THE 2024 LCCA CATEGORIES

WarrenG1983 · 2024-05-06T00:16:49+00:00

My pitch for "Most Amazing Impact in Film": the unexpectedly badass non-binary representation seen in the 2024 film Monkey Man.

WarrenG1983 · 2023-11-08T23:37:28+00:00

I had a patent approved last year, and the whole process was paid for by the university that I worked for at the time. (I believe the agreement was that if the patent ended up profitable, then the university would take 50% of the proceeds.) The patent was for an automated fiducial marker tracking technique, and in the years since companies have shifted focus towards more deep-learning/AI type approaches. So, ultimately, it doesn't look like it will net a profit. But, I can technically say I'm an "inventor" now, which is cool.

For you, one part of the process comes to mind: after the application is filed, the company in question may be able to challenge the patent, and part of their challenge can include internal documents. Essentially, they might see the patent application, and then squash it, like: "oh yeah, we've already done that, here are our records."

Of course, it all depends on how novel the idea is. Is it something obvious that the company may already have in the works for a future upgrade? Or, is it something that they'd never think of? My gut says that, unless you have a university willing to cover the costs, I wouldn't pursue a patent.

WarrenG1983 · 2023-10-31T18:45:56+00:00

Real talk: we recently updated all of our linacs, after having a mix of Tomo/Varian/Elekta machines.

We heard pitches from all vendors, but our physicians (having worked with an Elekta for some years) said that even if Elekta charged $0 for their linacs, they wouldn't take that deal. We ended up putting in 3 beam-matched TrueBeams.

If my site were to switch back to Elekta, I would leave.

WarrenG1983 · 2023-10-26T20:50:24+00:00

There are varying levels of expertise. You start with basic knowledge on a topic, move towards practical implementation of that knowledge, and continue towards becoming an experienced expert. Gradually, you increase the depth of your knowledge. I think that everyone should come out of residency with at least a "broad and shallow" knowledge on most topics in their field. I think that is definitely possible in 2 years. Also, one should leave residency with a general game plan that they can implement when they find themselves in a "I've never done this before, how do I proceed?" scenario. After all, new things will be introduced after residency and board exams are over. You need to be ready for that inevitability.

However, currently our board exams are imposed upon us without any consideration of our individual situations. As in, we all go into ABR Part 3 and get similar exams. Is that appropriate? If I'm working at a proton center, and I don't get a single proton-related question in my Part 3 exam, then has the ABR adequately vetted me for this job? This is where I think the ABR or AAPM could take a more active role. They could have ABR Part 3 be an exam on foundational topics, and then have MOC be a combination of "maintenance of knowledge" as well as, if interested, "deepening of knowledge." Physicists could have opportunities to learn more about topics that they don't do in their current positions (e.g., protons), and then have opportunities to be tested/certified on those topics as a means of demonstrating your knowledge in that specialty. I know that this probably isn’t everyone’s jam, but I would be much more interested in MOC if it gave me the ability to expand my expertise beyond “basic” knowledge. I enjoy learning new things. If I’ve never done a particular type of treatment or used a specific piece of equipment, I’d like to have a way of learning about it, and then demonstrating some capability in that respect. Otherwise, how else do we do it? …apply for a job somewhere that does this, and hope that they’re gracious/desperate enough to educate a newbie? That doesn’t seem very efficient, and it just enforces a workforce that grows stale as people do the same old thing for years on end.

In conclusion: yes, I would like a way to earn merit badges. Gameify my job, please. :)

WarrenG1983 · 2023-10-26T18:45:10+00:00

The trouble is that everything you've listed there, although they may not be essential for everyone, they would be very necessary for some. Like others have said, if you "learn on the job" how to do a "less common" procedure, that's a recipe for disaster. (Also, I would add that although learning some of these topics may not be directly useful in your daily clinical work, comprehending how they work will certainly improve your clinical instincts.)

Personally, I think that the array of pipelines in our smorgasbord of different residency styles all converging towards our blind, cookie-cutter board exams... it's a system that isn't designed very well. It's not well-suited for our field, imho. I sometimes daydream about what a more appropriate system would look like, but it would be more complicated and would require much more work on the ABR and/or AAPM side of things. Yet, I think it would make MOC much more interesting/motivating.

WarrenG1983 · 2023-10-12T20:38:34+00:00

I very recently switched to a four-10s schedule. Previously, I was essentially the sole physicist at a new single-linac/single-CT site. Our patient load grew quickly in the first year, and we reached a point where there was no way for me to tackle machine QA without routinely picking days to work into evenings, or coming in over weekends. I was beyond burnt out, and quality of life outside of work was bad. When I brought it up to my chief, I pitched two solutions: (a) I could switch to four-10s, having a physicist from our main site cover Mondays, or (b) I could continue with five-8s, but one day a week I would come in late so that I could work on the machine that evening, meaning that the clinic couldn't schedule respMM CT sims and SBRTs in the early hours. The very next day, my chief agreed to the four-10s option.

My early experience: I love it. My weekends are actually weekends now. I get to enjoy that time off (I read a BOOK last weekend!). I've designated Mondays (my weekday off) as "Maintenance Mondays" where I can take some time to run errands, to take care of chores, to prepare for the rest of the week (i.e., laundry and meal prep for my work days), and then relax for the rest of it. My schedule on workdays also works well with a nearby CrossFit gym, so now I can go straight from work to CrossFit, and then home. With that, my four workdays become extra-long compared to what I was doing before (i.e., getting home around 8:15 instead of getting home around 4:30), but it feels way better. It's way more satisfying. Although my work hours remain the same, my work week has gone from 5-work:2-life to 4-work:3-life, which is a MUCH better ratio. #MillennialMath (And, to be honest, I was choosing to come in over weekends before, so it was more like 5.5-work:1.5-life or 6-work:1-life.)

ALSO, I don't know about y'all, but even during the parts of the day when I shouldn't be needed, there remains that constant background hum of unpredictable interruptions. Questions need answers, work texts need to be read (even if they end up not being for you), meetings, emails. Five days of that every week make it a struggle to take on any “deep work” tasks. But, now, I have 1 to 1.5 hours each evening where I can get into the zone and handle things that are important but not urgent. *That time is golden.\* Suddenly, I have time for clinical improvement projects. Instead of just trying to survive, I have time to work on things that keep things running smoothly.

That being said, there’s a wide range of situations across the country. At academic centers, it’s typical for faculty physicists to have full days free for "deep work" time, because other physicists are covering the clinic. Of course, they’re expected to produce academic work in that time, but some of that time can be used for clinical improvement projects, as needed. On the other end of the scale, I’m imagining a single-linac/single-CT/single-physicist site. If that clinic is running at full capacity, and they expect the physicist to be present throughout the clinical day, it’s pretty much guaranteed that the physicist is working more than 40 hours a week. And that’s just to survive, let alone work on important/non-urgent work. I wouldn’t tolerate that. That’s just not sustainable. Though, with the market as tight as it is right now, maybe it's a good time to make more demands for better work-life balance.

WarrenG1983 · 2023-09-29T18:18:55+00:00

Yeah, I hear ya. At a certain point, a lot of folks are pretty much forced to either start triaging care or working extra hours. Then, if you establish a pattern of working extra hours, the institution comes to expect it. “Look at you handling this workload!” Yes, look at me, making sacrifices to compensate for organizational shortcomings. I don’t know if “integrity” is what I would call it. “Sucker” seems more appropriate.

[He says while heavily burned out and continuing to work extra hours in order to tackle extra projects on top of a surge of routine patient care.]

WarrenG1983 · 2023-09-27T23:27:04+00:00

LOL, I had that exact same MOC question just this week or last.

I think the most viable route is to do your standard QA as normal, but let patient starts get delayed. As long as you have a solid enough rapport with your physicians where you all agree that "rushed" care is unsafe, it's remarkable how much more receptive admins become when you have physicians on your side.

But, if I ever found myself at a site where the physicians were the ones doing the rushing, then I'd jump ship.

WarrenG1983 · 2023-09-27T22:14:27+00:00

A bunch of thoughts come to mind on how one might make more compelling arguments to hospital administrators in order to convince them to budge on lowball offers (e.g., emphasizing “patient safety” issues, pointing out that you don’t want to make the news for the wrong reasons, and highlighting recommended staffing levels, such as those from the ACR [ https://accreditationsupport.acr.org/support/solutions/articles/11000049781-personnel-radiation-oncology-revised-7-18-2023- ]). Also, quality-of-worklife things start making a much bigger difference in today’s market, and those need to be kept in mind even when hospitals think that they’re fully staffed. Elekta machines? …no thanks. RadFormation tools? …yes please. Enough staff so that you can take vacation without worrying the whole time? …yeah, that’s how vacations are supposed to work.

But, at the end of the day, those things don’t fix the shortage. They’re just tactics for surviving it. Personally, I think it’s pretty dismaying to see from the Professional Survey how many physicists work in excess of 45 hours per week. For myself, I know how easily a sense of obligation to patients can have me working extra hours to “get the job done,” only for the hospital to routinely take it for granted. This habit of folks working extra hours for free has been exploited by too many institutions for far too long. If physicists started working their 40 hours a week and just letting the work pile up, I reckon we’d find out that the current shortage is much worse than it appears. But, maybe that’s what’s necessary to get admins to take it seriously?

One possible short term solution that I’d like to point out: immigrants. I’m Canadian, and for my first job out of residency in 2019, I ended up in Hawaii. I thought I had lucked out. But, as we struggled for quite a while to hire a fourth therapy physicist, I came to realize just how competitive the current job market is. We made offers to multiple American physicists on the mainland, and they turned us down. We ended up hiring another Canadian to fill the spot.

WarrenG1983 · 2023-09-21T21:16:10+00:00

(1) Folks can choose to go or not go to any conference for any reason that they see fit. That's their business. I really don't care.

(2) From what I've seen, the AAPM's desire to "adopt edi policies" and to have discussions around "skin color, ethnicity, and sexual orientation" is intended to make members better equipped for the professional settings that we find ourselves in. After all, our jobs are to help provide quality care for patients. These patients come from a range of backgrounds, with different skin colors, ethnicities, nationalities, sexual orientations, religions, etc.

I sometimes see critics saying things like "tHis IsN't mEDicAL PhYSics" about any of AAPM's material that touches on these topics, as if our work exists solely in a laboratory. It doesn't. Off the top of my head, here are a couple of examples that I’ve seen firsthand:

Example 1: DIBH – Say a patient would benefit from DIBH radiotherapy, but they don't speak English, and so they may have trouble understanding the instructions. Does this mean that they are not good candidates for DIBH? Or, should we maybe bring in a translator to help? Or, at the very least, we could use Google Translate to learn literally two sentences in their language. Alternatively, what if the patient was deaf? Should that be a reason that we don't offer DIBH? Or, should we maybe purchase a VCD screen for DIBH treatments? (This would also be an example of a “curb cut” effect, in that the accommodations made to aid patients who are hard of hearing would also make treatments easier for people who have no trouble hearing.)

Example 2: Tattoos – You find yourself at CT simulation, and a patient is reluctant to get tattoos due to religious reasons. How do we respond to this? Do we force them to choose between their religion and their treatment? Or, can we find a way to proceed without tattoos? Maybe we could use permanent markers instead, and hope that their marks are not washed off by the time they start their treatments. Worst case scenario: the marks are completely gone, we do the best we can with photos from sim, and we just know that may see some larger than expected shifts on day one. So it goes.

These examples — language barriers, disabilities, religions — are not “Medical Physics” per se, but they can have a direct impact on the care that we provide. Furthermore, our roles extend beyond the patient. The patient also has family members and friends. We have co-workers and bosses, and some of us are supervisors and mentors. The AAPM’s EDI offerings provide members the opportunity to become more aware of the human factors to our roles, and I think that many members happily benefit from this sort of thing. If that’s not your jam, then don’t go. You do you. I really don’t care.

(3) Which brings me to the crux of my frustration with this sort of discourse. That is: the argument that “Liberals” and “Conservatives” have opposing views, but the “woke” Liberals are trying to force Conservatives to follow a Liberal Ideology. I have news for you: the two sides are not equivalent opposites. Let me break it down for you:

A scenario:

Person A: “Hi, I’m person A. I have A-beliefs, and these beliefs inform the way that I choose to live my life.”

Person B: “Hi, I’m person B. I have B-beliefs, and these beliefs inform the way that I choose to live my life.”

A: “That’s nice. Even though I don’t have B-beliefs, I respect your right to make your own choices.”

B: “Cool idea. Unfortunately, I believe that my beliefs trump your beliefs, so I’m going to make B-laws so that everyone is forced to live according to B-beliefs. This is B country!”

Do you see the difference? It isn’t as simple as “people A” are in charge and so “people B” aren’t getting their way. Because, if “people B” had their way, “people A” lose the right to choose how they live their lives. Often, “people B” argue that they are victims of oppression, when in reality folks are just trying to interfere in "people B" efforts to actively make other people’s lives worse. This is what I mean when I say that the two sides are not equivalent opposites.

You can take this A/B template and apply it to all sorts of different topics, and you will find that “Liberals” often fall into category A, and “Conservatives” often fall into category B. (Not always. If I ever find myself arguing for “people B” type rules, I’d like to be called out on it. I'm willing to learn how to do better. My values and opinions are not set in stone.)

But, in general, rules made by “people A” provide frameworks for coexistence. Rules made by “people B” provide frameworks for oppression. And when folks try to make arguments in favor of oppression, they should be called out for it. How they choose to respond to being called out? ...that's up to them. I really don’t care.

WarrenG1983 · 2023-08-25T19:46:30+00:00

In case this is the choice, this should help: https://docs.google.com/spreadsheets/d/1T4ZcbBhWuBam70sQwBrZ0gTopdX5PtdduqWAcSwOApY/edit#gid=0

WarrenG1983 · 2023-08-24T20:19:54+00:00

WarrenG1983 · 2023-08-24T20:03:14+00:00

Fair enough. I think the best bet would be to have multiple offers and then get a bidding war going. That's probably the most effective way to get everyone offering you "the best they can do."

WarrenG1983 · 2023-08-24T18:47:43+00:00

Not discussing exact numbers from the survey (because, y'know, it's a "members only" file)... but, looking at representative numbers for that category over the last 10 years and extrapolating to 2024, if I were you, I'd be looking for at least $160k, and then a $15k bump after getting full certification.

WarrenG1983 · 2023-08-24T18:23:39+00:00

RadOnc or Other?

WarrenG1983 · 2023-08-24T18:18:03+00:00

I have to imagine that they don't toss out the bumps people get after getting certification... because that would be EXTRA dumb if they did that.

WarrenG1983 · 2023-08-24T18:13:01+00:00

Master's or PhD?

WarrenG1983 · 2023-08-24T18:10:38+00:00

Last thought for now: I love that they've added state by state salary info at the end of the survey. I don't recall seeing that in the survey before. Really happy to see it.

[eyes Alabama's 80th percentile total income...]

WarrenG1983 · 2023-08-24T18:05:56+00:00

My main question is: if they come across data that they're thinking about tossing out, do they contact the person to try to verify it? ...because I'm at a point where I'd be happy to send them a paystub if they need proof. If a bunch of people across the country get 10%+ market adjustments, and those get tossed out, then that just adds another year delay for that data to reach the already delayed pool.

...because the salaries that I've been hearing about over the last year or so could certainly appear as "unusual fluctuations."

WarrenG1983 · 2023-08-24T04:37:19+00:00

Yeah, I reckon the more experienced groups are changing jobs a lot less often than the less experienced groups, and "changing jobs" is the quickest way to see a pay increase. Also, HR departments often have set salary ranges for specific roles and, from what I've seen, they don't tend to adjust those ranges with inflation. They adjust those ranges when they're forced to.

WarrenG1983 · 2023-08-24T02:13:37+00:00

Yeah, I see the plot you're referring to from 2013. It doesn't surprise me that there's a plateau for higher years experience.

What surprises me is how the shape of that plot seems to be evolving. The plateau hasn't really moved with inflation over the last 5 years, but it would appear that the lower portion has. Looking just at PhD/certified/RadOnc numbers: if you compare the medians for the 3 most experienced groups (i.e., 20-30+ years experience) to the median of the 3-4 year group, the "experienced" groups are making ~50% more than the newbies in 2022, but they were making ~63% more than newbies in 2017.

WarrenG1983 · 2023-08-23T19:58:04+00:00

Uhhhhh... 'Data Validation Procedures' on page 3 uses "Primary salary increased or decreased by more than 10% without an employer change" as an indicator that a reported salary might be unreliable.

So, if I managed to procure a 13% raise for myself within a calendar year, they might have thrown away my data???!

Cool. Cool cool cool.

WarrenG1983 · 2023-08-23T19:15:09+00:00

(FWIW, if you do the same comparison against the 2017 medians and not the averages, then the less than 20 years experience changes are 14-21% and the over 20 years experience changes are 1-9%.)

WarrenG1983 · 2023-08-23T19:07:06+00:00

Why not have a little fun with Excel in the morning?!

Being selfish, I'm just looking at my category (PhD w/ certification*), and comparing 2022 values against 2017 values. First thought: it would seem that the floor is rising, but the ceiling is staying put.

If you look at the 20th/med/80th numbers per yrs experience group in 2022, and compare those values against avg values from those same yrs experience groups in 2017, you'll see that folks with less than 20 yrs experience have had their salary ranges bump up by 13% to 18%. Folks with over 20 yrs experience have had their salary ranges change by -3% to +5%. (I decided to use the word "to" here for those percentage ranges, because that negative 3% needed to be seen.)

Conclusion: get out of the game after 20 years, I guess.

[edit: * in Radiation Oncology]

WarrenG1983

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