SHOTS FIRED-Wallner Kachnic comm. re retracted PRO"quality of residents ... drifting ...downward"

[emt409]

Sorry for the Buzzfeed title, but I felt the absolute ridiculousness of the article merited a similarly ridiculous title.

Here it is.

Essentially, the commentary is slamming the recent critique of the ABR that was retracted (see other thread). The retracted article is still unavailable.

My favorite paragraph is this:

"Fourth, generally available National Residency Match Program (NRMP) data suggest that over the past decade, regardless of a belief within the radiation oncology community, trends in the quality of residents accepted for training have been drifting slightly downward (4)."​

Interestingly, the authors don't even bother to provide the citation number 4. Considering that Paul Waller (a DO), past ASTRO president that he is, would have very little hope of matching today, especially at places like Harvard or Vandy (where his 2nd author Lisa Kachnic was and now is currently chair), I find his commentary particularly amusing.

Poll below.

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Members don't see this ad.

 

[seper]

Your link is to ACR In-training exam. No relationship to ABR. It is written by different physician volunteers.

 

[emt409]

Your link is to ACR In-training exam. No relationship to ABR. It is written by different physician volunteers.

Oops, thanks seper, guess I right-clicked on wrong pdf in my dropbox folder. Fixed now.

 

[medgator]

Seems like a big non issue compared to the rampant expansion of slots coupled with increasing hypofractionation for multiple diseases... complaining about the table cloths while the titanic is starting to sink...

 

[seper]

I remember the written clinical ABR exam as a pretty fair, well-written test. Much better than the In-service, and it's meant to be so.

 

[OTN]

So, there are training programs which are not equipped to actually be training residents, but they still exist? Instead of allowing incredible and unnecessary expansion of existing programs and creation of new programs, perhaps we can close ones that are not sufficient and force others to improve? Let me guess: No.

"One of us (PEW) served as a faculty advisor for the Association of Residents in Radiation Oncology (ARRO) for six years and became keenly aware of the lack of didactic programming and schooled educators in many of our training programs."

 

[Haybrant]

Hey we can’t all be DO’s like Wallner and treat the whole patient, allopathics really don’t understand the importance of that like osteopaths do.

Physicians of their generation truly are some of the trashiest people in all of medicine morally and ethically.

 

[kristofer]

Hey we can’t all be DO’s like Wallner and treat the whole patient, allopathics really don’t understand the importance of that like osteopaths do.

Physicians of their generation truly are some of the trashiest people in all of medicine morally and ethically.

Bravo. POTY.
The whole thing is quite hilarious, especially the fact the article was so offensive it had to be pulled so they could pen this incendiary response (as if such a thing could be taken so personally -- why?). And quite embarrassing to the field at the same time.

 

[emt409]

Bravo. POTY.
The whole thing is quite hilarious, especially the fact the article was so offensive it had to be pulled so they could pen this incendiary response (as if such a thing could be taken so personally -- why?). And quite embarrassing to the field at the same time.

So I just managed to get a hold of the original article by Dr's Amdur and Lee. I've been asked not to post it yet, but I will when I can. It's very well written and well thought out, in stark contrast to the Wallner reply.

 

[Neuronix]

Sorry for the Buzzfeed title, but I felt the absolute ridiculousness of the article merited a similarly ridiculous title.

Here it is.

TIL you can reference Wikipedia in a PRO article.

 

[kristofer]

TIL you can reference Wikipedia in a PRO article.

The Wikipedia reference was one of the more respectable parts of it.

 

[RickyScott]

FWIW: Amdur one of smartest people i have come across..

 

[emt409]

FWIW: Amdur one of smartest people i have come across..

I haven't met him, but I have heard a number of people say the same thing.

 

[ak6819]

Interesting to say "trends in the quality of residents accepted for training have been drifting slightly downward " when just a few years ago Dr. Wallner wrote in regard to Shah's piece on residency expansion... "Our residency programs continue to experience an increase in the numbers of applicants and the quality of those applicants"

 

[deleted18755]

I can’t figure out what this is all about (a paper about something controversial was retracted after it was published online but a letter to editor in reference to the paper nobody can access was published?)

Sorry for being lazy but can somebody provide a very brief summary of what all of this is about?

 

[radiaterMike]

A paper "Thoughts on the American Board of Radiology Examinations and the Resident Experience in Radiation Oncology" was temporarily removed from PRO for one of several possible reasons- perhaps due to an error- ( as other reasons would result in permanent withdrawal - see http://www.practicalradonc.org/article/S1879-8500(18)30080-8/fulltext ). The figures from the paper were available for some reason. This is causing all sorts of conjecture and drama. An editorial on the article was recently published (before the PRO editorial staff got around to updating the original paper). Among other things, the authors stated the same thing that the SDN poll above is suggesting. People then decided it was a good idea to deride Wallner (who donates his time to the ABR) because he has a DO instead of an MD. That's about it.

 

[OTN]

I'm deriding Wallner's statement- not him- not because of his DO, but because I think arguing for residency expansion (in his Shah response) while only a bit later stating that many residencies are not fully equipped to educate their residents is disingenuous at best.

 

[DrfluffyMD]

He is a DO. And if things are going in the current direction there will be many DO radonc residents again.

 

[radiaterMike]

I’ll have to read (or re-read) his response to the Shah article. But in reality the only thing the ABR can do to curtail supply and demand in radiation oncology is to fail more examinees - which is not a good idea. To his credit, he (along with Kachnic and Zietman and others) was instrumental in eliminating the recertification exam and the need for pointless PQI projects. Also, his certification is grandfathered yet he chooses to comply with MOC. Kachnic was somehow spared the same vitriol on this board (perhaps because there are few nicer people than her).

 

[DebtRising]

Here is a qutoe from Wallner's response to Shah's paper in 2012 "Our residency programs continue to experience an increase in the numbers of applicants and the quality of those applicants..."

He also made outrageous claims that due to social media, all first year medical students know the regional job opportunities and salaries of the field. That's pretty bold and patently false - most first years don't even know radiation oncology, and geographic restrictions were only highlighted through this message board - not my advisers, not my PD, not my classmates who went into RO. And this board is roundly derided by people like Wallner. I attached a screenshot of Wallner's response to Shah in 2012 preview - it is grainy, but it is also the free version anyone sees when they google it, meaning I am not posting any content that requires a subscription.

Wallner's degree is independent of pointing out his hypocrisy on this issue.

Kachnic's role in ending the re-certification exam is not well respected among junior faculty. Combining this with the grandfathering in of certain physicians based on year has only allowed older practitioners to stay ensconced in their position longer, with less oversight. Was it a clunky and anxiety producing idea to have a big exam every 10 years? Sure - but isn't that somewhat the point - to make sure current practitioners are uptodate and have to put some blood and tears in to prove it? It's another ASTRO move that only hurts young physicians in this field by effectively dis-incentivizing retirement, and I doubt anyone could argue the current system does a better job of keeping physicians up to date. But sure, mid-career and later career physicians love it.

I try not to post because I post about one thing only and it gets enough oxygen on this board. But both the original paper and the response are both hilarious and sociopathic. There are senior people in the field who almost comically want to hurt the next generation of physicians. Rather than pen an opinion piece about the need to increase brachytherapy training requirements and implementing site specific quotas for prostate versus gyn in training to ensure graduating physicians can treat one of the most common disease sites we see, rather than discussing at a leadership level why fellowships have exploded, rather than exploring why resident expansion continues to increase when Smith et al predicted an oversupply, and further if residency expansion in this setting is some sort of knowing misuse of medicare funds, we get examinations of board exams and trashing current entrants into the field.

It does work on one level though - it is more morally justifiable to the self to continue to crush the future rad onc's if you believe them to be inferior to yourself. Good show all around, top shelf field.

 

[radiaterMike]

DebtRising - I'll concede that that editorial by Wallner and Shrieve is more or less garbage and worthy of criticism.

I don't know how your sentiment of "this board is roundly derided by people like Wallner" would specifically apply to him as opposed to those individuals you describe (I don't know who they are).

I don't know of any junior faculty or private practitioners that feel like the recertification exam disappearing is a loss, but I guess we run in different circles. The requirements of CME, SA-CME and continuous examination are supposed to "make sure current practitioners are uptodate." Whether those requirements actually do that or simply generate $ flow is debatable (many editorials and blogs suggest the latter). The grandfathering was not an ABR decision but rather applies to all specialty boards as the MOC could not be retroactively required (i.e when those individuals passed the boards they were given a lifetime certificate).

 

[OTN]

I’ll have to read (or re-read) his response to the Shah article. But in reality the only thing the ABR can do to curtail supply and demand in radiation oncology is to fail more examinees - which is not a good idea. To his credit, he (along with Kachnic and Zietman and others) was instrumental in eliminating the recertification exam and the need for pointless PQI projects. Also, his certification is grandfathered yet he chooses to comply with MOC. Kachnic was somehow spared the same vitriol on this board (perhaps because there are few nicer people than her).

Given that residency training is government-funded, and government spending has a responsibility to be done “for the good of the people” as much as possible, I do believe that it would be legal and morally responsible for the ABR to restrict trainee spots based on supply and demand. Every radonc residency spot that is not needed is another internal medicine position that does need to be funded.

 

[nkmiami]

Given that residency training is government-funded, and government spending has a responsibility to be done “for the good of the people” as much as possible, I do believe that it would be legal and morally responsible for the ABR to restrict trainee spots based on supply and demand. Every radonc residency spot that is not needed is another internal medicine position that does need to be funded.

Also, excess supply of xrt docs drives overutilization- there is plenty of academic literature on this- which government pays for.

There should be a legal test case, maybe it could be crowdfunded.

 

[radiaterMike]

OTN - The ABR simply does not have that authority. The ABR certifies graduates of residency programs - that's it. As I said before, the only thing the ABR could really do is fail more examinees (after failing so many times one has to retrain for a year). I doubt any current trainees really want that.

The RRC/ACGME decides on new programs, whether or not exisiting programs are meeting requirements and (on a program to program basis) if expansion is allowed. One would think that they could do something, but their canned response is that they only make decisions based on program merit and not supply/demand. That leaves chairs/SCAROP and ASTRO. They apparently are not doing anything either. A lot of folks saying its not their problem to solve and thus no solutions. However, the ABR's deflection of responsibility is justified.

 

[OTN]

Good point re: the ABR. You’re probably right it’s probably not them. However, I don’t really care which acronym-based organization does something, but something does indeed need to be done.

 

[RickyScott]

Good point re: the ABR. You’re probably right it’s probably not them. However, I don’t really care which acronym-based organization does something, but something does indeed need to be done.

Many of the same clique who serve on the abr are in ASTRO leadership positions and chairs. As our society, ASTRO should really lead here, but for reasons discussed extensively elsewhere, the interests of ASTRO leadership are probably served by residency expansion, in contrast to most members; hence, the decision to ignore and propagate it, or give it token attention. Nothing will happen until members stop paying their dues. If you are disgusted by whatever bs theme they come up with for the next meeting: results based/quality/technology/compassion/safety/personalized stuff, new era of blah, rather than addressing real issues facing our specialty, consider not being a member. Just pay for meetings that you attend.

 

[medgator]

Many of the same clique who serve on the abr are in ASTRO leadership positions and chairs. As our society, ASTRO should really lead here, but for reasons discussed extensively elsewhere, the interests of ASTRO leadership are probably served by residency expansion, in contrast to most members; hence, the decision to ignore and propagate it, or give it token attention. Nothing will happen until members stop paying their dues. If you are disgusted by whatever bs theme they come up with for the next meeting: results based/quality/technology/compassion/safety/personalized stuff, new era of blah, rather than addressing real issues facing our specialty, consider not being a member. Just pay for meetings that you attend.

No different than ASTRO trying to throw freestanding centers under the bus for years, opposing things like site-neutral and/or bundled payments in the past....which is why many in PP moved over to ACRO

 

[scarbrtj]

And quite embarrassing to the field at the same time.

I fear our poor 'ol specialty is losing its ability to be embarrassed.

 

[OTN]

Many of the same clique who serve on the abr are in ASTRO leadership positions and chairs. As our society, ASTRO should really lead here, but for reasons discussed extensively elsewhere, the interests of ASTRO leadership are probably served by residency expansion, in contrast to most members; hence, the decision to ignore and propagate it, or give it token attention. Nothing will happen until members stop paying their dues. If you are disgusted by whatever bs theme they come up with for the next meeting: results based/quality/technology/compassion/safety/personalized stuff, new era of blah, rather than addressing real issues facing our specialty, consider not being a member. Just pay for meetings that you attend.

I let my ASTRO membership lapse this past year for that very reason.

 

[thecarbonionangle]

Anybody MD/DO who particiated in the well coordinated hit job of Dr. Shah (thankfully now back in academics) deserves every comment scrutinizing them, especially in the context of making another disingeneous argument in regards to an article challenging the status quo.

Our “leaders” do not have our backs. The baby boomers are the worst generation ever.

 

[medgator]

Anybody MD/DO who particiated in the well coordinated hit job of Dr. Shah (thankfully now back in academics) deserves every comment scrutinizing them, especially in the context of making another disingeneous argument in regards to an article challenging the status quo.

Our “leaders” do not have our backs. The baby boomers are the worst generation ever.

It's our fault. We spend too much on avocado toast

 

[thecarbonionangle]

The solace of avocado toast makes the thought of my future in salina kansas more palatable. i may not be able to pick between regions of indian or chinese food, find a professional spouse but at least I will have good avocado. I hope Trump doesnt ruin that one for me, tho

 

[DrfluffyMD]

The solace of avocado toast makes the thought of my future in salina kansas more palatable. i may not be able to pick between regions of indian or chinese food, find a professional spouse but at least I will have good avocado. I hope Trump doesnt ruin that one for me, tho

You may not find a professional spouse but some of those farmer’s daughter type of women are cute.

 

[scarbrtj]

People then decided it was a good idea to deride Wallner (who donates his time to the ABR)

According to ABR tax filings Wallner gets ~270K a year from the ABR. Not exactly "donation." I'm sure he serves there well and deserves it. Just saying.

 

[radiaterMike]

According to ABR tax filings Wallner gets ~270K a year from the ABR. Not exactly "donation." I'm sure he serves there well and deserves it. Just saying.

Thanks. I misinterpreted Chartreuse Wombat’s comment on other thread that board members don’t get paid. I guess “Executive Staff” do. It looks like the executive director gets about 700k

 

[medgator]

Thanks. I misinterpreted Chartreuse Wombat’s comment on other thread that board members don’t get paid. I guess “Executive Staff” do. It looks like the executive director gets about 700k

Certainly much higher than median radiology or rad onc salary in this country...probably 90th percentile from the most recent MGMA I would imagine.

Par for the course for executives in healthcare

 

[Irradi8or]

According to ABR tax filings Wallner gets ~270K a year from the ABR. Not exactly "donation." I'm sure he serves there well and deserves it. Just saying.

Where did you guys find the ABR tax filing?

 

[laserbeams]

On the topic of filings: ASTRO 501c3 filing (via Pro Publica -- if the link doesn't work, try going here first).

ASTRO CEO makes ~$700k compensation, accounting for a large portion of the compensation for "current officers, directors, trustees, and key employees. Not reported is the itemized list for "Other salaries and wages" totally $5.55M (Part IX, column A, page 10).

For context, the annual meeting generates about $10M.

 

[radiaterMike]

Irradi8or- non for profits file an IRS form 990 which you can google. This will list the salaries of those employees who are the highest earners and those who have executive roles. It is usually not available until after a few years. The CEOs of many non for profits make startlingly high salaries though perhaps this reflects competitive salaries (ie relative to what those people could feasibly make in a for profit industry). If ASTRO’s positions and actions don’t sit well with you there is the option of not paying dues (as many in this site have advocated)- just as you have the option of not buying a product of a company. There really isn’t a similar option with the ABR unless you are in a practice where the hospital and insurers don’t require board certification and that circumstance won’t change.

 

[seper]

I guess that's what it is all about. A senior guy, being vigilant to protect his income.

 

[MDACCRules]

Now, the commentary has been removed as well.

 

[seper]

All these academics have got to increase their patient load. Evidently, too much time to write meaningless papers.

 

[radiaterMike]

FWIW - the Wallner et al. paper and editorial by Amdur and Lee are still not available- but an editorial (on the editorial) just popped up

https://www.practicalradonc.org/article/S1879-8500(18)30143-7/fulltext

 

[Chartreuse Wombat]

FWIW - the Wallner et al. paper and editorial by Amdur and Lee are still not available- but an editorial (on the editorial) just popped up

https://www.practicalradonc.org/article/S1879-8500(18)30143-7/fulltext

All relevant articles are available at the link below

https://www.practicalradonc.org/inpress

 

[beamseyeview]

Posted on the PRO homepage alongside the articles (Lee et al and Wallner et al still not available the last time I checked, Vapiwala's editorial is available).

Editor’s Note
The commentary by Amdur and Lee was originally accepted and responses from three stakeholders (ABR, Program Directors and ARRO) were invited. ARRO declined to provide a response. I intended for the original and the responses to be made available simultaneously. This did not happen as intended; an administrative error for which I take full responsibility. The original commentary and two responses are now available. None of the responses have been edited since original acceptance.

—W. Robert Lee, MD, MEd, Editor-in-Chief

 

[MDACCRules]

Declined to make a response?? Wow.

 

[medgator]

Declined to make a response?? Wow.

What would they say that would be worth publishing and not ruffle feathers?

 

[MDACCRules]

What would they say that would be worth publishing and not ruffle feathers?

Yah.. makes sense. Rad onc residents/physicians are not really interested in sticking up for themselves I guess. Guess there really is a downward trajectory in the quality of residents.

 

[evilbooyaa]

More like the people of ARRO don't want to get blackballed from every job in the country for daring to disagree.

 

[Gfunk6]

Yah.. makes sense. Rad onc residents/physicians are not really interested in sticking up for themselves I guess. Guess there really is a downward trajectory in the quality of residents.

Don’t know if this is sarcastic or not.

If not, keep in mind that residents are indentured servants. They are subject to the whim of their PD and Chair, either of whom could ruin their lives if they so pleased.

Thus, it is no wonder that residents put their heads down and take (temporary) abuse to avoid the possibility of derailment of their career.

Having been involved in ACGME investigations, there is no anonymity despite promises to the contrary. Also, there are ways to make unfavored residents “radioactive” without overtly hurting them.


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