Thoughts from a PGY-5

[FrostyHammer]

And that trial is cleverly using the primary endpoint of PFS (not OS) - less patients and follow up time required. Pharma's got their hands all over that decision, question is whether insurance would pay for a whopping 2 years of immunotherapy if there's only a PFS benefit without proof of OS benefit.

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[Burt Radnolds]

It's administered once a month in this trial instead of twice a month in stage 3, just fyi. Same total # of doses. Still seems like a long time. We have this trial open and it's a tough accruer for many reasons. It does allow for central (not ultracentral) and larger tumors (up to T3) which may be an area where you could enroll some borderline SBRT cases. They also just amended the protocol to allow the 8 fraction regimen if the big or central tumors make you a little gunshy.

 

[fiji128]

I noticed this thread posted in the Pathology forum and it sounds very similar to the rad onc job search these days, including jobs that are only available via the secrete handshake club, needing unlimited geographic flexibility, while, also at the same time having ties to whatever area is hiring, the professional organization attacking SDN rather then addressing over supply issues, I know someone who got a job so there is not a problem, ect.....

My Experience in the Job Search (thus far)

Hello all, Wanted to update you in regards to my job search. I have been looking for a position since last October 2019. I applied broadly across the country to whatever job fits my fellowship training, just to see what I could get. I know I wouldn’t be happy living in the places I applied to...

forums.studentdoctor.net

 

[scarbrtj]

I'm not sure about that. What about costs? Are we willing to pay any price for screening as long as there is tiny bit of overall survival benefit?
Ok, let me propose a 6-monthly whole body MRI starting at year 40 fpr EVERYBODY. It will probably produce a significant overall survival benefit.
Costs you say? Who cares?

To be clear
Mammograms reduce breast cancer specific mortality
Psa reduces prostate cancer specific mortality (euro data)
Lung ct reduces lung cancer specific mortality
this thread seems to imply that lack of overall survival advantage is a weakness of lung screening ct
Are we now against all screening?

An interesting factoid to put screening cost, and radiation oncology cost, in perspective...

3-D costs about $50 more per screening than 2-D, which amounts to a lot of money across a large population that is screened annually, Pisano points out. Data from 2017 show that about 33 million screening mammographies are performed in the United States each. If physicians use 3-D screening exclusively, that's $1.65 billion in extra cost annually.​

"This is an important study to figure out if our health system really does need to replace all breast imaging systems with tomosynthesis," she said.​

In 2018, about $1.6 billion was paid by CMS on the entirety of part B rad onc costs nationwide. Just in the switch from 2D mammography to 3D, there's potentially going to be ~$1.65 billion spent (~33 million women screened a year at an extra $50/patient for 3D vs 2D). I mean the whole 3D mammo trial ($100 million in cost) is about 5-10% of all of rad onc.

Which is another way to say (with a few caveats obv) America might wind up spending more on new screening methods for breast cancer than it will for the entirety of radiation oncology. And needless also to say America's already spending more on breast cancer screening than it does for all of radiation oncology.

 

[PhotonBomb]

PAs, NPs, Pharmacists, Podiatrists, and Dentists have higher payment amounts than Rad Onc.

I mean there are way way way more of them. So this isn’t really that relevant is it?

I mean overall teachers make more than rad oncs too.

 

[radiation]

This is part of the reason why I worry about perpetually keeping our field small. There is for sure a job problem now and will be difficult to accommodate the surplus residents in the current market. However, I think the long term goal of the field should be to create enough need for radiation oncology services that it supports a larger specialty workforce. Otherwise we will always be in a position of worse negotiating power and decision making.

 

[deleted573262]

This is part of the reason why I worry about perpetually keeping our field small. There is for sure a job problem now and will be difficult to accommodate the surplus residents in the current market. However, I think the long term goal of the field should be to create enough need for radiation oncology services that it supports a larger specialty workforce. Otherwise we will always be in a position of worse negotiating power and decision making.

The field should recruit and train leaders. Lots of residency research time that can be used to take management + leadership courses. If you're not at the table, you're on the menu.

 

[radiation]

The field should recruit and train leaders. Lots of residency research time that can be used to take management + leadership courses. If you're not at the table, you're on the menu.

This is a good point. When Carlos Perez was chair at WashU, he made his senior faculty members get MBAs (Grigsby and Michalski).

Interestingly, rad onc happens to have lots of leadership in high positions right now, eg President elect of ASCO is Lori Pierce, FDA head is Steve Hahn, and Wally Curran has been head of the major oncologic cooperative group (NRG) for some time now. My take is most of this board is dissatisfied in our leadership up to this point, but Pierce and Hahn are just starting their tenure. How can we capitalize on that and where should they be focusing their energy (besides residency reform)?

 

[RickyScott]

This is a good point. When Carlos Perez was chair at WashU, he made his senior faculty members get MBAs (Grigsby and Michalski).

Interestingly, rad onc happens to have lots of leadership in high positions right now, eg President elect of ASCO is Lori Pierce, FDA head is Steve Hahn, and Wally Curran has been head of the major oncologic cooperative group (NRG) for some time now. My take is most of this board is dissatisfied in our leadership up to this point, but Pierce and Hahn are just starting their tenure. How can we capitalize on that and where should they be focusing their energy (besides residency reform)?

Steve Hahn, who is also a medical oncologist, will have close to 0 impact on radiation as head of FDA? One of issues with present leadership is that ASTRO leadership positions are all about the title/prestige/proffesional recognition, more about having a title to elevate and improves personal prestige In home institution. No one is there to solve problems, deal with difficult situations, or implement an agenda. Leadership here is such a bs term to throw around. Look I realize many leadership positions in many fields may have this issue, but it seems leadership in randonc is so skewed to the title/self promotion and actually more about “lack of leadership!”
Paul H made this so clear in his acceptance speech where he showed pics of family for 20 minutes and discussed how they must be so honored to see him. Bruce M is wysiswyg (as a doc, human being, etc)

 

[fiji128]

Steve Hahn, who is also a medical oncologist, will have close to 0 impact on radiation as head of FDA? One of issues with present leadership is that ASTRO leadership positions are all about the title/prestige/proffesional recognition, more about having a title to elevate and improves personal prestige In home institution. No one is there to solve problems, deal with difficult situations, or implement an agenda. Leadership here is such a bs term to throw around. Look I realize many leadership positions in many fields may have this issue, but it seems leadership in randonc is so skewed to the title/self promotion and actually more about “lack of leadership!”
Paul H made this so clear in his acceptance speech where he showed pics of family for 20 minutes and discussed how they must be so honored to see him. Bruce M is wysiswyg (as a doc, human being, etc)

On Point!

 

[deleted1002574]

The leadership literally doesn’t see the problem, yet. The only people in academic medicine that are becoming believers are the PDs and other junior faculty that are watching the bloodbath of interviews and the upcoming match.

Even if there are 50 unfilled positions, maybe 25 (or all 50) will be SOAPed and the chairman from their perch won’t notice anything wrong.

(The “pact” not to SOAP is very weak, as they will mitigate this by ranking even the weakest candidates and find a justification to interview a person for a SOAP ... “Well, this woman DID have an aunt who received radiation, so we can say she has a personal interest in RO)

 

[RickyScott]

The leadership literally doesn’t see the problem, yet. The only people in academic medicine that are becoming believers are the PDs and other junior faculty that are watching the bloodbath of interviews and the upcoming match.

Even if there are 50 unfilled positions, maybe 25 (or all 50) will be SOAPed and the chairman from their perch won’t notice anything wrong.

(The “pact” not to SOAP is very weak, as they will mitigate this by ranking even the weakest candidates and find a justification to interview a person for a SOAP ... “Well, this woman DID have an aunt who received radiation, so we can say she has a personal interest in RO)

first off, lets have basic definition of leadership- probably involves making decisions and addressing problems. It is not primarily accepting title, regaling in praise and professional recognition. Word leadership simply doesn’t apply to president of Astro.

Pathology degenerated to the point that there was 1)JAMA publication on how field gone to hell
2) vast majority of pathologists are not us trained! Yet still “leadership” denies that they have job issues, so don’t expect anything in radonc. Really things have gotten so bad in path that I am not sure it should be part of “medicine” Yet cap just thinks medstudents are uniformed and should be applying to the field!

l

 

[PhotonBomb]

Pathology also faces a very different problem in that what they do just does
Not reimburse well.

 

[RickyScott]

Pathology also faces a very different problem in that what they do just does
Not reimburse well.

I really have no idea. I was always under impression that pathologists each bill tons in technical fees. In terms of applicants to speacialty, no matter how bad things are in pathology, will still attract some medstudents with lab background.