency basis and he laughs, that is all you need to know. The most immediate question you need to answer is arbitration. If there is an arbitration provision you are not getting to court, which means basically no discovery or class action, which basically means your legal options are nil.

I believe the ABMS board are in need of serious reform, but the chances of being able to do this through a legal process are small. If your faculty members will support a revolt, you have a good chance. That should be your focus.

[/QUOTE]

There is going to be a high burden for a court to even consider the merits of the case. First, you will have to convince a court that they should be in a position to substitute their own judgement for that of a specialty organization of experts, when it comes to "keeping the public safe" (thats the argument the\ abr will make: in the name of nuclear/radiation safety, we implement exacting standards). Courts are predisposed to push cases into arbitration or defer judgement (as long as a coherent argument can be made) to get out of extra work:

None of us know Wallner's motives and not many seem to agree with me that this related to oversupply of docs. However, from what I know personally,I doubt that Wallner (who must be over 80) has any kind of equity stake in 21C or gets much from 21c other than a small part time babysitting salary. Maybe, he is just a schmuck?

 

[deleted947887]

The people warning against litigation are those interested in seeing greater market control. Like I said, if you feel you are in the right, litigation is the answer, irrespective of all the fear mongering. A court will hear your case (as they have in the past).

 

[RickyScott]

The people warning against litigation are those interested in seeing greater market control. Like I said, if you feel you are in the right, litigation is the answer, irrespective of all the fear mongering. A court will hear your case (as they have in the past).

I am warning against paying an attorney hourly rates. If one will take it on contingency, you have nothing to lose.

 

[RadOncLazers]

Absolutely.

I am warning against paying an attorney hourly rates. If one will take it on contingency, you have nothing to lose.

 

[Vandalia]

The people warning against litigation are those interested in seeing greater market control. Like I said, if you feel you are in the right, litigation is the answer, irrespective of all the fear mongering. A court will hear your case (as they have in the past).

No, they will not. You either have no knowledge of the US legal system or you are running a scam. Sure, a court will issue an order on anything you file, but that is not what you want; you need a ruling on the merits which is a totally different thing. The US Supreme Court has slapped down a number of states for failing to enforce arbitration. If there is an arbitration provision, you will not be able to reach the courts.

https://www.supremecourt.gov/opinions/11pdf/11-391.pdf

 

[deleted947887]

No, they will not. You either have no knowledge of the US legal system or you are running a scam. Sure, a court will issue an order on anything you file, but that is not what you want; you need a ruling on the merits which is a totally different thing. The US Supreme Court has slapped down a number of states for failing to enforce arbitration. If there is an arbitration provision, you will not be able to reach the courts.

https://www.supremecourt.gov/opinions/11pdf/11-391.pdf

There is no arbitration provision.

That's bad logic. I am not running a scam, and I do have knowledge of the US legal system.

 

[KHE88]

The ABR is idiotic. Just make another test, give it in the winter, and all of this goes away. PEW can retire in peace and drift off into senility in southwest Florida. But nope, they are looking forward to a back and forth pissing contest in PRO. They are chomping at the bit to present their "data" at upcoming meetings. Giving us a retake with a fair exam screws that data up. Make us take 3 exams at the same time next year and preserve that failure rate. With what I'm sure is going to be a doozy of a clinical written too (if there were grumblings about a 90% pass rate on bio, you think there's not grumblings about a 97% pass rate on clinical)? They couldn't just fail 30% on clinical this year when only 10% of that class failed bio and physics. For us though, just watch...

 

[deleted947887]

Wallner and the ABR have one motive. To make money. This nonsense about small programs is a way to explain their F#$& up. Small programs have less PhDs, have less people involved with the boards, have less fill-in-the-blank. What ever it is, it's irrelevant. The ABR protects the public? Then they owe the public a lot, because the last 10 years have seen slew of BC radiation oncologists hurting the public.

 

[deleted18755]

Medical students...
Do not go into radiation oncology unless you can match into a top 5-10 program. If you think you are ok with practicing in small town America in the midwest, just add another 1-2 years to the 5 years of residency because ABR has decided that all residents from smaller programs are dumb and not worthy of board certification. Other residents might paint a brighter picture by saying that most jobs are not advertised, and they are referred jobs by their attendings. This has not been the case for me or my friends at smaller programs. Go into med onc if you like oncology. You'll make just as much money and have your choice of location. Actually, you'll probably make more money in med onc in desirable cities because there are no jobs in big cities for rad onc graduates from average programs anymore. The only jobs are fellowships in big cities. For people who want to do research, there are no majority research jobs in rad onc any more unless you want to do a multi year fellowship or post doc. The expectation for a faculty position in med onc is to submit a NIH K08 application after 2 years of being an assistant professor. In rad onc, the expectation is to already have a grant so you can get a first job as an assistant professor if you want any protected research time. Our rad onc leaders have ruined this field for us.

Leaders in the field,
You can immediately solve this problem by cutting residency slots by half. If you do so, ABR will again think that residents are of higher calibre because there are less slots and not fail half the graduating class anymore. Your graduating residents can actually find a decent paying job at a location they desire. Private practice people will also not feel threatened anymore. You can also continue to feel good about the superiority/competitiveness of rad onc instead of having the specialty filled with IMGs. Everybody will be happy.

Please discuss at ASTRO next week and CUT RESIDENCY POSITIONS IN HALF. Until then,

MEDICAL STUDENTS....DO NOT BECOME A RADIATION ONCOLOGIST.

Everybody will be happy!?! What about the geriatric senior faculty at academic programs who have been banishing junior faculty (who were the absolute cream of the crop of medical schools and often MD/PhD’s) to satellite sites with private practice work but academic salary (guess to whom all the extra revenue went?) for the past 10-15+ years who would no longer have full resident coverage? Who will scribe their notes, do their volumes, write up the SEER analyses, retrospective reviews, and other garbage research nobody reads?

 

[deleted18755]

I’ve been a bit isolated in general and specifically with regards to academic programs but I can’t help but notice the following and wonder whether it’s as widespread as it appears to me:

For the past 10-15+ years radiation oncology has undoubtedly/objectively been among the most competitive specialities and therefore attracted some of the most hard working and brilliant medical students with almost universal research experience and I believe literally by far the highest proportion of PhD’s. However, if you look around the major academic centers it’s the same people there who were in place 10-15+ years ago (many major academic centers are filled with people well into their 60’s and often literally 70+ year olds). Where are all the brilliant medical students (99% of whom during interviews talked nonstop about how they plan an academic career and the majority of whom were actually well positioned to do so) and at least a decades worth of brilliant academically oriented residents (many of whom had PhD’s, were on the Holman pathway, or at least demonstrated research productivity even as medical students?).

Hint: check the satellite centers 15-30 minutes (10 years ago), ~45 minutes (5years ago), and literally 1-1.5+ hours (current) from the mothership.

In general medical students aren’t stupid and the “leaders” in our field better believe that too medical students have many options. How long can these dinasuars in academics keep telling medical students how brilliant they are and how great their research is, encourage them to apply for residency (but only if they are interested in academics since we are such a research heavy/Intellectual field), use them during residency, and then after they’ve done everything perfectly, published a billion papers, etc, not only not support them but actively ship them off to the satellite center to treat breast and prostate all day (make sure you hypofractionate!), and just repeat the cycle with the only constant that the old guys keep eating their young!?!

This examination nonsense is just more of the same theme that a handful of very powerful people is dooming this awesome speciality.

 

[KHE88]

I’ve been a bit isolated in general and specifically with regards to academic programs but I can’t help but notice the following and wonder whether it’s as widespread as it appears to me:

For the past 10-15+ years radiation oncology has undoubtedly/objectively been among the most competitive specialities and therefore attracted some of the most hard working and brilliant medical students with almost universal research experience and I believe literally by far the highest proportion of PhD’s. However, if you look around the major academic centers it’s the same people there who were in place 10-15+ years ago (many major academic centers are filled with people well into their 60’s and often literally 70+ year olds). Where are all the brilliant medical students (99% of whom during interviews talked nonstop about how they plan an academic career and the majority of whom were actually well positioned to do so) and at least a decades worth of brilliant academically oriented residents (many of whom had PhD’s, were on the Holman pathway, or at least demonstrated research productivity even as medical students?).

Hint: check the satellite centers 15-30 minutes (10 years ago), ~45 minutes (5years ago), and literally 1-1.5+ hours (current) from the mothership.

In general medical students aren’t stupid and the “leaders” in our field better believe that too medical students have many options. How long can these dinasuars in academics keep telling medical students how brilliant they are and how great their research is, encourage them to apply for residency (but only if they are interested in academics since we are such a research heavy/Intellectual field), use them during residency, and then after they’ve done everything perfectly, published a billion papers, etc, not only not support them but actively ship them off to the satellite center to treat breast and prostate all day (make sure you hypofractionate!), and just repeat the cycle with the only constant that the old guys keep eating their young!?!

This examination nonsense is just more of the same theme that a handful of very powerful people is dooming this awesome speciality.

This x100. The baby boom generation has totally screwed this specialty and won't leave until they have milked it for ever last cent of profit. I have seen and heard stories of "leaders" in our field who are unable to practice safely. Treating with 2D techniques. Overdosing cord. Not knowing how to use IMRT. These are the people that grandfathered themselves around having to re-certify for boards. Then they do this ---- to the bright young people just hoping to earn even a quarter of what these guys did in their heyday.

There are still good jobs out there, but they are in small towns and rural areas away from large metros. It's unclear if these will still be here in 10 years when current med students will need them. More likely, your reward for suffering through 4 years of residency (note-writing, dosimetrist-level contouring, and generating retrospective chart reviews for attendings to add to their CV, followed by ridiculous weed-out board exams your last year) will be getting paid straight 250-300k salary (no production bonus) to mindnumbingly babysit a satellite linac. Yeah, I suppose it's fine to skimp on clinical training if your only job is to check films and make cookbook plans following a non-negotiable care pathway established by the mothership. Oh, and don't forget to keep publishing those retrospective chart reviews because you're an "academic" now, and there's 100 other new grads waiting for your job to open up.

 

[RickyScott]

Medical students...
Do not go into radiation oncology unless you can match into a top 5-10 program.

MEDICAL STUDENTS....DO NOT BECOME A RADIATION ONCOLOGIST.

Several points

I think a top 10 program will likely assure you of a position as a satellite monkey in a university network, but will not provide much of an edge for a job outside of a university system.

I just want to address future salaries as I have been talking with a friend who is an economist. At some point, on average, future salaries will approach/ fall below locums rates. They have to eventually meet. Even outside of medicine, the daily/locums rate on average is higher than its salaried equivalent.

Regarding leaders in our field: Yes, I know several (including one chair/head and neck expert and another total schmuck GI "thought leader" where there is such a tremendous discrepancy between their eloquent and well done presentations and talks at ASTRO etc vs very poor clinical skills/contouring etc.

 

[deleted947887]

ABR

A lot of people are not happy with how this was handled.

 

[evilbooyaa]

ABR

A lot of people are not happy with how this was handled.

?? Don't see anything noteworthy here. Lots of pretty standard shifting. It's not a change to the board exam - it's a change to who makes up their various boards. How is this in anyway going to affect anything? Wallner and Kachnic are still the main people on boards.

 

[radoncbyassociation]

For the people who passed Radbio and Physics? What did you study? How long did you study? And how did you approach the last few weeks before the exam? Also anyone out there that passed all 3 in one shot?

 

[radbioistheworst]

For the people who passed Radbio and Physics? What did you study? How long did you study? And how did you approach the last few weeks before the exam? Also anyone out there that passed all 3 in one shot?

You don’t want my radbio advice.

But for physics I thought caggiano was really helpful. Listen to lectures along with his notes he’s a great lecturer and can help you determine which sections are higher yield. The questions are probably overkill, but if you can handle them, especially the calculations, you’ll be fine for the exam. I noticed the calculations on this year’s exam were as tough if not tougher than typical RAPHEX questions, but definitely not as hard as Caggiano. Of course do as many RAPHEX questions as you can and try your best to understand why the right answer is right and wrong choices are wrong. Take note of everything you’re unfamiliar with (ie some random wrong answer choice that’s easy to overlook) and read up on it. I did not use Khan or any other textbook. I was literally in the 10th percentile for 2 years of raphex and physics in-service prior to the exam but got 4s in every category so if I can do it anyone can.

Then again I was 75+ percentile in radbio for 3 years and failed that but I digress


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[RadOncG]

The blog submission to KevinMD was published today. It must be an old vs. young doctor theme today since this was published right after an article titled "Why do doctors treat their own so cruelly"

It can be found here: A test taker’s worst nightmare became reality

Please like, comment, and share to increase reach. Let the ABR know that we will continue to publish resident perspectives. Obviously those from smaller programs will have trouble with writing and grammar so the bigger program residents will have to help out.

Potential future blog post titles:
1. Paul Wallner is a fortune teller- How one man predicted that residents from small programs would fail
2. If your program does not have as many residents as fraud and anti-kickback settlements by 21st century oncology then it should be shut down

 

[evilbooyaa]

Good attempt overall. Can't say I would've done any better myself because that isn't my strongsuit, but it doesn't seem to have the punch necessary. Like there's no emotion in the words. It just seems like a statement of facts.

Really wish it had harped on physics as well, and given some background for a non rad-onc audience of what is necessary for board licensure ("In Radiation Oncology, a one-year preliminary year in medicine or surgery is followed by 4 years of radiation oncology training. At the end of the 4th year of residency (3rd year within . Maybe it was written before the 'official' rates were out. Maybe it needs an editor's or author's update that it was written before the confirmed 70ish percent pass rate for both exams was released. Before Wallner blamed small programs for the failure. Mention the actual pass rates. Nobody cares about 3 standard deviations except stats nerds (which is all of Rad-onc). Say Pass rate went from 95% to 70% in one year, and was blamed on one year of complete ineptitude in training programs, rather than the fact that the test had changed. Discuss the Angoff method and cite literature about how it's susceptible to bias (even though the creators of the test feel that it's perfect).

 

[RadOncG]

Good attempt overall. Can't say I would've done any better myself because that isn't my strongsuit, but it doesn't seem to have the punch necessary. Like there's no emotion in the words. It just seems like a statement of facts.

Really wish it had harped on physics as well, and given some background for a non rad-onc audience of what is necessary for board licensure ("In Radiation Oncology, a one-year preliminary year in medicine or surgery is followed by 4 years of radiation oncology training. At the end of the 4th year of residency (3rd year within . Maybe it was written before the 'official' rates were out. Maybe it needs an editor's or author's update that it was written before the confirmed 70ish percent pass rate for both exams was released. Before Wallner blamed small programs for the failure. Mention the actual pass rates. Nobody cares about 3 standard deviations except stats nerds (which is all of Rad-onc). Say Pass rate went from 95% to 70% in one year, and was blamed on one year of complete ineptitude in training programs, rather than the fact that the test had changed. Discuss the Angoff method and cite literature about how it's susceptible to bias (even though the creators of the test feel that it's perfect).

Great suggestions. Unfortunately there was a significant delay between writing and publication so some information can be updated for future publications. Always a fine line between too much and too little punch so the editing tended to trend towards statement of facts versus emotion for better or worse.

 

[deleted947887]

Medscape: Medscape Access

The DOJ urged Maryland legislators seeking change in the specialty certification system to "strongly consider" an approach that expands the number of organizations that can confer board certification for recognition by hospitals and insurers and for other purposes.

"More competition by bona fide certifying bodies may offer important benefits — including lowering the costs for physicians to be certified or improving the quality of certification services — for healthcare providers, consumers, and payers," the DOJ letter reads.

The bill, he said, "didn't want to prohibit the use of MOC. Instead, it really looks to encourage competition in certification, the idea being, why should we have one private organization certifying doctors?"


You want to talk about burnout among experienced clinicians who otherwise love medicine? Look not to yet another New England based task force and academic grant-based nonsensical endeavor. Here is a quintessential example of what depresses us. It is called betrayal.

 

[RO28]

Anyone have any reports from the ADROP/ABR meeting today?

 

[Tony&lisa]

I wasn't sure when it was. Anyone with knowledge?

 

[multitudes]

ADROP was Saturday. I heard it wasn’t very insightful. They reiterated higher rates of failure at smaller programs and a higher rate of clinicians involved in Angoff scoring which could have impacted how they thought residents “should” answer questions.

So basically, no actionable information to help make changes. Super.

 

[Tony&lisa]

So then what now?

 

[thecarbonionangle]

Overall feeling is ABR triple doubled down on everything. Kachnic gave an anti small program presentation. Seems like everyone is digging in even more. Low hopes for any change.

 

[RO28]

Overwll feeling is ABR triple doubled down on everything. Kachnic gave an anti small program presentation. Seems like everyone is digging in even more. Low hopes for any change.

This is complete garbage. I have never been so frustrated in my life.

 

[Tony&lisa]

That can't be everything, right? Ok, so Kachnik/Wallner repeated the same stuff (small programs, angoff, bla bla) and then what? Not a single PD got up and said that's all very cute but bottom line is this pass rate is not acceptable and clearly shows a problem with the test and we need to fix it? They just presented the same biased rhetoric and the meeting was adjurned?

 

[radbioistheworst]

Apparently Amdur proposed raising the pass rate to 90 or at least 80 for both and it was rejected outright. As was a mid-year re-take.


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[RadOncLazers]

Done deal. It’s time for a lawsuit and publicity. This is absolutely appalling. Please PM if interested.

 

[deleted947887]

Didn't take the exam, but I'd donate to a lawsuit fund.

 

[Tony&lisa]

I just can't yet believe that after all this, the advocacy, the awesome ARRO letter, all the emails, Wallner/Kachnik could just get up, spout the same rhetoric they've been saying all along, which we all know is garbage and biased, and then shut down the few little attempts at comments? Its like we made it easy for them. They barely had to put up a fight at all, and just had to read the content of the letter they already wrote but in speech form.
Really? Is that it? Is he that intimidating and all-powerful that the PDs, ARRO, and all of us just lay down and put our tails between our legs? I just can't accept that one bitter man has so much control over all of our lives. What about the masses not just "asking" for a re-score but demanding it? What about a much-needed changing of the gaurd?
ARRO, PDs, what is the next step? (Short of lawsuit).