The case for fellowship reform

[Chartreuse Wombat]

NCI is unlikely to support a biochemical endpoint. Toxicity is possible but the expected rate of severe toxicities (which are the most reliable and objective) is likely to be low. Sample size depends on the number of events and (fortunately for patients but unfortunately for clinical trialists) the number of events would be low.

Interesting that ASCENDE-RT is invoked. This is a small study (n=400) that will likely never show a difference in a meaningful endpoint like DM or OS. Yes, the bRFS is different but that doesn't always translate into OS, DM, etc (cf RTOG 0126 with 1500 patients-big DFS with 79 Gy but no difference in OS, DM).

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[radiation]

Beautiful post. It does sound like an excellent education experience and you clearly have passion and motivation but...

Doesn't this vignette prove the main premise of this thread? You train at one of the most famous hospitals in the world that is located in a 20+ million population metropolitan area. Columbia is one of the top ranked US News and World Report hospitals, NCI designated comprehensive cancer center and proudly runs an Advanced Radiation Oncology Clinical Fellowship. Yet you had to make special arrangements to receive prostate brachytherapy training in suburban Chicago.

Just to play devil's advocate here, is doing specialized prostate brachytherapy training after a general radiation oncology residency that much different than doing something like a breast cancer surgical oncology fellowship out of general surgery training? Or a neuroradiology fellowship after radiology?
I think most here are arguing for basic brachytherapy competence that should not require a fellowship, which I completely agree with. But I would also argue that being competent in brachytherapy is one thing vs. potential value in establishing a board-certified fellowship that creates true procedural expertise. This is true in most other specialties that offer procedures, almost all of them offer fellowships in procedures that many generalists in that specialty might have basic competency in.

 

[Mandelin Rain]

Certainly true, though, I haven't seen too many job postings for "Prostate Brachytherapist" out there so I wouldn't hang my hat on just that. Conversely, the breast surgeons I know aren't exactly doing many (any) lap choles, appys, I&D, ostomys, nor lipoma removals; and there is a line of administrators to hire them if they express interest.

Additionally, with something like breast surgery, you are learning/refining more that the base procedural aspects of lumpectomy, mastectomy, etc.... you are learning to be the initial point of oncologic care for breast cancer patients and how to then direct their care. Who needs TAM for high risk lesions. How often to order mammo for this vs that. Understanding the surgical literature on axillary sampling. When to refer to other specialties, i.e. neoadjuvant, considerations for reconstruction, etc..... If you've heard a general surgeon vs a breast surgeon at tumor board you definitely get the sense that there is MUCH more to that year than learning how to tuck the scar next to the areola.

 

[medgator]

Certainly true, though, I haven't seen too many job postings for "Prostate Brachytherapist" out there so I wouldn't hang my hat on just that. Conversely, the breast surgeons I know aren't exactly doing many (any) lap choles, appys, I&D, ostomys, nor lipoma removals; and there is a line of administrators to hire them if they express interest.

Additionally, with something like breast surgery, you are learning/refining more that the base procedural aspects of lumpectomy, mastectomy, etc.... you are learning to be the initial point of oncologic care for breast cancer patients and how to then direct their care. Who needs TAM for high risk lesions. How often to order mammo for this vs that. Understanding the surgical literature on axillary sampling. When to refer to other specialties, i.e. neoadjuvant, considerations for reconstruction, etc..... If you've heard a general surgeon vs a breast surgeon at tumor board you definitely get the sense that there is MUCH more to that year than learning how to tuck the scar next to the areola.

Yes, some of them even order oncotype before dual referring to med and rad Onc etc.

 

[Mandelin Rain]

The problem with many of the "fellowships" offered in rad onc is that they are niche items that are completely dependent on local factors that you don't necessarily control. I think they are a great value add in a very small number of situations that you need to actively seek out. They are marginal to no value added in the vast majority of jobs though.

Actually, if someone spent their previous year doing a proton fellowship, that'd probably a net negative for many jobs that didn't come with a cyclotron.

 

[seper]

Despite a financial hit, I doubt anyone has actually suffered from doing 1 year RO "fellowship". Easy year, more time to study for boards, etc.

The problem with many of the "fellowships" offered in rad onc is that they are niche items that are completely dependent on local factors that you don't necessarily control. I think they are a great value add in a very small number of situations that you need to actively seek out. They are marginal to no value added in the vast majority of jobs though.

Actually, if someone spent their previous year doing a proton fellowship, that'd probably a net negative for many jobs that didn't come with a cyclotron.

 

[Mandelin Rain]

Being honest, I'd view someone who did a 1 year proton "fellowship" more negatively than a new grad with no "fellowship".

1. Questionable judgement to take a "fellowship" in the first place? Did they feel inadequately trained?
2. A year away from standard clinical responsibilities to focus on something we don't do. Will they not hit the ground running?
3. Did they take the fellowship just to stay in a city? Will they leave to go back to that city if a job opens?
4. Will they leave the minute a proton job opens?
5. Will they want to return to academia?

This is someone we probably don't even interview. When you do a "fellowship", you're declaring a clinical focus and career aspiration. If that doesn't match the job available, I think it certainly can become a negative.

Take the breast surgeon example. If you're a 2 person gen surgery group looking for a partner to take some of your gen surgery volume and split q3 ER call with you, are you viewing a breast surgeon in a more favorable or negative light?

 

[medgator]

Being honest, I'd view someone who did a 1 year proton "fellowship" more negatively than a new grad with no "fellowship".

1. Questionable judgement to take a "fellowship" in the first place? Did they feel inadequately trained?
2. A year away from standard clinical responsibilities to focus on something we don't do. Will they not hit the ground running?
3. Did they take the fellowship just to stay in a city? Will they leave to go back to that city if a job opens?
4. Will they leave the minute a proton job opens?
5. Will they want to return to academia?

This is someone we probably don't even interview. When you do a "fellowship", you're declaring a clinical focus and career aspiration. If that doesn't match the job available, I think it certainly can become a negative.

I agree with a caveat... Namely if the individual was trying to wait out a year to see if a job opened in the area where they have geographical ties

 

[Lamount]

Being honest, I'd view someone who did a 1 year proton "fellowship" more negatively than a new grad with no "fellowship".

1. Questionable judgement to take a "fellowship" in the first place? Did they feel inadequately trained?
2. A year away from standard clinical responsibilities to focus on something we don't do. Will they not hit the ground running?
3. Did they take the fellowship just to stay in a city? Will they leave to go back to that city if a job opens?
4. Will they leave the minute a proton job opens?
5. Will they want to return to academia?

This is someone we probably don't even interview. When you do a "fellowship", you're declaring a clinical focus and career aspiration. If that doesn't match the job available, I think it certainly can become a negative.

Take the breast surgeon example. If you're a 2 person gen surgery group looking for a partner to take some of your gen surgery volume and split q3 ER call with you, are you viewing a breast surgeon in a more favorable or negative light?

Would generally agree that one should only do a proton fellowship if one wants to work at a proton center... I similarly expect that a peds fellowship wouldn't win you awards at a center that doesn't treat children.

The only caveat regards a fellowship with well-known faculty who are willing to pick up the phone for you. In academics, such a phone call can go a long way, even if you are applying for a job outside the practice of your fellowship.

 

[AlreadyRegretThis]

When you do a "fellowship", you're declaring a clinical focus and career aspiration.

This is how fellowships are supposed to work, in specialties that have real accredited subspecializations like the breast surgery example. The flip side is that those fellowships select for candidates who are interested in maintaining that focus in their careers, and jobs exist in which that's possible.

I was talking to people in the peds rad onc fellowship world a couple years ago, and it actually seems to operate kind of like this. Hospice & Palliative Care is a weird one because it drops rad oncs into the very real ABIM-run fellowship training, under the auspices of co-sponsorship, and offers a distinct skill set but then there's not a clear career path on which to use it back in the rad onc world. Everything else seems like more a failure to launch from residency than anything else - but launching from residency is hard in recent years and only getting harder! For reasons I feel like are not so much the fault of the residents, and if anything, more in the hands of the same people offering undefined, unofficial, unaccredited fellowship positions of uncertain value.

 

[medgator]

This is how fellowships are supposed to work, in specialties that have real accredited subspecializations like the breast surgery example. The flip side is that those fellowships select for candidates who are interested in maintaining that focus in their careers, and jobs exist in which that's possible.

I was talking to people in the peds rad onc fellowship world a couple years ago, and it actually seems to operate kind of like this. Hospice & Palliative Care is a weird one because it drops rad oncs into the very real ABIM-run fellowship training, under the auspices of co-sponsorship, and offers a distinct skill set but then there's not a clear career path on which to use it back in the rad onc world. Everything else seems like more a failure to launch from residency than anything else - but launching from residency is hard in recent years and only getting harder! For reasons I feel like are not so much the fault of the residents, and if anything, more in the hands of the same people offering undefined, unofficial, unaccredited fellowship positions of uncertain value.

Well said. The rise of fellowships, esp in areas outside of brachy peds etc in things like "advanced radiation" igrt sbrt, all of which are unaccredited speaks to a degrading of the residency experience and rad onc the specialty itself thanks to residency expansion

 

[OTN]

Radonc fellowships (OTHER THAN PEDS) unfortunately also help to peddle the incredibly erroneous, highly insulting, and paternalistic opinion that we shouldn't be radonc "generalists" like RW so derisively calls us. I feel very strongly that the vast, vast majority of us who trained in the last 10-15 years- remember, we were some of the best medical students around- are able to treat all disease sites, with all techniques, with no problem. Why board certify us in all sites if this isn't the case? Why make us recertify in all sites?

I still need one of the ivory tower denziens to tell me what- exactly - they are doing for their patients that they think I cannot do because I am a "generalist." I want them to be precise in their language, but I'm not holding my breath.

Not only do they offer very little in terms of training (OTHER THAN PEDS) "fellowships" in radonc help continue the lie that we have to subspecialize in order to be good radiation oncologists. That is 100% false.

 

[scarbrtj]

Radonc fellowships (OTHER THAN PEDS) unfortunately also help to peddle the incredibly erroneous, highly insulting, and paternalistic opinion that we shouldn't be radonc "generalists" like RW so derisively calls us. I feel very strongly that the vast, vast majority of us who trained in the last 10-15 years- remember, we were some of the best medical students around- are able to treat all disease sites, with all techniques, with no problem. Why board certify us in all sites if this isn't the case? Why make us recertify in all sites?

I still need one of the ivory tower denziens to tell me what- exactly - they are doing for their patients that they think I cannot do because I am a "generalist." I want them to be precise in their language, but I'm not holding my breath.

Not only do they offer very little in terms of training (OTHER THAN PEDS) "fellowships" in radonc help continue the lie that we have to subspecialize in order to be good radiation oncologists. That is 100% false.

When I was leaving residency and getting my first job, it was going to be by myself starting a new clinic. No other rad oncs in my group. Jay Harris asked me, "Are you sure you're ready to be out there on your own?" This is something general surgeons never get asked e.g. by their attendings. Else they wouldn't let them graduate residency! Sure it's nice to have partners, but much of medicine is a single player game and rightly so. And to top it off, I left residency fully board certified. Academic rad onc really, really needs to have some soul-searching about this from top to bottom.

 

[Aphtalyfe]

Radonc fellowships (OTHER THAN PEDS) unfortunately also help to peddle the incredibly erroneous, highly insulting, and paternalistic opinion that we shouldn't be radonc "generalists" like RW so derisively calls us. I feel very strongly that the vast, vast majority of us who trained in the last 10-15 years- remember, we were some of the best medical students around- are able to treat all disease sites, with all techniques, with no problem. Why board certify us in all sites if this isn't the case? Why make us recertify in all sites?

I still need one of the ivory tower denziens to tell me what- exactly - they are doing for their patients that they think I cannot do because I am a "generalist." I want them to be precise in their language, but I'm not holding my breath.

Not only do they offer very little in terms of training (OTHER THAN PEDS) "fellowships" in radonc help continue the lie that we have to subspecialize in order to be good radiation oncologists. That is 100% false.

Hi, fellowship trained brachytherapist here. Very much not trying to start an argument.

Wanted to start off by saying I agree that most fellowships are probably just an administrative quest for cheap labor. I guess I would be one of the ivory tower occupants that you are referring to, but quite frankly I'm just here for fun/learning more than anything. I have great respect for all the good/compassionate radoncs out there, regardless of their practice location/type. I frequently refer patients out to centers that are in closer proximity to their home.

That being said... Off the top of my head, some of the referrals we get from the community (and other ivory towers):

Oral cavity cancer brachytherapy boost for non-surgical candidates
Rectal brachytherapy boost for non-surgical candidates
Interventional radiology CT guided brachytherapy for previously SBRT'd lung met or primary lung cancer patients ineligible for surgery and ineligible for cryo/microwave ablation
Endobronchial brachytherapy for previously SBRT'd lung and with tumor obstruction
Very bulky IIIB cervix cancer requiring interstitial brachytherapy boost (or really anyone needing interstitial brachytherapy boost)
Definitive salvage interstitial brachytherapy for endometrial cuff recurrence (>1 cm depth) after previously receiving 45-50Gy and VC boost
Salvage HDR brachytherapy for radiorecurrent (EBRT, SBRT, or LDR) prostate cancer
Esophageal brachytherapy for radiorecurrent disease (ineligible for surgery)
HDR boost for unfavorable/high-risk prostate cancer
Interstitial brachytherapy boost for vulvar cancer
Eye plaque brachytherapy for choroidal melanoma

We have done some weird stuff like interstitial skin (not surface) for a patient who had a horrible back and couldn't lay flat/still enough for EBRT sim/treatment.

Pretty much anything requiring an OR and anything that is radiorecurrent... we see a lot of that.

I'm sure there are EBRT or non-brachytherapy ways of doing the above... but most centers are just happy to let us handle their complex cases so they don't have to.

 

[PhotonBomb]

but you're just in an ivory towerrrr, maaaaaaaan. - bunch of people, probably

Awesome, thanks for posting, glad to call you a colleague in this field!

 

[deleted947887]

Hi, fellowship trained brachytherapist here. Very much not trying to start an argument.

Wanted to start off by saying I agree that most fellowships are probably just an administrative quest for cheap labor. I guess I would be one of the ivory tower occupants that you are referring to, but quite frankly I'm just here for fun/learning more than anything. I have great respect for all the good/compassionate radoncs out there, regardless of their practice location/type. I frequently refer patients out to centers that are in closer proximity to their home.

That being said... Off the top of my head, some of the referrals we get from the community (and other ivory towers):

Oral cavity cancer brachytherapy boost for non-surgical candidates
Rectal brachytherapy boost for non-surgical candidates
Interventional radiology CT guided brachytherapy for previously SBRT'd lung met or primary lung cancer patients ineligible for surgery and ineligible for cryo/microwave ablation
Endobronchial brachytherapy for previously SBRT'd lung and with tumor obstruction
Very bulky IIIB cervix cancer requiring interstitial brachytherapy boost (or really anyone needing interstitial brachytherapy boost)
Definitive salvage interstitial brachytherapy for endometrial cuff recurrence (>1 cm depth) after previously receiving 45-50Gy and VC boost
Salvage HDR brachytherapy for radiorecurrent (EBRT, SBRT, or LDR) prostate cancer
Esophageal brachytherapy for radiorecurrent disease (ineligible for surgery)
HDR boost for unfavorable/high-risk prostate cancer
Interstitial brachytherapy boost for vulvar cancer
Eye plaque brachytherapy for choroidal melanoma

We have done some weird stuff like interstitial skin (not surface) for a patient who had a horrible back and couldn't lay flat/still enough for EBRT sim/treatment.

Pretty much anything requiring an OR and anything that is radiorecurrent... we see a lot of that.

I'm sure there are EBRT or non-brachytherapy ways of doing the above... but most centers are just happy to let us handle their complex cases so they don't have to.

Out of sheer curiosity, how do you do rectal brachytherapy boost for nonsurgical candidates?

 

[AlreadyRegretThis]

Counterpoint: All of those are great cases for referral center, uh, referral IMO, but don't require the person on the receiving end to have fellowship training, just experience and equipment. And surgical & anesthesia collaboration, etc. But the ivory tower in which I was recently a resident did several of those procedures, was actually a high-volume center in some, and not a fellowship trained brachytherapist in sight. (Or a brachytherapy fellowship, so even with the cases spread over all the residents we each got a decent amount of training out of it)

 

[medgator]

Counterpoint: All of those are great cases for referral center, uh, referral IMO, but don't require the person on the receiving end to have fellowship training, just experience and equipment. And surgical & anesthesia collaboration, etc. But the ivory tower in which I was recently a resident did several of those procedures, was actually a high-volume center in some, and not a fellowship trained brachytherapist in sight. (Or a brachytherapy fellowship, so even with the cases spread over all the residents we each got a decent amount of training out of it)

I did several syed, tongue, and sarcoma implants during training. None of that gets used now but I'm sure it wouldn't have been a difficult transition to end up in a place where I did a lot of it sans fellowship.

Then again, I started my training during the pre expansion era.

 

[Lamount]

Everything becomes so black and white on the internet.

Fellowships are neither pure good nor pure evil... and there is no need to speculate. If you are curious about a particular fellowship, look where the past 3 years of fellows ended up. In our field, this shouldn't be too hard to find out. If you would trade another year of training for any one of their jobs... go for it. If not, don't.

Specialization is also a mixed picture. There are times when you need a specialist- i.e. if you have a chordoma (approx 300 a year nationally), you probably shouldn't go to someone who has only treated one other in their entire career. On the other hand, there is clearly nothing special about stage III NSCLC that should compel a patient to travel 3 hours to an academic center when their is an excellent generalist in the community. The field needs both generalists and specialists.

 

[OTN]

Hi, fellowship trained brachytherapist here. Very much not trying to start an argument.

Wanted to start off by saying I agree that most fellowships are probably just an administrative quest for cheap labor. I guess I would be one of the ivory tower occupants that you are referring to, but quite frankly I'm just here for fun/learning more than anything. I have great respect for all the good/compassionate radoncs out there, regardless of their practice location/type. I frequently refer patients out to centers that are in closer proximity to their home.

That being said... Off the top of my head, some of the referrals we get from the community (and other ivory towers):

Oral cavity cancer brachytherapy boost for non-surgical candidates
Rectal brachytherapy boost for non-surgical candidates
Interventional radiology CT guided brachytherapy for previously SBRT'd lung met or primary lung cancer patients ineligible for surgery and ineligible for cryo/microwave ablation
Endobronchial brachytherapy for previously SBRT'd lung and with tumor obstruction
Very bulky IIIB cervix cancer requiring interstitial brachytherapy boost (or really anyone needing interstitial brachytherapy boost)
Definitive salvage interstitial brachytherapy for endometrial cuff recurrence (>1 cm depth) after previously receiving 45-50Gy and VC boost
Salvage HDR brachytherapy for radiorecurrent (EBRT, SBRT, or LDR) prostate cancer
Esophageal brachytherapy for radiorecurrent disease (ineligible for surgery)
HDR boost for unfavorable/high-risk prostate cancer
Interstitial brachytherapy boost for vulvar cancer
Eye plaque brachytherapy for choroidal melanoma

We have done some weird stuff like interstitial skin (not surface) for a patient who had a horrible back and couldn't lay flat/still enough for EBRT sim/treatment.

Pretty much anything requiring an OR and anything that is radiorecurrent... we see a lot of that.

I'm sure there are EBRT or non-brachytherapy ways of doing the above... but most centers are just happy to let us handle their complex cases so they don't have to.

I agree with complex brachytherapy fellowships as well- you got me on that. Not a lot of volume, so it can be tough for programs to offer lots of training there. Makes sense that if you want to be a radonc who specializes in brachytherapy, I can get behind that.

Pretty small number of jobs in that arena, though, to be practical about it, so it’s not going to be a route of training for most residents.

I’ve treated chordomas before- not ones that would benefit from protons, of course. I felt comfortable treating, and the outcomes have been good.

 

[thecarbonionangle]

There were very few jobs this year requiring highly specific and extensive brachy experience this year so chance of getting that sort of job after fellowship probably lower than one thinks. Fellowship survey a few years ago had i think 50 pct failure of fellows to secure a job in their fellowship field.

 

[Aphtalyfe]

Out of sheer curiosity, how do you do rectal brachytherapy boost for nonsurgical candidates?

5 Gy x 3 after 50 Gy EBRT. Need fiducial markers placed by GI. We have to MacGyver our applicator because the double balloon rectal applicators I like are discontinued.

Counterpoint: All of those are great cases for referral center, uh, referral IMO, but don't require the person on the receiving end to have fellowship training, just experience and equipment. And surgical & anesthesia collaboration, etc. But the ivory tower in which I was recently a resident did several of those procedures, was actually a high-volume center in some, and not a fellowship trained brachytherapist in sight. (Or a brachytherapy fellowship, so even with the cases spread over all the residents we each got a decent amount of training out of it)

I think it's similar to radiology fellowship. For example the older chest attendings didn't do a fellowship. I don't think you need fellowship to be a good brachytherapist... but it's hard to get enough interstitial gyn/gu cases at most institutions during residency. I think I did somewhere around 400 interstitial implants (prostate/gyn) during fellowship. Did I need 400 to be competent? Probably not. Is the 6 (or whatever number it is now) required to finish residency enough to do a complex interstitial implant/treatment independently? Probably not.

I agree with complex brachytherapy fellowships as well- you got me on that. Not a lot of volume, so it can be tough for programs to offer lots of training there. Makes sense that if you want to be a radonc who specializes in brachytherapy, I can get behind that.

Pretty small number of jobs in that arena, though, to be practical about it, so it’s not going to be a route of training for most residents.

There were very few jobs this year requiring highly specific and extensive brachy experience this year so chance of getting that sort of job after fellowship probably lower than one thinks. Fellowship survey a few years ago had i think 50 pct failure of fellows to secure a job in their fellowship field.

There were 3 openings when I applied (this time last year) looking for complex interstitial experience. (one near SF) Of the hundreds of applicants the #1 and #2 on their lists were either established older brachytherapy attendings or fellowship trained brachy people.

I haven't been looking to change jobs, but even without looking I know of 2 openings for a complex interstitial brachytherapist. (Again, one near SF) For the less desirable locations they might look to hire someone and train them... but for the highly desirable locations it seems like they are looking for someone who can plug-and-play.

I was admittedly lucky in getting my position... but the number of listed complex interstitial job openings is probably ~2-4 a year? The number of fellowship trained brachytherapists per year is ~2-3? And the number of unlisted openings is anyone's guess.

I guess what I'm saying is... the supply is similar to the demand for fellowship trained brachytherapists. Also, don't do a brachy fellowship unless you really want to do complex brachy.

 

[SubserviantToABR]

You all should do a fellowship in clinical informatics:

https://www.redjournal.org/article/S0360-3016(19)33968-9/

or

Medical education:

https://www.redjournal.org/article/S0360-3016(19)33953-7/

While these are noble paths, surely, I don't think there are many that go into residency to do informatics or education.

I, including many of us, read what others post about radiation oncology. Everyone says that it is a gratifying field and that's the reason to go into radiation oncology, which I wholeheartedly agree. Then, why do we not address the elephant in the room? We don't need to focus on splinter career paths, like education or informatics. We don't need a lot of fellowships or alternative careers (like frontier medicine???), maybe, for the few that want to focus on something. Maybe, the vast majority of us just want to care for patients., which, isn't why we went into radiation oncology in the first place? ¯\_(ツ)_/¯

 

[beamseyeview]

Another private practice fellowship, this time by the Inova group... who coincidentally just posted a job a few weeks ago to hire a new associate...

'mather OR proton OR therapy OR advanced OR radiation OR oncology OR fellowship OR STATECODE:"VA"' Jobs | ASTRO Radiation Oncology Career Center

2,828 'mather OR proton OR therapy OR advanced OR radiation OR oncology OR fellowship OR STATECODE:

careers.astro.org

 

[RickyScott]

Another private practice fellowship, this time by the Inova group... who coincidentally just posted a job a few weeks ago to hire a new associate...

'mather OR proton OR therapy OR advanced OR radiation OR oncology OR fellowship OR STATECODE:"VA"' Jobs | ASTRO Radiation Oncology Career Center

2,828 'mather OR proton OR therapy OR advanced OR radiation OR oncology OR fellowship OR STATECODE:

careers.astro.org

That they have so little experience with protons, how dare they be opening up a fellowship?

 

[PhotonBomb]

 

[scarbrtj]

Another private practice fellowship, this time by the Inova group... who coincidentally just posted a job a few weeks ago to hire a new associate...

'mather OR proton OR therapy OR advanced OR radiation OR oncology OR fellowship OR STATECODE:"VA"' Jobs | ASTRO Radiation Oncology Career Center

2,828 'mather OR proton OR therapy OR advanced OR radiation OR oncology OR fellowship OR STATECODE:

careers.astro.org

That they have so little experience with protons, how dare they be opening up a fellowship?

Just like Peter King at one time refused to call the Washington DC NFL team the Redskins, I think we should all quit calling these things "fellowships" and refer to them by the preferred nomenclature of apprenticeship or clerkship. I mean for Pete's sake if we can all agree not to call IMRT by its name, surely we can agree to call these "fellowships" something else despite what the purveyors of the "fellowships" refer to them as.

 

[deleted941485]

That they have so little experience with protons, how dare they be opening up a fellowship?

lol welcome to rad onc 2020! Seriously how are we different than nuc Med?

 

[thecarbonionangle]

That they have so little experience with protons, how dare they be opening up a fellowship?

Because they know some poor person will be desperate enough to take it in hope that it materializes, however unlikely, to a job offer in a so called “good practice” which is clearly explotative. Thats why

 

[Tigerstang]

Another private practice fellowship, this time by the Inova group... who coincidentally just posted a job a few weeks ago to hire a new associate...

'mather OR proton OR therapy OR advanced OR radiation OR oncology OR fellowship OR STATECODE:"VA"' Jobs | ASTRO Radiation Oncology Career Center

2,828 'mather OR proton OR therapy OR advanced OR radiation OR oncology OR fellowship OR STATECODE:

careers.astro.org

At least they've demonstrated themselves to be scumbags, openly. Better than those practices that pretend not to be scummy, but really are.

 

[fiji128]

I saw that in my astro career center email this morning. What a joke. I guess the attendings running this proton center don't want to do all those prostate H and P's and prior authorizations. They didn't even list a salary for this position. I wonder if other specialties offer non accredited "fellowships" by private practice groups. I doubt it. ASTRO leadership recently came out with a paper arguing against these very type of explotative positions.

https://www.redjournal.org/article/S0360-3016(19)33870-2/fulltext

But yet our professional group won't stop posting them on their own career center website? Would be a super easy step to take but may cost ASTRO a few hundred dollars in listing fees. Banning the listing of these type of positions would at least show they are actually willing to take action on something.

 

[thecarbonionangle]

I saw that in my astro career center email this morning. What a joke. I guess the attendings running this proton center don't want to do all those prostate H and P's and prior authorizations. They didn't even list a salary for this position. I wonder if other specialties offer non accredited "fellowships" by private practice groups. I doubt it. ASTRO leadership recently came out with a paper arguing against these very type of explotative positions.

https://www.redjournal.org/article/S0360-3016(19)33870-2/fulltext

But yet our professional group won't stop posting them on their own career center website? Would be a super easy step to take but may cost ASTRO a few hundred dollars in listing fees. Banning the listing of these type of positions would at least show they are actually willing to take action on something.

Derm has them too. People spend years in them at a pp in hopes of getting into derm

 

[seper]

ASTRO careers website indeed needs a cleanup. "fellowships" and also supportive staff job ads should go.

 

[fiji128]

Derm has them too. People spend years in them at a pp in hopes of getting into derm

Of course that's prior to residency and board eligibility/certification.

 

[scarbrtj]

Our man Simul

 

[xrthopeful]

Simul gonna get wiped off the map. Don't mess with the Zohan, as they say.

 

[RickyScott]

Simul gonna get wiped off the map. Don't mess with the Zohan, as they say.

Yah, simul if you are reading this go anon. It is not worth it. Everything you say is spot on, but the facts will stand on their own without your name behind them- very self evident at this point. Just invites retaliation.

 

[deleted941485]

When I was leaving residency and getting my first job, it was going to be by myself starting a new clinic. No other rad oncs in my group. Jay Harris asked me, "Are you sure you're ready to be out there on your own?" This is something general surgeons never get asked e.g. by their attendings. Else they wouldn't let them graduate residency! Sure it's nice to have partners, but much of medicine is a single player game and rightly so. And to top it off, I left residency fully board certified. Academic rad onc really, really needs to have some soul-searching about this from top to bottom.

Well now a days with changes in duty hours and lack of exposure. It seems that senior surgeons are asking this question more and more of new surgery grads.

 

[RickyScott]

Well now a days with changes in duty hours and lack of exposure. It seems that senior surgeons are asking this question more and more of new surgery grads.

Do you think a surgeon who works 100-120 hrs week is better trained than one who works 80. You need to sleep to consolidate memories etc.

 

[deleted573262]

Do you think a surgeon who works 100-120 hrs week is better trained than one who works 80. You need to sleep to consolidate memories etc.

fellowships are common in surgery. it is also common for graduating residents to take jobs where they train and have more senior attending come into OR with them for several months/years. not arguing that people need sleep and 80 hours/week should be enough for proper training.

 

[deleted941485]

Do you think a surgeon who works 100-120 hrs week is better trained than one who works 80. You need to sleep to consolidate memories etc.

Seemed to Work out alright for our predecessors. Why this particular cohort is so needy isn’t particularly clear. Maybe we are pushing through too many medical students who lack the physical and intellectual resilience to be in such a field. Thin skin hurt feelings...garbage.

But by all means Get some sleep in fact take more time away from clinic and stretch out the residency a bit. Make it a leisurely walkthrough.

Why would I ever want to be operated on by anyone whose completed a residency in the last 15 years? I guess nobody will have a choice.