MDACC no longer accepting consults if patients might be treated elsewhere

[RadOncDoc21]

I actually don’t mind sending patients for a second opinion. I make the same regardless if I treat one patient or 30 so I feel free to do what’s best for my patients. Most of the time, they end up going to the academic center because let’s face it, they have all the fancy ads and resources compared to my simple community hospital.

99% of the time though, their treatment plan was the same except the patient did have to undergo a bunch of repeat imaging and tests. I usually find that reassuring that at least my plan was on par with what the “experts” recommended. Sometimes I do see the patients back but again it’s a business so I don’t expect to ever see them again.

I’m comfortable with my situation and could not survive one day dealing with the politics in academic medicine, also my salary is in the 75%tile and I work 4 days a week, so I’m satisfied. I stopped caring about the name of the institution on my white coat and more about myself. At the end of the day it’s all about the bottom line to all of these places.

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[OTN]

Lol wait so she liked her surgeon and her med onc but needed a second radonc opinion after seeing you? I don’t think the problem is with MDACC. Hot take! But hey, trashing mdacc is fun we all enjoy it.

I actually love seeing second opinion consults. Once the pathology is corrected, staging is completed, and the patient is referred to any necessary additional services, often times the treatment changes. Ultimately I find that the patients are grateful. PP docs have a giant Napoleon complex against academic medical centers and it’s manifested in pointless threads like this.

This was going to be her third opinion, and her case was in a grey area, so I actually wanted her to go to MDA to break the tie between another doc and I.

I see zero problem with pointing out significant issues with one of the major cancer centers in this country on this board, especially when the issues directly affected a patient of mine.

I don’t even really mind the arrogance; (“once the pathology is corrected” lol) what’s the point of being an academic radonc if you don’t indulge in it? Certainly not money or power, and unless you’re one of the 10 or so radoncs doing actual worthwhile research, that’s not it, either. Indulge away for all I care. Just see the patients whose taxes currently pay for part of your budget. Not a big ask.

 

[jeebus69]

I love this thread. You call it arrogance, I call it real life because I see it regularly. Radiology and pathology are the basis of oncology and when they are wrong, patients suffer. After experiencing the community and where I am now, I know where I’d like my family members to be treated. Good luck out there!

 

[TheWallnerus]

Seems like fraud because it is but again, health care is a billion dollar business. They know what they are doing and if the customers (patients) are willing to pay up, then the system (insurance companies, etc) will continue to allow it. As docs, we are all just pawns in this deadly game.

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[TheWallnerus]

I love this thread. You call it arrogance, I call it real life because I see it regularly. Radiology and pathology are the basis of oncology and when they are wrong, patients suffer. After experiencing the community and where I am now, I know where I’d like my family members to be treated. Good luck out there!

It's a good thing we are getting all these second reads (I'm $ure they're provided as a free $ervice) at the academic centers because the data certainly bears out that academic second reads are better than community first reads.

 

[TheWallnerus]

Patients have to come and do multi specialty eval (surg Onc/med Onc/Gyn onc/radonc) in order to receive a 2nd (or 1st, or any) opinion.

 

[communitydoc13]

Radiology and pathology are the basis of oncology

I encourage second opinions for patients with means and good PS who have cancers with poor outcomes or where it's a very gray area in terms of clinical decision making.

But in terms of repeat imaging (not repeat review of existing imaging, which I have no problem with), the value seems pretty bogus to me in most cases.

Exceptions I can think of include: 3D abdominal CT with recon for pancreatic cancer, particularly for evaluation of resectability or target delineation. PSMA PET (although what to do with this info is unclear) with integration into clinical trial and repeat CNS MRI for treatment planning only (not to look for 35 mets with 30 already apparent on outside study).

However, I have seen more standard repeat CT c/a/p studies than makes any sense and repeat multiparametric MRI for prostate (seems like very many different protocols here) when local staging evident on existing study.

Regarding path review, my community pathologists routinely send difficult cases to Mayo. So I'm guessing that repeat path review is MDACC vs Mayo or a similar clash of the titans. Honestly, I think a tie break makes the most sense statistically in those cases where these institutions don't agree. I don't think they facilitate this?

 

[RickyScott]

2 thoughts:
1)how bad can community radonc be after 15+ years of churning out AOA grads?

2) attendings at places like mdacc have to seriously question whether they are doing “more bad than good” given enormous financial toxicity. At what price point are you simply doing straight up harm? Hopefully, Texas will come through with price transparency.

 

[RadOncDoc21]

Lol wait so she liked her surgeon and her med onc but needed a second radonc opinion after seeing you? I don’t think the problem is with MDACC. Hot take! But hey, trashing mdacc is fun we all enjoy it.

I actually love seeing second opinion consults. Once the pathology is corrected, staging is completed, and the patient is referred to any necessary additional services, often times the treatment changes. Ultimately I find that the patients are grateful. PP docs have a giant Napoleon complex against academic medical centers and it’s manifested in pointless threads like this.

When I was a resident(at a large academic center), I truly valued my experience being at a place where we would give a lot of second opinions and yes we did see a lot of bad care, honestly most were from the surgeons who were obviously not specialized in cancer care. Most of the time, the docs I worked with would give their advice and if it was something that their rad onc could do locally, the patients were usually given the choice to go back. There was a mutual relationship between the academic docs and the community.

Unfortunately, these places are becoming more aggressive, likely due to having lower volumes and more squeeze coming from the admins. I even had patients who were told that “only gamma knife can treat brain mets.” I’m ok with being challenged, but not the dishonesty.

I really don’t think this should be a PP vs academic battle because as physicians, we are losing the war on the “quality of care” for our patients and just helping the system get richer, I’m a pawn like everyone else except I understand the game more now then I did in the past.

 

[deleted941485]

Hot take: MDACC residents struggle in private practice and I'd think very hard before hiring one.

Those residents have bigger worries. Besides if they happen to land a PP gig in the Houston area probably just a matter of time before MDACC takes it.

 

[deleted941485]

I would say at the end of the day none of this has anything to do with patients/good medicine. I'm sure its just a business calculation centered on generating the most amount of revenue for the least cost.

I mean I guess I interpret it a little differently. They probably are still hurting from COVID 19 revenues and basically are looking at every avenue to retain patients. I work at a satellite office so I don't get these opinions often even as a resident I never got too many second opinions.

In this ****ty HC environment, I think even the big dogs are starting to feel the heat so at some level I can understand it.

I mean honestly its a joke what I get for a consult and they can be time consuming (Lit reviews, calling other colleagues who also have **** to do, having a the discussion etc).

In this day and age, patients have way to many options especially in major metro areas and honestly the second opinions that happen to make it to my door, it isnt like the consulting doctor came up with some brilliant plan of care at that couldn't be delivered elsewhere.

When I was a resident(at a large academic center), I truly valued my experience being at a place where we would give a lot of second opinions and yes we did see a lot of bad care, honestly most were from the surgeons who were obviously not specialized in cancer care. Most of the time, the docs I worked with would give their advice and if it was something that their rad onc could do locally, the patients were usually given the choice to go back. There was a mutual relationship between the academic docs and the community.

Unfortunately, these places are becoming more aggressive, likely due to having lower volumes and more squeeze coming from the admins. I even had patients who were told that “only gamma knife can treat brain mets.” I’m ok with being challenged, but not the dishonesty.

I really don’t think this should be a PP vs academic battle because as physicians, we are losing the war on the “quality of care” for our patients and just helping the system get richer, I’m a pawn like everyone else except I understand the game more now then I did in the past.

 

[TheWallnerus]

2 thoughts:
1)how bad can community radonc be after 15+ years of churning out AOA grads?

2) attendings at places like mdacc have to seriously question whether they are doing “more bad than good” given enormous financial toxicity. At what price point are you simply doing straight up harm? Hopefully, Texas will come through with price transparency.

It's just like in that episode of "Star Trek TNG" where the Federation had been improving their warp drive technology and going faster and faster and the Federation higher ups were so happy. But in the meantime a group of some low level people were discovering that the warping was destroying and polluting the fabric of spacetime. Picard, a good man, didn't wanna believe it and suggestions that warping was harmful made him really angry. Eventually though he couldn't ignore the data and had to face facts. He quit excessive warping and changed his ways for the betterment of the universe.

 

[drewdog1973]

“I heard that Mdacc residents struggle in private practice.”

Uh? Okay. Can dig at them all you want for their business practices, but that line about the residents just stinks of SDN unverifiable anecdotal hot garbage.

 

[RickyScott]

“I heard that Mdacc residents struggle in private practice.”

Uh? Okay. Can dig at them all you want for their business practices, but that line about the residents just stinks of SDN unverifiable anecdotal hot garbage.

I also doubt most mdacc residents would struggle, but as a whole, I find sdn to be more reliable (but not perfect) about most issues compared w/ say Astro, “leaders” or a proton study from mdacc.

Numerous falsifiable predictions have been made here that turned out to be spot on 1)that large centers were charging at least 3-5 x cms rates (many were calling that accusation unsubstantiated hot garbage) 2) that job market would blow up due to expansion, hypofract , and supervision changes.

 

[deleted969641]

Can you imagine if this happened in literally any other business?

Your roof is leaking, but a roofer refuses to come out and take a look and tell you what's wrong and what needs to be fixed unless you agree upfront to hire his company to replace the entire roof. In fact, in most other lines of work people give "free estimates!"

Even if MDACC is only collecting $500 for a consult, an early stage breast takes what, 30 minutes of work? That's $1000/hour for your time. I wouldn't turn my nose up at that, and it sounds like MDACC is collecting much more than that for routine consults, many of which are probably virtual now.

 

[drewdog1973]

I also doubt most mdacc residents would struggle, but as a whole, I find sdn to be more reliable (but not perfect) about most issues compared w/ say Astro, “leaders” or a proton study from mdacc.

Numerous falsifiable predictions have been made here that turned out to be spot on 1)that large centers were charging at least 3-5 x cms rates (many were calling that accusation unsubstantiated hot garbage) 2) that job market would blow up due to expansion, hypofract , and supervision changes.

What about ism.

SDN right about a lot. But, just being slightly more right than ASTRO blowhards is hardly a goal.

What is it with this place and badmouthing residents and students ?

 

[medgator]

What about ism.

SDN right about a lot. But, just being slightly more right than ASTRO blowhards is hardly a goal.

What is it with this place and badmouthing residents and students ?

At some point residents (and students) will be held accountable for going into a field as saturated and overtrained as this one. Honestly, anyone graduating mid decade or beyond shouldn't shocked when they don't have a job, or don't have a job because of some capricious criteria about where they trained.

Pedigree already being discussed as a way to screen applicants for jobs etc by hospital admins who don't know any better.

Think of this as simply in reverse....

 

[drewdog1973]

Hospital administrators (non MDs) out of region don’t know who MD Anderson is. It’s just our world that cares. Just like residents from anywhere, some are good, some are great. Everyone graduating now is pretty good, even from bad programs

 

[w00tz]

I've heard the whole MDACC residents would be bad in PP talk, but I don't buy it. I think the only thing you can argue is that it may a rough transition, because the practice environment is so different. But I'm sure it's nothing that the top 10% of rad onc residents would not be able to adapt to in a few months in practice.

Disclaimer: Did not go to MDA, but know many current and former residents.

 

[RickyScott]

At some point residents (and students) will be held accountable for going into a field as saturated and overtrained as this one. Honestly, anyone graduating mid decade or beyond shouldn't shocked when they don't have a job, or don't have a job because of some capricious criteria about where they trained.

Pedigree already being discussed as a way to screen applicants for jobs etc by hospital admins who don't know any better.

Think of this as simply in reverse....

I plan to check in on some of the vocal medstudents on twitter in 5 years. Curious as to how the gap year works out- will he land a satellite job at mskcc on 5 years? Competition within some of these large programs is going to be ultraintense.

 

[BobbyHeenan]

I've heard the whole MDACC residents would be bad in PP talk, but I don't buy it. I think the only thing you can argue is that it may a rough transition, because the practice environment is so different. But I'm sure it's nothing that the top 10% of rad onc residents would not be able to adapt to in a few months in practice.

Disclaimer: Did not go to MDA, but know many current and former residents.

This has been my experience with a good friend MDA trained colleague (surg onc).

Practice environment and patient population so different. He adjusted but it can shocking he said.

 

[Lamount]

Out of all of the common themes on SDN, disparaging residents from a given program is one of the least justifiable.
It’s petty, speculative, and ends up tainting the reasonable fact-based concerns that others raise on SDN

 

[medgator]

Out of all of the common themes on SDN, disparaging residents from a given program is one of the least justifiable.
It’s petty, speculative, and ends up tainting the reasonable fact-based concerns that others raise on SDN

At some point, you can only feign ignorance for so long..... I'd say anyone starting training in the 2020s should be well aware of what they are getting into when they graduate

 

[radiation]

I also doubt most mdacc residents would struggle, but as a whole, I find sdn to be more reliable (but not perfect) about most issues compared w/ say Astro, “leaders” or a proton study from mdacc.

Numerous falsifiable predictions have been made here that turned out to be spot on 1)that large centers were charging at least 3-5 x cms rates (many were calling that accusation unsubstantiated hot garbage) 2) that job market would blow up due to expansion, hypofract , and supervision changes.

The self back-patting that I constantly see on SDN is always funny to me because its often the same people that are calling out the rad onc twiterrati for doing the same thing. Predicting the job market problems was not some exclusive insight to SDN, many people knew this was coming but dont feel the need to go on the internet to talk about it.

The other thing I love about SDN is the constant ****ting on PDs and academics just trying to do their dayjobs and live their lives when they are equally as culpable as the AOA guys who went into private practice, made a bunch money, didnt get involved in any specialty organizations or leadership, then act surprised when there are a bunch of idiots making decisions for specialty. What good is a golden age of AOA candidates if they dont do anything to help their specialty?

 

[medgator]

The other thing I love about SDN is the constant ****ting on PDs and academics just trying to do their dayjobs and live their lives when they are equally as culpable as the AOA guys who went into private practice, made a bunch money, didnt get involved in any specialty organizations or leadership, then act surprised when there are a bunch of idiots making decisions for specialty. What good is a golden age of AOA candidates if they dont do anything to help their specialty?

Blaming AOA folks in PP for the shameless expansion in residency programs and spots by academic chairs and PDs?

Wow, I've heard it all now... Going to blame private practitioners for all that academic center pricing/proton financial toxicity too?

 

[Lamount]

At some point, you can only feign ignorance for so long..... I'd say anyone starting training in the 2020s should be well aware of what they are getting into when they graduate

They are well aware.

...but I don’t know what this has to do with disparaging them. I’m happily employed and it sounds like you are too. Don’t you wish the same for everyone in our field, regardless of where they train?

 

[medgator]

They are well aware.

...but I don’t know what this has to do with disparaging them. I’m happily employed and it sounds like you are too. Don’t you wish the same for everyone in our field, regardless of where they train?

Yes. Unfortunately half of them aren't getting that. Would you sign up for a situation where you had a not insignificant chance of being un/underemployed at the end of the long haul?

 

[drewdog1973]

At some point, you can only feign ignorance for so long..... I'd say anyone starting training in the 2020s should be well aware of what they are getting into when they graduate

How does this address La Mount’s comment about denigrating residents from specific programs ?

 

[drewdog1973]

How does this address La Mount’s comment about denigrating residents from specific programs ?

I’m re-reading it. Non sequitur AF

 

[deleted941485]

At some point, you can only feign ignorance for so long..... I'd say anyone starting training in the 2020s should be well aware of what they are getting into when they graduate

I surely have no sympathy for them at this point. They cannot say that they have not been told. But then again when I see the new grads out there now they make me want to vomit.

 

[deleted941485]

The self back-patting that I constantly see on SDN is always funny to me because its often the same people that are calling out the rad onc twiterrati for doing the same thing. Predicting the job market problems was not some exclusive insight to SDN, many people knew this was coming but dont feel the need to go on the internet to talk about it.

The other thing I love about SDN is the constant ****ting on PDs and academics just trying to do their dayjobs and live their lives when they are equally as culpable as the AOA guys who went into private practice, made a bunch money, didnt get involved in any specialty organizations or leadership, then act surprised when there are a bunch of idiots making decisions for specialty. What good is a golden age of AOA candidates if they dont do anything to help their specialty?

They did not get involved in ASTRO because their interests diverged considerably from the academic centers over the years and they formed ACRO and other associations. ASTRO is academic dominated and represents the interests of pps exempt centers. Sure maybe they should have stuck around but in all likelihood they would have been pushed to the side in favor of the MGH and MSKCCs of the world.

The academy calls the shots here.

 

[RickyScott]

How does this address La Mount’s comment about denigrating residents from specific programs ?

In principle, residents from specific programs should not be denigrated, but I am having a hard time coming up with a good reason any us md should attend West Virginia type place in this job market, other than they have some serious issues.

 

[medgator]

How does this address La Mount’s comment about denigrating residents from specific programs ?

Such denigration is already happening in the marketplace at certain practices if Twitter and word on the street is to believed?

What would you call it when certain well known practices in the east coast only interview residents from certain "top tier" programs?

Works both ways imo... Certain practices only want Anderson and Sloane while others couldn't care less and feel a smaller mid tier place would train better for community practice

 

[drewdog1973]

Such denigration is already happening in the marketplace at certain practices if Twitter and word on the street is to believed?

What would you call it when certain well known practices in the east coast only interview residents from certain "top tier" programs?

1. SDN saying “I hear residents from this program can’t hang in private practice”

vs

2. Snobby private practices saying “We only hire Harvard and Sloan people”

How do you not see this as two different concepts?

 

[medgator]

1. SDN saying “I hear residents from this program can’t hang in private practice”

vs

2. Snobby private practices saying “We only hire Harvard and Sloan people”

How do you not see this as two different concepts?

Why do you think #2 is saying that and how is that any different than #1? How do you not see that they aren't that far off from each other?

 

[RadOncDoc21]

Can it be fair to say that we all have different preferences? I definitely don’t want a “rock star” on my team though. I just want a good doc I can share call with.

 

[FrostyHammer]

Hot take: MDACC residents struggle in private practice

I agree with drewdog... This is a really inane statement that is a way oversimplified generalization. I didn't train there but I call on any MDACC alumni to attest to the accuracy of this statement. I like SDN but there is way too much fake news that gets thrown around here. Can't criticize the Twitterati without pointing a finger at ourselves too.

 

[drewdog1973]

Why do you think #2 is saying that and how is that any different than #1? How do you not see that they aren't that far off from each other?

Because one is talking about the quality of residents which vary widely

One is easily determined by looking at the pedigree of hires.

Classic SDN misdirection without addressing inane prior statement, usually false.

 

[medgator]

Because one is talking about the quality of residents which vary widely

One is easily determined by looking at the pedigree of hires.

Classic SDN misdirection without addressing inane prior statement, usually false.

And why was that pedigree chosen? Gets back to the same underlying issue.

The elite coastal practices can think non harvard/sloane docs don't know what they are doing, evidence be damned. They choose to act on their feelings. Not sure why that is all of a sudden a problem in reverse?.

 

[medgator]

I agree with drewdog... This is a really inane statement that is a way oversimplified generalization. I didn't train there but I call on any MDACC alumni to attest to the accuracy of this statement. I like SDN but there is way too much fake news that gets thrown around here. Can't criticize the Twitterati without pointing a finger at ourselves too.

Fair point @drewdog1973

 

[drewdog1973]

And why was that pedigree chosen? Gets back to the same underlying issue.

The elite coastal practices can think non harvard/sloane docs don't know what they are doing, evidence be damned. They choose to act on their feelings. Not sure why that is all of a sudden a problem in reverse?.

It’s fine for people to hire who they want to want, with whatever biases they have.

But, isn’t this the student doctor network ? Do we have some interest in labeling all graduates of a program to be unable to do private practice (without any real evidence of course?). They graduate 7 a year. You’re telling me someone has a understanding of 140 doctors over the last 20 years and some percentage of them aren’t “as good” at private practice? As compared to who? Based on what metric? What other program has as large of a footprint to even make that comparison with?

If you want to defend this “hot garbage take”, come with something. Like anything. Even “I heard from my dosimetrist’s frat brother’s ex girlfriend that some Anderson grad in El Paso couldn’t hack it, so they are faculty at Stanford now” or whatever.

Otherwise, what’s the point? It’s just “Ginny and Georgia” without the pretty people, i.e. gossipy trash.

 

[RadOncDoc21]

It’s fine for people to hire who they want to want, with whatever biases they have.

But, isn’t this the student doctor network ? Do we have some interest in labeling all graduates of a program to be unable to do private practice (without any real evidence of course?). They graduate 7 a year. You’re telling me someone has a understanding of 140 doctors over the last 20 years and some percentage of them aren’t “as good” at private practice? As compared to who? Based on what metric? What other program has as large of a footprint to even make that comparison with?

If you want to defend this “hot garbage take”, come with something. Like anything. Even “I heard from my dosimetrist’s frat brother’s ex girlfriend that some Anderson grad in El Paso couldn’t hack it, so they are faculty at Stanford now” or whatever.

Otherwise, what’s the point? It’s just “Ginny and Georgia” without the pretty people, i.e. gossipy trash.

Are you saying the internet may have a little bit of “fake news?”

I think the “viewers” of this forum need to take everything with a grain of salt. It’s impossible to be able to fact check everyone, hell we couldn’t do that for years on our very own president:

100 Days Without Trump on Twitter: A Nation Scrolls More Calmly (Published 2021)

Democrats are breathing easier. Republicans are crying censorship. For all of the country’s news consumers, a strange quiet has descended after a four-year bombardment of presidential verbiage.

www.nytimes.com

I would assume that the majority of folks assume that MDACC residents are considered top notch and more than likely all will turn out to be excellent or at the very least, capable rad onc docs. There may be a few bad apples here and there but lthat’s everywhere. Maybe somebody had a bad experience with one of them, who knows?

I’m sure they will all be able to find “a job somewhere,” which is the highest goal to achieve in our field these days. The only person on the internet who is incapable of ever saying anything false is Simul (this is a fact)!

 

[RickyScott]

The self back-patting that I constantly see on SDN is always funny to me because its often the same people that are calling out the rad onc twiterrati for doing the same thing. Predicting the job market problems was not some exclusive insight to SDN, many people knew this was coming but dont feel the need to go on the internet to talk about it.

The other thing I love about SDN is the constant ****ting on PDs and academics just trying to do their dayjobs and live their lives when they are equally as culpable as the AOA guys who went into private practice, made a bunch money, didnt get involved in any specialty organizations or leadership, then act surprised when there are a bunch of idiots making decisions for specialty. What good is a golden age of AOA candidates if they dont do anything to help their specialty?

The self back-patting that I constantly see on SDN is always funny to me because its often the same people that are calling out the rad onc twiterrati for doing the same thing. Predicting the job market problems was not some exclusive insight to SDN, many people knew this was coming but dont feel the need to go on the internet to talk about it.

The other thing I love about SDN is the constant ****ting on PDs and academics just trying to do their dayjobs and live their lives when they are equally as culpable as the AOA guys who went into private practice, made a bunch money, didnt get involved in any specialty organizations or leadership, then act surprised when there are a bunch of idiots making decisions for specialty. What good is a golden age of AOA candidates if they dont do anything to help their specialty?

No self back-patting here. Fully agree that the predictions were entirely obvious. This is more of an indictment of Astros greed and legitimacy-fact that they work against their members interests than self congratulations. Yes, there is truly a low bar here in terms of sdn being more legitimate than Astro, and the trash published by the likes of potters, Dan Golden, Ben smith, Michael steinberg, Astro and others. Sdn remains best insight into specialiy for medstudents.

 

[yesmaster]

didn't get involved in any specialty organizations or leadership, then act surprised when there are a bunch of idiots making decisions

"I didn't leave ASTRO, ASTRO left me"

 

[medgator]

Straight from Simul, recent VVPN virtual panel. Very, very accurate for most of us out in non academic, community practice

 

[SubserviantToABR]

Straight from Simul, recent VVPN virtual panel. Very, very accurate for most of us out in non academic, community practice

I'm associated with a large academic institution and would say that it is also accurate for me and my colleagues in academia. Our future as a specialty is governed by the few idiots, many of whom are frequently discussed here.

Many of us wish we have the courage to speak up like our EM colleagues recently and use the position in academics to make change happen. However, with this current job market the way it is, I don't have anywhere to go, without completely upending my life (although, I continually keep my eyes peeled for my out!). I can assure you, if I was to speak up, while I wouldn't get fired for being vocal, my life would be hell.

Maybe at some point soon, they see what we (and medical students are seeing) see in the future of our specialty and cut those damn residency spots.

 

[Mandelin Rain]

LOL, my self described “hot take” was too spicy. Like an over seasoned biryani.

Not very hot to say, “based on a limited number of first and second hand accounts, as well as historical rumor, some MDACC graduates struggle to acclimate to PP to a greater degree than one would expect from such an excellent institution. More, than many residents from other (less well funded) residencies. In the context of the opening post of this thread, I’d speculate that this may be related to the army of people employed to protect the doctors from doing the mundane tasks that most PP doctors would consider a routine and necessary part of the job, like seeing second opinions unlikely to be treated at their facility (have heard/seen other examples as well).”

 

[drewdog1973]

LOL, my self described “hot take” was too spicy. Like an over seasoned biryani.

Not very hot to say, “based on a limited number of first and second hand accounts, as well as historical rumor, some MDACC graduates struggle to acclimate to PP to a greater degree than one would expect from such an excellent institution. More, than many residents from other (less well funded) residencies. In the context of the opening post of this thread, I’d speculate that this may be related to the army of people employed to protect the doctors from doing the mundane tasks that most PP doctors would consider a routine and necessary part of the job, like seeing second opinions unlikely to be treated at their facility (have heard/seen other examples as well).”

“Based on a limited number of first and second hand accounts, some residents from all programs struggle to acclimate to PP/hospital/academic jobs as compared to some other residents from all programs”

 

[Mandelin Rain]

“Based on a limited number of first and second hand accounts, some residents from all programs struggle to acclimate to PP/hospital/academic jobs as compared to some other residents from all programs”

Facts