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ASTRO Blog

ASTRO Blog

The Future of our Field

By Thomas Eichler, MD, FASTRO, ASTRO Chair

After more than a decade of enjoying the prestige of being one of the most highly sought-after specialties in the medical student match process, there have been troubling signs in the past few years that something was amiss. In 2019, the number of medical students who initially matched into radiation oncology declined with multiple slots unfilled. At the time, there was speculation about whether this was an anomaly or the beginning of a trend that had been forecast years before. In 2020, the field saw a larger decline in the number of medical students who matched, coupled with an increase in the number of people who then entered the field through the Supplemental Offer and Acceptance Program (SOAP) process. In fact, radiation oncology had the highest percentage of spots filled through the SOAP of any medical specialty.

From a treatment perspective, many factors, including the decreased use of radiation for some disease sites and an increased use of hypofractionation, bring into question the long-term viability of our specialty. Despite the many positive aspects of radiation oncology, there are growing concerns about the future of the workforce. There has been an increase in the number of available trainee positions despite the apparent decline in medical student interest and concern regarding patient volume projections. These issues contribute to forecasts of declining income streams and anxieties about the future given the recently proposed ― and now delayed ―  radiation oncology alternative payment model. The worrisome trend in the SOAP percentages for radiation oncology underscores some of these negative perceptions about the field among students and residency applicants, which are in turn amplified on social media platforms. Not surprisingly, many students are confused about what career path to choose and may be discouraged to pursue radiation oncology before they even truly explore it.

ASTRO leaders have sought to be forthright with our members about challenges in the field (see previous blog posts below) and ASTRO’s role in addressing them. While there are strict anti-trust principles ASTRO must abide by, the Board of Directors felt compelled to issue a definitive statement so that there is no ambiguity about our position.

ASTRO Position Statement on the U.S. Radiation Oncology Workforce

  • Radiation oncology has long been a critical component of multidisciplinary cancer management, driven by clinical and scientific innovation. Recent advances in technology and our understanding of cancer biology have allowed radiation oncologists to offer more accurate and effective therapies, often in fewer total treatments than before, resulting in improved patient care. ASTRO has observed growth in residency training positions over the past two decades. With more efficient treatment delivery, fewer radiation oncologists may be needed in the coming years. Residency training positions should be reserved for those who are enthusiastic about the field and should reflect the anticipated societal need for radiation therapy services. As we prepare the next generation of radiation oncologists for independent practice, we encourage stakeholders to carefully consider these aspects affecting our specialty as they review the size and scope of their training programs.
     
    Additionally, ASTRO acknowledges the continued need to grow and nurture diversity within the next generation of our workforce. We serve diverse peoples, and our trainees and faculty should reflect that diversity. We are committed to addressing all aspects of bias as we seek to ensure equity and inclusion within our specialty and to improve health outcomes for all our patients.


While we acknowledge that this statement will not magically solve the issues impacting the field, we do want to be clear with our current and future members about ASTRO’s stance on this critical issue. We also strive to keep the lines of communication open with all members, including our residents. We listen to and appreciate the insights and perspectives from Association of Residents in Radiation Oncology (ARRO) to better understand their perceptions and experiences. Results from a survey of the class of 2020 found that residents had an average of five job interviews, received at least two job offers and, perhaps most significantly, 89% of residents were satisfied with the offers they received. While there are some vocal naysayers on social media, the direct response from residents gives us confidence and hope about the current realities in the field.

Radiation oncology has always sought the best and the brightest minds for our field because we know it is a truly rewarding area of cancer treatment. That will not change. We have deeply meaningful interactions with our patients, curing many of their cancers, alleviating suffering and extending life. Technology continues to play a large role in the field with novel and groundbreaking synergies between radiation and systemic agents, including immunotherapeutics, and many contemporary research questions are emerging, ripe for exploration and clinical trials. The field is also expanding due to innovations in radiopharmaceuticals and theranostics, offering radiation oncologists exciting new ways in which to help patients. While the future is unpredictable, we unequivocally believe in the continued impact and relevance of our specialty going forward, and perhaps more importantly, have unshakeable faith in the dedicated professionals who have made radiation oncology fundamental in the fight against cancer.

Read previous posts:

A Commitment to the Field  - Dr. Theodore DeWeese, March 10, 2020
The Residency Training Landscape, Continued - Dr. Paul Harari, May 28, 2019
The Residency Training Landscape - Dr. Paul Harari, March 20, 2019

Posted: January 5, 2021 | 4 comments


Register now ― the early-bird deadline is extended! ― and show your commitment to radiation oncology

Why the ASTRO Annual Meeting is more important, now, than ever

by Theodore DeWeese, MD, FASTRO, ASTRO Chair

ASTRO’s 2020 Annual Meeting theme, “Global Oncology: Radiation Therapy in a Changing World,” was chosen in mid-2019. Who could have imagined just how prescient the topic would be and how much the world would change since then?

This will be my 27th ASTRO Annual Meeting, and I am looking forward to it as much as I did, if not more, than my first year attending the meeting as a resident. I am especially enthusiastic about the immersive educational experiences the ASTRO staff and your professional colleagues have planned for you.

Last year in my Welcome Address article to our Chicago attendees, I wrote: “We all strive to transform science and improve care for patients on a daily basis, and the ability for our specialty to lead in these domains has never been greater. But, if we are to be highly successful, we cannot do these things in isolation.”

What a difference a year makes.

Who could have known that much of the world would be in isolation for a large portion of 2020? Yet, we have seen how reactive and responsive our field has been in this unprecedented time, which allowed us to quickly reengineer how we transform science and care for our patients. And our specialty’s ability to focus on patient health has truly never been greater, as we have seen through your unselfish and dedicated work caring for, and continuing treatment of, your patients during this public health emergency.

I went on to write that “working closely with our colleagues is important.” I would argue that this year it’s more important than ever. This year’s Annual Meeting will provide you with the opportunity to work closely, albeit virtually, with your colleagues from around the globe on the latest scientific advances.  We already know that COVID-19 will have a long-term impact on cancer care for years to come, so the chance to learn from your peers in the global oncology community is especially important.

I also want to acknowledge and respond to all who have expressed your feelings about our pricing structure, both for members and residents. As Laura Thevenot shared in her blog post, the financial implications to a relatively small specialty association have been significant. Canceling the Miami meeting incurred tremendous costs. Our Annual Meeting is a primary revenue source for ASTRO and because we had to cancel the in-person meeting due to COVID-19 and the need to keep our communities safe, the organization absorbed the many monetary damages associated with canceling a city-wide annual meeting. The Board had to take extraordinary fiscal action inside ASTRO to keep our activities and member support services going. We know the Annual Meeting is the key educational activity of the year for many of our members and, thus, we as a Board decided to go “all in” on the best learning platform possible in order to keep our members engaged and educated and provide an experience that members would be willing to support. We also spoke with numerous department chairs and leaders about their support for their residents. Overwhelmingly, they noted that the savings from airfare, hotels and meals would allow them to support their resident’s attendance at our meeting. And to-date, we have seen strong registrations for our members-in-training. To ensure that as many as possible can attend, we are freezing the member-in-training and student rates at the early-bird level for the duration of the registration period. We also know that many people are still assessing their expenses for the year, so we are also extending our early-bird deadline for all attendees until September 8 to give you more time to secure your annual meeting attendance at the lowest rate.

Why register early?

  1. The meeting, customized for our specialty’s unique needs, includes all the educational and scientific programming you are accustomed to.
  2. In recognition of the financial impact our meeting cancellation will have on the Miami Beach area, ASTRO will donate a portion of all early-bird registration fees to two Florida cancer patient support organizations. We are happy to announce that the recipients are Caring Friends Cancer Support Group and Gilda's Club South Florida and we are pleased to show our support for their important work during this challenging time.
  3. All early-bird registrations will be recognized on our Patient Support Honor Roll, which will be unveiled during the Annual Meeting.

I am particularly excited about the internationally renowned Keynote speakers who will deliver remarks on timely topics including global health, COVID-19 and racial justice and equality. We are working on the final details of their presentations and will announce their names and the schedule soon. We also will have Storytelling, a new session that encourages you to share your experiences and interact with other attendees. The virtual poster hall offers a new feature ― author narration ― just one of this year’s virtual platform innovations designed to inspire and encourage you.

Not being able to meet in person is a disappointment, I concede. However, participating in this year’s ASTRO Annual Meeting offers you many opportunities that would not be possible in person, most notably that the content will be available to all registered attendees until November 30 to ensure access to all the presentations and materials. This year there are just as many ― if not more ― competing sessions, but you won’t have to miss any of them in this online format. There are more than 200 hours of CME credit opportunities — something that has never been possible before during a four-day meeting. We are also able to offer CAMPEP and ASRT credits. Additional new features include Master Classes on topics that include leadership, radiopharmaceuticals and the integration of medical marijuana into radiation oncology practice, and we are also bringing you more Cancer Breakthroughs sessions to showcase the top science from meetings that were postponed or held virtually, including ASCO, ESTRO and AAPM. The Cancer Breakthroughs session was added last year and was one of our highest evaluated sessions.

I truly am excited about the 2020 Annual Meeting and hope you are too. We know the importance that this meeting and the content presented provide in continuing your education and providing the latest science from the field. I invite you to check out the Meeting Highlights on the website and register now. We want you to take advantage of the best rates possible, so we’ve extended the early-bird registration through September 8 at 11:59 p.m. Eastern time. Your participation is important to creating a collaborative experience and I look forward to “seeing” you at the meeting.

Posted: August 18, 2020 | 0 comments


A Commitment to the Field

By Theodore DeWeese, MD, FASTRO, ASTRO Board Chair

Next week, the National Resident Matching Program® kicks off Match Week, which will culminate with Match Day on March 20. This is an important and exciting day for both students and training programs and represents the first glimpse at the future leaders of our field. We are fortunate to recruit outstanding resident physicians to our field, a group who values the key role radiation oncology plays in the care of patients and who can pursue the future of research in oncology. We anticipate that like last year, there will be an imbalance between the number of programs offering positions and the number of students who match into the radiation oncology specialty. Radiation oncology was not the only specialty to experience a market correction last year, and there are numerous factors that contributed to the expected gap this year. We also recognize that over the last decade there has been a gradual but steady expansion in residency programs and positions, and it is unlikely for this imbalance to be corrected in just a year or two. While outside factors such as board certification exams, program-level training issues and institutional hiring practices are beyond ASTRO’s direct control, there are a number of things that we as a membership society did in the past year to address some of the field’s challenges, and I want to share some of what has been done to-date.

Exams and Training

As a normal course of business, the ASTRO Board regularly discusses the future of the field with an eye toward new treatment options such as theranostics to expand the role of radiation oncologists as leaders in oncology care. With this and other opportunities in mind, ASTRO submitted comments to the ACGME last spring to help shape future training requirements for residents. As the field continues to mature, so too the ACGME Radiation Oncology Program Requirements should evolve. The ASTRO Board also publicly supported the proposal that the ABR make the radiation oncology examination blueprint accessible on its website, including topics and the percentage of the examination dedicated to a topic. We understand the ABR has agreed to develop these blueprints, and this transparency will provide important guidance for trainees, allowing them to focus their studying efforts.

To address resident training and education, ADROP, the Association for Directors of Radiation Oncology Programs, created an information exchange network. This allows programs to share resources, including curricula, with radiation oncology residency program directors, assistant program directors and associate program directors. In addition, leaders of the Society of Chairs of Academic Radiation Oncology Programs (SCAROP) discuss resident issues during their monthly leadership calls and at their Annual Meeting, keeping the topic and the well-being of the field top of mind.

And we continue to listen. During ASTRO19, the ASTRO Board invited the ARRO Chair to share trainee perspectives on priority issues including the board examination processes. The Board also met with leaders from the ABR and ADROP to talk more about resident physician training. We also wanted to hear from recent residents who matched into the specialty about their experiences. I am heartened by residents like Amishi Bajaj, MD, who matched into radiation oncology in 2018 at the McGaw Medical Center of Northwestern University. As she noted, “I matched at my dream program in my dream institution. I absolutely love my department and my institution, and I am endlessly inspired by my attendings and coresidents, who are not only brilliant physicians but also wonderfully kind people.”

New Research

As a way to support the next generation of researchers and to improve outcomes and quality of life for cancer patients, ASTRO created two new Research Training Fellowships with industry partners AstraZeneca and Varian. The Fellowships are designed to advance the field of radiation oncology by providing new research opportunities in an industry setting. The program will allow each Fellow to gain experience in medical affairs, clinical research and research/development from an industry perspective. We received many high-quality submissions and nominations, and we will be making the announcement about the two Fellow recipients in the weeks to come.

Commitment to Diversity and Inclusion

In an effort to introduce radiation oncology to students from historically underrepresented groups, ASTRO led an effort to connect with Chicago-area high school and college students and invited budding scientists to come to ASTRO19. The students met a range of ASTRO members, including radiation oncologists, residents and medical physicists. The students were also given a tour of the Exhibit Hall where they met leaders from a variety of companies to learn more about the latest medical advances. Because most medical schools do not require a rotation through radiation oncology, it is our hope that introducing young women and men from underrepresented minority groups to our field at this formative stage of their education will inform their future career decisions.

Addressing Patient Needs

We have heard concern about the job market and the timing of job offers for those completing residency, and we understand that many residents seek to work in academic settings. In fact, a recent Red Journal article, “Top Concerns of Radiation Oncology Trainees in 2019: Job Market, Board Examinations and Residency Expansion,” by Kahn, et al noted that “graduates strongly prefer jobs that are located in large cities (population >500,000) and that specific geographic regions, such as the Midwest, are considered to be less desirable.” Those preferences are certainly consistent with previous resident graduates. Interestingly, and importantly from a job search perspective, an analysis done for the ASTRO Rural Task Force revealed that 15% of Americans live in a non-metro area with only 6% of radiation oncologists practicing in these non-metro areas. Such information is not widely known and may help future residents consider these opportunities. Working in non-metro and smaller community settings can have tangible and direct impact where there is high patient need for quality oncologic care.

Volunteering Makes the Field Stronger

We want our field to grow in a healthy way, and the best way to change the course of the field or ASTRO as a membership society is for you to get involved. By serving as a volunteer on a committee or task force, your voice and perspective have more impact and weight.

One thing we continue to hear is that many medical students aren’t introduced to the specialty or have minimal exposure to what radiation oncology entails. As Mudit Chowdhary, MD, chief resident at Rush University Medical Center noted, “In hindsight, I realize how lucky I was to have learned about radiation oncology. Like many, I had never heard of this field even after two years of medical school. During this time, my future brother-in-law matched into a radiation oncology residency program and encouraged me to learn more about the specialty.” Another thing you can do without joining a formal committee is take the opportunity to educate your peer physicians or the medical students you encounter. The volunteers in ASTRO’s Communications Committee recently released updated slide decks that all ASTRO members can access to introduce or educate your colleagues and patients about the latest advances in radiation therapy. There is one RT overview presentation for the general public and two presentations for medical professionals: a general overview and the first in a series of disease-site specific trainings, this one focused on lung cancer treatments.

Amishi noted in her essay: “To the medical students out there who similarly identify as lovers of medicine in all its forms: Don’t forget to consider radiation oncology. You really can have it all.” As we look ahead to the Match results to come, we remain thankful to all those who are currently practicing and training in radiation oncology, and for the commitment of medical students seeking to help cancer patients by joining the radiation oncology field. ASTRO will continue to be an advocate for the field and do its best to influence how the scope of the specialty continues to evolve.

 

Read previous posts:

The Residency Training Landscape (posted March 20, 2019)
The Residency Training Landscape, continued (posted May 28, 2019)
Posted: March 10, 2020 | 0 comments


At NRC, Advocating for Radiation Oncologist Leadership in Radiopharms

By Theodore DeWeese, MD, FASTRO, ASTRO Board Chair

On Wednesday, November 20, I met with Nuclear Regulatory Commission (NRC) Chairman Kristine Svinicki and commissioners Jeff Baran and Annie Caputo, as well as with NRC staff, to preserve strong training and experience (T&E) requirements for radiopharmaceuticals.

Over the past several years, in response to external pressure, the NRC staff has been reviewing the current requirements found in 10 CFR § 35.300 and 10 CFR § 35.390 to determine whether changes should be made. Part of this review has included outreach to stakeholders, including ASTRO, for their opinion and analysis of possible changes. As ASTRO chair, one of my priorities is to ensure that radiation oncologists play a leading role in the administration of radiopharmaceuticals. Fending off potential ill-advised changes to training and experience requirements will help achieve that goal.

Current regulations require that an authorized user (AU) be either board certified or complete 700 hours of training. The relevant sections of the regulations can be found here: Training for the use of unsealed byproduct material for which a written directive is required and Training for the parenteral administration of unsealed byproduct material requiring a written directive.

On the surface, reviewing current requirements to ensure their relevance is important and necessary. However, we are concerned that this review could initiate rulemaking to loosen the current 700-hour requirement – something that ASTRO, and partner organizations, oppose because the current requirements are appropriate, protect the safety of patients, the public, and practitioners, and should not be changed.

The NRC staff has concluded its review and is preparing a report to the commissioners. This report will outline policy options, as well as a recommendation for commission action. A version of the report was made public in October, so we were able to see the options the staff laid out; however, it did not include the staff’s final recommendation.

In the draft paper, the staff outlines two different approaches, each with several options, as follows:

Approach 1: Revise the T&E regulatory framework to remove prescriptive requirements, and the NRC and Agreement States would no longer review and approve T&E for AUs.

  • Option 1a: Specialty Board Credentialing– Physicians must be certified by any medical specialty board.
  • Option 1b: Licensee Credentialing– Licensees develop their own policies and procedures for credentialing their physicians.
  • Option 1c: NRC-recognized Specialty Board Credentialing – Physicians must be certified by a medical specialty board that has been recognized by the NRC as meeting high-level board certification criteria.
 

Approach 2: Maintain or enhance the existing T&E regulatory framework.

  • Option 2a: Status Quo– No changes.
  • Option 2b: Tailored Requirements– T&E would be tailored and reduced for use of individual or categories of radiopharmaceuticals.
  • Option 2c: Emerging Radiopharmaceuticals– Individual reviews of each emerging radiopharmaceutical to determine drug specific T&E and other requirements.
  • Option 2d: Team-based Requirements– T&E would be reduced based on pairing AUs with other individuals with radiation safety training.
 

The staff paper also states: “The NRC regulates medical uses of byproduct material to ensure the safety of workers and the general public, and while patient access concerns were considered by the staff, the NRC cannot regulate T&E with a primary goal of increasing patient access to radiopharmaceuticals or improving geographic distribution of AUs.”

In response, the NRC’s Advisory Committee on the Medical Use of Isotopes (ACMUI), made the following ASTRO-supported recommendations:

  1. The Subcommittee recommends maintaining the status quo under 10 CFR § 35.390. While strongly affirming the structural superiority of the status quo over the other options proposed in the draft paper, we acknowledge there is room for a comprehensive review of the specific requirements in § 35.390 such as the seemingly arbitrary requirement of 700 hours. The Subcommittee (and likely, ACMUI) would welcome the opportunity to critically assess these details.
  2. If the NRC proceeds to grant AU status by NRC-recognized specialty boards, the T&E should be equivalent to § 35.390.
  3. The Subcommittee recognizes the value of an alternate pathway and is willing to review and evaluate the requisite knowledge, preceptor-reviewed experience and competency assessments.
 

ASTRO and I believe maintaining the status quo (Option 2a) for training and experience for radiopharmaceuticals is appropriate, protects the safety of patients, the public, and practitioners, and should not be changed. The NRC’s focus on patient safety and the safety of the general public as it develops training and experience requirements is appropriate. The classroom and clinical experiences encompassed by radiation oncology and nuclear medicine training programs provide appropriate levels of knowledge and skill for any current and future radioactive agents.

Reporting data also supports maintaining the status quo. While non-expert AUs would introduce significant radiation risks, radiopharmaceuticals — when administered under the supervision of comprehensively trained and experienced AUs — have an exemplary safety record, and the current regulations ensure that safety. In both 2017 and 2018, there was one event reported to the NRC using Ra-223. Between January 2014 and May 2019, only 16 out of 9,848 total events entered into RO-ILS: Radiation Oncology Incident Learning System® were related to radiopharmaceuticals. As indicated in the self-reported data, none of these events have been reported to either the NRC or an Agreement State.

Weakening AU T&E requirements would not create an influx of new licensed health care facilities providing these therapies in remote geographical areas. Rather, there are other considerations guiding facilities’ decisions, such as:

  • availability/preference for alternative therapies,
  • the high cost of these drugs,
  • complexity of the patient cases, and
  • financial and staff resources required (radiation safety officer services, technologists/therapists with appropriate licensure, license fees, etc.). 
 

I was very pleased with the meetings, and I came away hopeful that ultimately the NRC will keep the status quo and will not initiate new rulemaking to lessen the current T&E requirements.  ASTRO will keep up the pressure and continue reporting on developments.

ASTRO is interested in receiving your feedback regarding the T&E requirements for radiopharmaceuticals. Use the comments below to share your thoughts.

 

Posted: January 3, 2020 | 0 comments


The Residency Training Landscape, Continued

By Paul Harari, MD, FASTRO, ASTRO Board Chair

In the seven years that I have served on the ASTRO Board in various capacities, our leadership has heard from key stakeholders and discussed and debated many important issues. We’ve discussed the future of brachytherapy and the emerging promise of theranostics and artificial intelligence along with the variability of radiation and cancer biology faculty and the need for common curriculum across residency training programs.

Given the attention this year to residency and training issues, I want to continue the discussion about matters that impact our field. Earlier this year we learned that the ACGME residency training requirements would be updated and that part of the deliberation process included public comments. Given the impact that ACGME rules have within our departments and practices, ASTRO did provide comments on a range of topics.

While we think that by and large the current radiation oncology training requirements are good, we feel there are areas that could be adjusted. Knowing that any changes in ACGME’s residency requirements will impact future residents and the field, I want to give some context to ASTRO’s position on ACGME’s proposed changes to the radiation oncology residency program requirements.

Does Program Size Matter?

ASTRO appreciates the difficulty of identifying the right mix between faculty and residents, particularly when some programs are quite large and others small. The three factors that impact this balance are minimum number of faculty, minimum number of residents, and the faculty-to-resident ratio. We recognize that numeric rules do not guarantee success when it comes to education and training, and that minimum requirements are simply an attempt to strike the best balance.

At one point in time, ASTRO thought the idea of increasing both the minimum number of faculty and the minimum number of residents might be a worthy approach. But after further analysis and discussion, we concluded that there is insufficient data at this time to support an increase in the minimum number of residents. If ACGME elects to share anonymized data about key factors such as ABR pass/fail rates or case logs with information about program size, that may shed further light on the question of whether program size matters. In the absence of such clear data, ASTRO believes four residents is an acceptable minimum.

We do have concerns, however, about the current faculty to resident ratio. We fully support that both the cancer biologist (or radiobiologist) and the medical physicist be considered core faculty. We think that given the increasing complexity of multidisciplinary cancer care, at least four different clinical faculty are needed to provide guidance and knowledge transfer for residents to develop the depth of understanding required for practice. Thus, we recommend that the faculty:resident ratio be increased from 0.67:1 to 1:1 and that it be further clarified that this ratio applies to clinical physician faculty. We think that this size-agnostic metric would help improve quality across all programs.

Resident Experiences

As I stated in my March blog post, ASTRO has an eye toward the future health and growth of the specialty. From this perspective, we are supportive of many of the proposals to update residency program’s case minimums and curriculum.

  • ASTRO supports the proposal to require disease-specific clinical rotations. As multidisciplinary, multimodality treatments and increased sophistication of radiation delivery continue to expand and define the standard of care for many cancer patients, we believe this training is imperative.
  • As we look to the future, we anticipate the need for radiation oncologists to be prepared to manage patients who are receiving theranostics and other radiopharmaceuticals. The ongoing use of Xofigo®, the recent approval of Lutethera® and the imminent approval of a PSMA-targeted radioligand and other novel radiolabeled agents in the pipeline lead us to believe that the current requirements are likely insufficient. We are supportive of this update to increase the minimum number of cases.
  • We have significant concerns about the levels of brachytherapy training, particularly in light of recent reports showing underutilization of brachytherapy for patients with cervical cancer and an associated decline in cure rates. We are concerned that the current intracavitary requirements could be met with vaginal cylinders only and without exposure to tandem-based insertions for cervix or endometrial cancer. We wholeheartedly support this proposed change.
  • We agree with the update for resident scholarly activity to require that the results of investigative projects be submitted for publication. We are hopeful that if residents must submit a manuscript during their residency training, faculty at the institution will provide mentorship guidance to help further residents’ scholarly skills.

 

While ASTRO heard concerns about many of these topics, we had not heard concerns that the current resident training requirements are insufficient for external beam cases. After discussion, ASTRO leadership agreed that the focus in the current requirements related to a maximum of 250 treated patients per year is an appropriate upper limit. We have several concerns with changing the definition of the upper limit to 350 simulations per year. First, this could be ambiguous (e.g., is this initial simulation only or does it include adaptive simulation or verification simulation or boost simulation or even simple/block check simulation)? Second, we are concerned that more than 250 initial simulations (i.e., more than 250 treated patients as per the current definition) will not afford residents ample time to read and learn from each simulated case. In many academic practices, full-time attending physician workload does not exceed 250 initial simulations per year, and thus we think this is a reasonable benchmark for the upper limit of patients treated by a resident.

Looking Towards the Future

Radiation oncology has attracted many hundreds of truly outstanding residents to the field over the last several decades. Despite the most recent match challenges, I strongly believe that the discipline remains vibrant, dynamic, intellectually and emotionally rewarding, and a wonderful blend of cancer biology, technology and compassionate cancer care for cure and/or palliation. The more we engage the voice of our trainees and early career practitioners in the dialogue, the stronger our field can become for future generations of providers and cancer patients.

Posted: May 28, 2019 | 1 comments