You guys got what you wanted

[medgator]

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

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

No one is talking about banning private insurance with m4a as any kind of mainstream platform. Even now, Canada and the UK both have private insurance options.

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Members don't see this ad.

 

[deleted605854]

No one is talking about banning private insurance with m4a as any kind of mainstream platform. Even now, Canada and the UK both have private insurance options.

UK has had private options for most things as far as I know. I'm not familiar with the system but I know some clin oncs there who have private clinics over the weekend or when they're not working for the NHS

Canada has private insurance for medications and imaging is slowly creeping in. Private rad Onc was a thing for a while but then the government got rid of it. It might come back.

Is this man Public Enemy No. 1?

The Globe and Mail offers the most authoritative news in Canada, featuring national and international news

www.theglobeandmail.com

Rad Onc always seem to make the news for villainy

 

[OTN]

No one is talking about banning private insurance with m4a as any kind of mainstream platform. Even now, Canada and the UK both have private insurance options.

The only M4A plan that has been proposed, by Senator Sanders, absolutely bans private insurance. It specifically bans private insurance from providing insurance for any health service that is also covered by M4A. This is very, very important to understand.

 

[deleted605854]

The only M4A plan that has been proposed, by Senator Sanders, absolutely bans private insurance. It specifically bans private insurance from providing insurance for any health service that is also covered by M4A. This is very, very important to understand.

That's exactly like the Canadian system or at least how it started

 

[radOresident]

Has anyone in Congress really taken Sanders' plan seriously? I get the intention behind it, but I don't see anyone truly considering that it could become a reality. A robust public option seems much more likely to pass

 

[RickyScott]

Has anyone in Congress really taken Sanders' plan seriously? I get the intention behind it, but I don't see anyone truly considering that it could become a reality. A robust public option seems much more likely to pass

I don’t expect a Medicare for all. Much more likely is expansion of Obamacare, price reform etc Hopefully, it starts in our own field with price transparency early next year.

 

[scarbrtj]

When do we get to hear you pontificate about FLASH?

FLASH has legs. Ten Gy in a microsecond and no side effects (and no contouring, inverse optimization, etc). It's a new radiobiology that much is for sure. But look I have no idea what or how we'll be practicing in ten years or more. But I can make guesses!

 

[dieABRdie]

Why are the radoncs not practicing? Also, system is going to evolve that if you want a radonc salary, you have to see patients. Some academic docs can see very few pts and because department is highly profitable with 3-5 x negotiated prices of freestanding center. Price transparency is not going to be kind to this field. Not will any type of national health care.
At the end of the day, if no medical student should choose radonc with the notion that he can support himself seeing 3-4 pts per week or less.

Agreed. I see price transparency as one of the next major kick in the nads coming for our field. A huge percentage of those academic jobs will evaporate once the inflated reimbursement is no longer there.... and we know that is propping up the market right now. It was a major factor in me switching to community practice from an academic track.

 

[dieABRdie]

The only M4A plan that has been proposed, by Senator Sanders, absolutely bans private insurance. It specifically bans private insurance from providing insurance for any health service that is also covered by M4A. This is very, very important to understand.

This was definitely an aspect that scared the crap out of me. I'm all for a system that provides a mechanism for covering all its citizens... but banning physicians from participating in a private market is completely unacceptable for me.

 

[VA Hopeful Dr]

Has anyone in Congress really taken Sanders' plan seriously? I get the intention behind it, but I don't see anyone truly considering that it could become a reality. A robust public option seems much more likely to pass

Yes.

Cosponsors - S.1129 - 116th Congress (2019-2020): Medicare for All Act of 2019

Cosponsors of S.1129 - 116th Congress (2019-2020): Medicare for All Act of 2019

www.congress.gov

 

[radOresident]

Yes.

Cosponsors - S.1129 - 116th Congress (2019-2020): Medicare for All Act of 2019

Cosponsors of S.1129 - 116th Congress (2019-2020): Medicare for All Act of 2019

www.congress.gov

Some of that list would stand behind it in any case (Warren and Markey being the most obvious examples), but I suspect many cosponsored it to prove their leftist street cred knowing it would never come to a vote. Harris, Booker, and Gillibrand all reneged on their support for abolishing private insurers when they had their feet to the fire during the primaries. It is a very unpopular stance among voters of both parties. I strongly believe (and hope) we will never see a Sanders-style Medicare for All plan in my lifetime, it's just the newest boogeyman used to rile up voters.

 

[Ray D. Ayshun]

This was definitely an aspect that scared the crap out of me. I'm all for a system that provides a mechanism for covering all its citizens... but banning physicians from participating in a private market is completely unacceptable for me.

Which part? The part where private insurance is absolutely banned, or banned for things not covered by m4a?

 

[OTN]

Which part? The part where private insurance is absolutely banned, or banned for things not covered by m4a?

Very little is not covered by the proposed M4A, so it effectively bans private insurance. Only cosmetic stuff falls outside their Medicare coverage.

 

[Ray D. Ayshun]

Very little is not covered by the proposed M4A, so it effectively bans private insurance. Only cosmetic stuff falls outside their Medicare coverage.

Well, either way, I have fewer issues with my medicare patients than with my private insurance patients, so I guess I can't say I'm in the same boat as you or dieabrdie, agreeing with dieabrdie's name notwithstanding.

 

[RickyScott]

I

Agreed. I see price transparency as one of the next major kick in the nads coming for our field. A huge percentage of those academic jobs will evaporate once the inflated reimbursement is no longer there.... and we know that is propping up the market right now. It was a major factor in me switching to community practice from an academic track.

I think many in our field don’t truly believe that large academic centers are charging significantly higher prices for same services, nor understand the harm with respect to departmental/faculty/residency expansion and the bubble it has created.

 

[deleted941485]

This was definitely an aspect that scared the crap out of me. I'm all for a system that provides a mechanism for covering all its citizens... but banning physicians from participating in a private market is completely unacceptable for me.

I honestly can’t see a scenario where a substantial amount of the physician RO workforce will ever be practicing privately ever again. Weather it’s M4A or the public option which is just slow motion M4A. Sure you don’t have to participate but good luck finding any patients who would ever want to be treated by you oh and you’ll probably to subject to a bunch of undue scrutinity for every decision you make and taxes. The government is in the process of killing healthcare...any choice they give you regarding insurance participation will be no choice at all.

 

[deleted941485]

I

I think many in our field don’t truly believe that large academic centers are charging significantly higher prices for same services, nor understand the harm with respect to departmental/faculty/residency expansion and the bubble it has created.

I am skeptical that even if academic centers finally get the shaft. This will invariably screw us.

 

[elementaryschooleconomics]

I think many in our field don’t truly believe that large academic centers are charging significantly higher prices for same services, nor understand the harm with respect to departmental/faculty/residency expansion and the bubble it has created.

I strongly agree. Many of the faculty and residents in my department are strangely ignorant on what I would consider basic (elementary) economics in our field. On the one hand, I understand - I had to actively seek out and learn things on my own because it's not part of the standard curriculum. But given how much attention this has gotten - and its effects on medical student applications - I am surprised at the continued level of ignorance. It's one thing if you've looked at the data yourself and disagree with me, it's another if you disagree because the Chair told you everything was OK and you just believe it to be true...

 

[RickyScott]

There is a difference between “knowledge” and “belief”. Even if they had the “knowledge” (which I doubt) still would not “believe.” Similar scenario with apm: it was talked about for years, Azar said it was coming, astro came out in support, but got the feeling many somehow“believed” it just wouldn’t happen or impact the job market.

 

[medgator]

The only M4A plan that has been proposed, by Senator Sanders, absolutely bans private insurance. It specifically bans private insurance from providing insurance for any health service that is also covered by M4A. This is very, very important to understand.

I think the option that is being discussed by everyone else and is more politically feasible, as below:

Some of that list would stand behind it in any case (Warren and Markey being the most obvious examples), but I suspect many cosponsored it to prove their leftist street cred knowing it would never come to a vote. Harris, Booker, and Gillibrand all reneged on their support for abolishing private insurers when they had their feet to the fire during the primaries. It is a very unpopular stance among voters of both parties. I strongly believe (and hope) we will never see a Sanders-style Medicare for All plan in my lifetime, it's just the newest boogeyman used to rile up voters.

It's political untenable in this country which is why i don't worry about it. Obamacare/aca was actually a Republican idea (Romney care, individual mandate came from the heritage foundation etc) and that's as govt as it will get imo (which makes it all the more strange that the current GOP opposes it so much)

 

[elementaryschooleconomics]

Updated numbers from November 9th:

You can see the action here:
ERAS Statistics

So virtually the same number of total applicants as last year - just a shift in where those applicants are coming from:

 

[thecarbonionangle]

Updated numbers from November 9th:

View attachment 324297

You can see the action here:
ERAS Statistics

So virtually the same number of total applicants as last year - just a shift in where those applicants are coming from:

View attachment 324298

As some may say, more “compassionate” applicants who would enjoy the “good living” of getting paid same as a pediatrician

 

[radiation]

In contrast, med onc has had more US applicants than IMG applicants starting in 2018. There are a few of ways to interpret this
- the breakdown of US vs IMG applicants is not a useful predictor of specialty job dynamics and is more of lagging indicator (ie despite years of predominantly IMG applicants as recently as 2018, heme/onc now has salaries increase with more jobs)
- For an internal medicine senior resident, heme/onc looks like a good choice because by the time they graduate the job market is still likely to be good
- For a medical student, there is a possibility that heme/onc is peaking in terms of lifestyle/jobs/pay, and by the time they would be able to take advantage, the dynamics may change dramatically (ie drug costs become unsustainable and largescale reimbursement changes will occur)

 

[Chartreuse Wombat]

Peak RO in 2017 with 233 US Seniors. Those that matched are currently in training. In 2021 233 is now 113 (despite increases in US Seniors overall). That certainly happened fast.

 

[medgator]

Peak RO in 2017 with 233 US Seniors. Those that matched are currently in training. In 2021 233 is now 113 (despite increases in US Seniors overall). That certainly happened fast.

Will be interesting to see where those 113 are in a decade....

 

[drewdog1973]

Publicly and privately, leaders in the field believe SDN caused this. As if this forum singlehandedly changed the course of an entire specialty. There are posters above me that are known academics that post anonymously and I wish they would speak publicly. But, party line is that “If it wasn’t for those crazy SDNers, everything would be fine.” Sigh.

 

[medgator]

Publicly and privately, leaders in the field believe SDN caused this. As if this forum singlehandedly changed the course of an entire specialty. There are posters above me that are known academics that post anonymously and I wish they would speak publicly. But, party line is that “If it wasn’t for those crazy SDNers, everything would be fine.” Sigh.

Yet for all those "leaders" with their collective heads in the sand, there are also well known folks in academics who have been outspoken about this problem for years and even more who have acknowledged they need to do something about it. Bob Amdur and Brian Kavanagh come to mind

 

[RickyScott]

Yet for all those "leaders" with their collective heads in the sand, there are also well known folks in academics who have been outspoken about this problem for years and even more who have acknowledged they need to do something about it. Bob Amdur and Brian Kavanagh come to mind

And zeitman who started warning about this almost 10 years ago

 

[elementaryschooleconomics]

Publicly and privately, leaders in the field believe SDN caused this. As if this forum singlehandedly changed the course of an entire specialty. There are posters above me that are known academics that post anonymously and I wish they would speak publicly. But, party line is that “If it wasn’t for those crazy SDNers, everything would be fine.” Sigh.

I totally agree.

Those folks aren't doing the math. "Bloodbath in the Red Journal", arguably the opening shot of the "supply/demand era" of SDN, was in the summer of 2013. RadOnc residencies saw continued growth for almost 5 years after that!

What the "leaders" in this field need to ask themselves is what changed since 2013? That's easy - anyone with half a brain can do the math. I'm a great example of what happened.

- I graduated medical school in 2016.

- I'm an MD-PhD, and have been involved with/thinking about doing RadOnc since the late 2000's.

- I have been using SDN since I decided I wanted to go to medical school in the early/mid-2000's.

- You better believe I have been reading this forum for over a decade. I definitely followed the Bloodbath thread when it was new.

- I found it concerning but not compelling. Why? Because the only "hard" data at that time is the infamous Ben Smith paper from 2010 predicting undersupply. I read that paper, I read the arguments on SDN, and decided while the arguments had merit, it probably wasn't as bad as the internet thought.

- Then, when I was in M3/M4 in 2014-2015, setting up rotations, I read through the forum again. Still, I didn't find the data that compelling. I went ahead and applied, Matching in 2016.

- Of course, updated data starts coming out in 2016, like this paper from Falit/Smith/Zeitman.

- So the literature starts catching up in 2016, and the SDN arguments become very compelling. Then, in 2018 the ABR decides to fail a bunch of kids over radbio/physics and blame it on them being weak/dumb - doing themselves and the field no favors.

- From 2016 to now, an avalanche of data comes out demonstrating that we are training WAY too many Radiation Oncologists. General supervision, APM, Medicare cuts...y'all know the drill.

The only thing SDN has done to cause the US MD Senior drop from 2017-now is give students access to the data. For "leaders" to blame it on this forum is cheap and lazy. Do better!

 

[scarbrtj]

I totally agree.

Those folks aren't doing the math. "Bloodbath in the Red Journal", arguably the opening shot of the "supply/demand era" of SDN, was in the summer of 2013. RadOnc residencies saw continued growth for almost 5 years after that!

What the "leaders" in this field need to ask themselves is what changed since 2013? That's easy - anyone with half a brain can do the math. I'm a great example of what happened.

- I graduated medical school in 2016.

- I'm an MD-PhD, and have been involved with/thinking about doing RadOnc since the late 2000's.

- I have been using SDN since I decided I wanted to go to medical school in the early/mid-2000's.

- You better believe I have been reading this forum for over a decade. I definitely followed the Bloodbath thread when it was new.

- I found it concerning but not compelling. Why? Because the only "hard" data at that time is the infamous Ben Smith paper from 2010 predicting undersupply. I read that paper, I read the arguments on SDN, and decided while the arguments had merit, it probably wasn't as bad as the internet thought.

- Then, when I was in M3/M4 in 2014-2015, setting up rotations, I read through the forum again. Still, I didn't find the data that compelling. I went ahead and applied, Matching in 2016.

- Of course, updated data starts coming out in 2016, like this paper from Falit/Smith/Zeitman.

- So the literature starts catching up in 2016, and the SDN arguments become very compelling. Then, in 2018 the ABR decides to fail a bunch of kids over radbio/physics and blame it on them being weak/dumb - doing themselves and the field no favors.

- From 2016 to now, an avalanche of data comes out demonstrating that we are training WAY too many Radiation Oncologists. General supervision, APM, Medicare cuts...y'all know the drill.

The only thing SDN has done to cause the US MD Senior drop from 2017-now is give students access to the data. For "leaders" to blame it on this forum is cheap and lazy. Do better!

I bet your H&P’s are awesome

 

[elementaryschooleconomics]

I bet your H&P’s are awesome

I have been accused of writing "dissertation-style notes", to which I reply:

 

[fiji128]

View attachment 324298

Looks like rad onc is returning to its roots! No program that acknowledges reality and aggressively recruits warm bodies should go unmatched! But I do find it hard to believe that there are still 113 US MDs willing to roll the dice on their future like this.

 

[Doctorer]

Looks like rad onc is returning to its roots! No program that acknowledges reality and aggressively recruits warm bodies should go unmatched! But I do find it hard to believe that there are still 113 US MDs willing to roll the dice on their future like this.

They're not sending their best. They're not sending you. They're not sending you. They're sending people that have lots of problems, and they're bringing those problems with us. And some, I assume, are good people.

I kid (mostly)!

 

[thecarbonionangle]

They're not sending their best. They're not sending you. They're not sending you. They're sending people that have lots of problems, and they're bringing those problems with us. And some, I assume, are good people.

I kid (mostly)!

I keep reading it and many people are saying it!!!

 

[Mandelin Rain]

I watched the Big Short last night. Don't know why, but I just felt like sharing that here.

 

[scarbrtj]

I watched the Big Short last night. Don't know why, but I just felt like sharing that here.

Germane

 

[fiji128]

Those 113 US MDs are taking a Big Long position on rad onc, smh.

 

[Grubbe-a-dub-dub]

Those 113 US MDs are taking a Big Long position on rad onc, smh.

They can't say no one warned them. Everyone and their mother on here are screaming stay away, yet they want to gamble.

 

[evilbooyaa]

I totally agree.

Those folks aren't doing the math. "Bloodbath in the Red Journal", arguably the opening shot of the "supply/demand era" of SDN, was in the summer of 2013. RadOnc residencies saw continued growth for almost 5 years after that!

What the "leaders" in this field need to ask themselves is what changed since 2013? That's easy - anyone with half a brain can do the math. I'm a great example of what happened.

- I graduated medical school in 2016.

- I'm an MD-PhD, and have been involved with/thinking about doing RadOnc since the late 2000's.

- I have been using SDN since I decided I wanted to go to medical school in the early/mid-2000's.

- You better believe I have been reading this forum for over a decade. I definitely followed the Bloodbath thread when it was new.

- I found it concerning but not compelling. Why? Because the only "hard" data at that time is the infamous Ben Smith paper from 2010 predicting undersupply. I read that paper, I read the arguments on SDN, and decided while the arguments had merit, it probably wasn't as bad as the internet thought.

- Then, when I was in M3/M4 in 2014-2015, setting up rotations, I read through the forum again. Still, I didn't find the data that compelling. I went ahead and applied, Matching in 2016.

- Of course, updated data starts coming out in 2016, like this paper from Falit/Smith/Zeitman.

- So the literature starts catching up in 2016, and the SDN arguments become very compelling. Then, in 2018 the ABR decides to fail a bunch of kids over radbio/physics and blame it on them being weak/dumb - doing themselves and the field no favors.

- From 2016 to now, an avalanche of data comes out demonstrating that we are training WAY too many Radiation Oncologists. General supervision, APM, Medicare cuts...y'all know the drill.

The only thing SDN has done to cause the US MD Senior drop from 2017-now is give students access to the data. For "leaders" to blame it on this forum is cheap and lazy. Do better!

I have edited and agree with the above resident note.

Narrator: He had not edited the above note.

 

[drewdog1973]

The really fun part about all this is that because they think this is 99% SDN, they think that they can use social media to "fix the problem". Turns out, having 50% of the applicants compared to years past and 66 FMGs is a symptom, not the disease itself. Those that are truly interested will do fine in residency - I don't think the old metrics mean jack. The people that are worried about residents passing boards and what not - it's up to them to get the residents to be able to pass. Don't comment pre-emptively on the "quality" of the residents before they have even set foot in clinic. Now, doing well in residency and passing exams will have little to do with actually getting a job, but no one really but us truly want to have that discussion.

 

[w00tz]

They can't say no one warned them. Everyone and their mother on here are screaming stay away, yet they want to gamble.

I know, it's baffling to me. Trying to wrap my head around how there are still a lot of applicants. I know the FMGs will be happy to land any residency. I suspect the US grads figure they will be shoe-ins for spots in the top residencies and will be protected from the tight job market?

Is there even a Google docs/spreadsheet this year? Virtual interview impressions???


Browsing through it made me think of something else. When I applied - prelims and TY were getting more competitive. I wonder if all the FMGs, who traditionally have a harder time matching in general, will all be able to secure these positions. Or are there more available these days?

2nd EDIT:
Yea, poor sample of 19 applicants, but still, wow.

And the job placement tab is interesting too. Okay, I'm done. Going to work on contours now.

 

[Neuronix]

Please, no direct links to the interview spreadsheet. We need to avoid confusion between sdn and this spreadsheet which is and always has been unaffiliated with sdn.

Just Google it, it is very easy to find. Future articles in our society's journal can call it the "reddit spreadsheet" or "google spreadsheet" or something else.

https://www.redjournal.org/article/S0360-3016(19)30792-8/fulltext

 

[elementaryschooleconomics]

This is a hilarious recent post in a very turbulent row:

This reads like someone actively acknowledging the cognitive dissonance they feel is uncomfortable and wants to block out reality to feel better.

Also, as someone currently in the job market with a lot of friends doing the same, whoever claims that the "job market is better than it was 6 years ago" is off the wall wild.

 

[taserlaser]

It hasn’t hit them that the fierce competition that used to be faced getting into rad onc, will just be postponed another 6-7 years (who’s going to get a job without a fellowship, or two really). And what that means when their bills come due. Easier to pivot to another specialty now, than after 5-7 years.

Values mature and change over such a period of time, and they may learn to regret. They can’t say they weren’t warned, but it is sad.

 

[Ray D. Ayshun]

It's that story of the man standing on his roof as the floodwaters rise. Two boats and a helicopter show up to get him out. and he says, "I don't need help, God will save me." Then, after drowning, he's standing in front of god and asks it, "Why didn't you save me?" The response: "I sent you two boats and a helicopter..."

Postscript: The man then says,"Could be worse. I could be finishing radonc residency in 2026."

 

[thecarbonionangle]

This is a hilarious recent post in a very turbulent row:

View attachment 324407

This reads like someone actively acknowledging the cognitive dissonance they feel is uncomfortable and wants to block out reality to feel better.

Also, as someone currently in the job market with a lot of friends doing the same, whoever claims that the "job market is better than it was 6 years ago" is off the wall wild.

Very “busy” chairs/attendings with 6 patients on treat and a resident to do their work are clearly trolling and gaslighting the google doc (6 yrs ago dead give away). That document is tainted and would be highly suspicious of these comments. They need a warm body and believe me many places have decided to lie, deceive, do anything to get it, even going as far as to enlist poor residents gun to head and moving carrot in front. I know this to be true from private conversations with residents in multiple places. Just remember this folks, no net overall good ever ultimately comes from working for THE man.

 

[elementaryschooleconomics]

Very “busy” chairs/attendings with 6 patients on treat and a resident to do their work are clearly trolling and gaslighting the google doc (6 yrs ago dead give away). That document is tainted and would be highly suspicious of these comments. They need a warm body and believe me many places have decided to lie, deceive, do anything to get it. I know this to be true from private conversations with residents in multiple places.

That's why I hate the Google Spreadsheet - there's no accountability.

On SDN, I guess I could be pretending to be a PGY-5 MD-PhD RadOnc resident, but at least my posts have to be consistent with me pretending to be that. If I started posting as a med student or mid-career faculty while on this account, that would be caught immediately.

But on the Google Spreadsheet? Anyone can write anything, you can pretend to have a conversation between multiple people all by yourself. Without any form of identification (anonymous or not), crazy things can be said. Twitter wants to throw shade on SDN for "anonymous trolls", but the Google Spreadsheet is the 4chan of medicine...

 

[thecarbonionangle]

If the google speadsheet is 4chan, the attending/chair trolls are definitely the 8chan. These warm blood thirsty vampires are out like the bats under the bridge near my work at dusk

 

[fiji128]

According to med student posters on the spread sheet it sounds like "good" residents that go to "nice" programs can expect to have a job in 2026 via the secrete hand shake network. Why not roll the dice on your entire professional future on something like that. I guess this is based on magical thinking and believing the used car salesman chairs and program directors that are so desperate to do/say anything to fill. Well not quite desperate enough to substantially cut spots or close useless programs. When is KO going to do the right thing and cut his residency spots by 50% while he advocates for 3 fractions breast? When is the ASTRO president going to show real leadership and close that dumpster fire of a program that was started for no other reason then to give her prestige?

 

[Doctorer]

The funniest thing on the spreadsheet are people condemning negative comments from residents and attendings as "trolls," with the argument that they're much too busy to ever post on a spreadsheet.

Trust me, they aren't.