The Accelerators Podcast

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The Accelerators (Drs. Matt Spraker and Simul Parikh) host Radiation Oncologist and prolific X'er Dr. Dave Chang for a discussion of Small Market Radiation Oncology.

We wax philosophical about the work and life of docs formerly known as #LittleRadOnc: radiation oncologists often under resourced and practicing solo, working miles away from large US cities. 

Dave's personal stories emphasize that the reality of radiation oncology "maldistribution" is a lot more complicated than is often described by city slicker researchers.

Simul and Dave close the episode by discussing practical problems faced by Small Market Radiation Oncology and potential solutions, including... of course... supervision policy!

The only link for this show is the X announcement of Dr. Glaucomflecken's medical school.

The Accelerators Podcast is a Photon Media production. 

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The Accelerators (Drs. Matt Spraker and Simul Parikh) host radiation oncologists Dr. Jona Hattangadi-Gluth and PGY-5 resident Dr. Austin Hopper. Jona is a central nervous system malignancies expert, co-lead of the Central Nervous System Disease Team and Associate Professor of Radiation Oncology at UC San Diego.

In this episode, we discuss Jona's lab's work in understanding the link between brain tumors, radiation (and other) treatments, and neurocognitive toxicity.

We start by discussing Austin's recently presented work that developed an normal tissue complication probability (NTCP) model for radiation dose and attention/processing speed. 

Later, we discuss specific methods used in the NTCP work. How can this work be translated to clinical counseling and practice? 

Also, Matt argues that building NTCP models based on neurocognitive outcomes, such as attention or fine motor control, can be more difficult to model than more simple clinical outcomes such as pneumonitis.

Here are some links to things we discussed during the show:

• Connor et al., 2023. Fine Motor Skill Decline After Brain Radiation Therapy—A Multivariate Normal Tissue Complication Probability Study of a Prospective Trial
• Unnikrishnan et al., 2021. Phase II Clinical Trial of Image-Guided Cognitive-Sparing SRS in Patients With Brain Metastases
• Oscar's Mexican Seafood, Oncology Twitter's favorite fish tacos in San Diego.

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.

If you'd like to support our efforts, please visit the Cold Light Legacy Company to learn more.

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Welcome to MattPAC*, a new Accelerators pilot concept!

Radiation Oncologist Dr. Matt Spraker aims to introduce important healthcare policy concepts rooted in current events. Each show is designed to be efficient with your time and inspire you to get engaged with #RadOnc advocacy in 30 minutes or less.  

In MattPAC #1, Matt covers two current congressional bills that are currently being considered for inclusion into next year's Medicare legislation: HR 2474 and HR3674. These bills seek to link Medicare physician pay to inflation and boost practice expense reimbursement for freestanding practices. The history of Medicare, administration processes, the payment formula, and sites of service are covered for context. 

Here are some good resources for further reading on these topics:

• A paper on how Medicare drove hospital desegregation, especially in the south.
• Power To Heal: Medicare and The Civil Rights Revolution
• How is Medicare Funded?
• Information about Medicare administration and procedures, Wikipedia
• A lot of info on the RUC, AMA
• The medicare physician fee schedule payment formula, MedicalBillersAndCoders.com
• Interesting write up of history of conversion factors, AMA
• Medicare payments are not keeping up with inflation, AMA
• Framework for Rational Medicare, AMA
• AMA letter to congress about these issues, March 2023
• AMA commends MedPAC for recognizing challenges of inflationary environment, April 2023
• HR 2474
• A Primer On Office Based Specialty Care, USPA
• USPA Letter to MedPAC about threats to free standing specialty practices, such as Rad Onc
• 2023 survey of multi-specialty practices regarding Medicare cuts
• HR 3674

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.

*MattPAC is not a political action committee, it's just a cute name. If you'd like to support our efforts, please visit the Cold Light Legacy Company to learn more.

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Friend of the show and GI super friend Dr. Nina Sanford joins The Accelerators (Drs. Matt Spraker and Simul Parikh) to host #RadOnc luminary Dr. Robert Timmerman, MD.

Our discussion concludes with a discussion of proton and adaptive radiotherapy, Wagyu beef, life advice, and Simul's Hot Seat.

Here are a couple of book recommendations from the show: 

• Why We Sleep by Matthew Walker, PhD
• Outlive by Peter Attia, MD

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.

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Friend of the show and GI super friend Dr. Nina Sanford joins The Accelerators (Drs. Matt Spraker and Simul Parikh) to host #RadOnc luminary Dr. Robert Timmerman, MD.

No notes.

It's Bob Timmerman, just listen.

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy.

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Accelerators co-host Dr. Matt Spraker is joined by Out Of The Basement co-host and Dr. Jason Beckta. We're talking #ASTRO23 and jobs, the theme of the conference for Matt.

This episode is, in part, a reaction to Jason's most recent OOTB episode: Chicken Little Strikes Back. Jason weaves 2023's "hot" job market and the workforce data into a master narrative to describe the changing market across recent years.  As this episode is heavily referenced here, you may want to listen first!  (But its not required)

Matt and Jason kick off by discussing interview experiences at ASTRO 2017 in San Diego. We then share thoughts about the 2023 "workforce session", what this means for medical students and graduating residents, and a plea for Rad Onc advocacy in the broadest sense.

The episode concludes with more discussion of the conference and our future.

Here are links to things mentioned in the show:

• Dr. Susannah Ellsworth Xeet on over/under supply, and her thread on the session.
• Matt Xeet on the alarming SOAP data and the "12,000 RVU Poll"
• How Much Are Resident Physicians Worth by Dr. Carmody, an excellent read on "the economy of residents"

The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy.

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It's a Photon Media crossover episode! Accelerators co-hosts Drs. Matt Spraker and Simul Parikh team up with Dr. Jason Beckta, host of the Out Of The Basement podcast, to talk about billing.

We are joined by Shawna Stacey, ROCC, MBA, Coding and Billing Specialist at Radformation. The episode kicks off with a discussion about why you should care about billing and coding. Matt, Simul, and Jason discuss their (lack of training) training and experiences trying to learn on the job.

Simply learning about billing and coding doesn't make you greedy, it helps you understand how you are paid for your work. A transparent and well funded clinic offers the best chance of optimizing care for your patients!

Feeling overwhelmed by billing and wish you could just stick to patient care? Us too.

Later in the episode, we discuss resources that help you not care, especially Radformation's QuickCode. You already know how AutoContour and ClearCheck have automated your clinic, QuickCode does it for billing and coding. 

Don't believe us? We close the episode by asking Jason and Simul to "break" QuickCode with a complicated billing and coding scenario that is sure to frighten even the experts. 

Here are some things we discussed during the show:

• "What is a MAC?", from CMS
• "What's an LCD?", from Medicare.gov
• ACROInsights Newsletter from the Goverment Relations/Economics Committee (membership required)

Editor's Note: While our love for their products is genuine, The Accelerators were compensated for this episode and Radformation participated in planning the content. The discussions in this episode are the opinions of the participants and are not billing and coding advice.

Please see our website for complete information on our past and current sponsors.

The Accelerators Podcast is a Photon Media production. 

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This week, Dr. Matt Spraker hosts medical student and Rad Onc applicant Dr. Laura Flores, PhD to discuss The Rad Onc Match! 

With all these links there's no room for a summary, so just listen!

• Rank Order List: Buyers and Sellers Edition and accompanying video
• The Accelerators Podcast, Composite QoL Measure for #RadOnc Happiness
• That WaPo article about physician salaries and an excellent SDN post explaining why the number reported for Rad Onc is inflated
• Matt Spraker's Threads 
  • ERAS competitiveness
  • Degree during residency
• Tweet from Dr. Mary Mahoney on applicant demographics
• Holistic Review
• The Accelerators Podcast, ACROPolis Live! at #ACRO2023
• Out Of The Basement Podcast, History of RadOnc: the "2018 exams"
• The Accelerators Podcast, In Conversation with Join Luh
• Shah et al., The ASTRO Workforce Study
• ACGME Program Requirements for Radiation Oncology

For a deep dive, please check out the many Photon Media podcasts on the workforce.  From The Accelerators Podcast: 

• The One About Jobs
• Facility Volumes to Assess the Job Market
• Analyzing Job Board Postings
• New Starts: Residents

From Out Of The Basement:

• Rad Onc Job Secrets Part 1 and Part 2
• ASTRO Workforce Interim (2022) and Final Analysis
• Supply and Demand Impact

Podcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music by Emmy-award winning artist Lucas Cantor Santiago.

The Accelerators Podcast is a Photon Media production. 

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On this week's episode, Accelerator Dr. Simul Parikh hosts Radiation Oncologist Dr. Daniel Koffler to discuss psychedelics in oncology!

They kick off the conversation by discussing ketamine. They review it's use in head and neck and gynecologic cancers, and discuss two trials by Daniel and colleagues (see below).

Later, they discuss the systemic use of psychedelics, some practical advice for incorporating psychedelics (topical and systemic) and collaborating with psychiatrists and psychologists in your local practice.

Here are some things discussed during the show as well as some more stuff you should check out:

• Clinical trial of ketamine mouthwash by Daniel and friends (get the protocol)
• Clinical trial of ketamine psychotherapy (KAPTIVATED) by the same
• Analgesic effects of topical ketamine, a review
• Treatment of severe mucositis pain with oral ketamine mouthwash
• Topical Ketamine in the Treatment of Mucositis Pain, a dramatic case report
• "Finding medical value in mescaline" in Nature
• Efficacy of ketamine therapy in the treatment of depression
• Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Depression

(Editor's Book Recommendation! For an excellent book on the history of psychedelics research and their resurgence, check out How To Change Your Mind by Michael Pollen)

Podcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music by Emmy-award winning artist Lucas Cantor Santiago.

The Accelerators Podcast is a Photon Media production. 

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This week The Accelerators (Drs. Anna Brown, Matt Spraker, and Simul Parikh) host radiation oncologist and legend Dr. Join Luh. This show is all about Join!

We discuss his path through internal and emergency medicine to radiation oncology, and his experience working as a rural, community radiation oncologist. What are the joys and challenges of serving a small community?

We then discuss Join's advocacy for his practice and his patients throughout his career with a special focus on his RO-APM editorial in the JCO. 

We close the episode with the return of Simul's Lightning Round! 

Texas versus California, which would you pick?

Here are some other things we discussed during the show:

• The Peacock Radiotherapy System and Where goest the Peacock?
• California Assembly Bill 890 and a CalMatters review of the bill
• The Accelerators Podcast: ACROPolis Live! Welcome to Rad Onc

Podcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music by Emmy-award winning artist Lucas Cantor Santiago.

The Accelerators Podcast is a Photon Media production.