Notice bibliographique
Résumé
Regarding the article in the April 10 issue about the ASCO study predicting that there will not be enough oncologists to meet the need by the year 2020, all I can say is that the organization has completely missed the point. They may be very good at compiling statistics, but they are not so good at figuring out what they mean. It should come as no surprise to those of us who work for a living that no one wants to be a medical oncologist anymore. The reason is simple: In the wake of the Medicare Modernization Act of 2003, we have taken a 68% decrease in overall profitability. Plainly put, it no longer pays to give chemotherapy. This makes us the lowest-paid internists in town. Who in their right mind would spend an extra three years in Fellowship to enter a profession in which you will work the first 10 years of your practice life to pay back your student loans? In the training program at which I once taught, three out of four Fellows quit over the last two years for this reason. The young people are not stupid. Point #1: Providing guidance and support to help increase ASCO'S members' productivity and efficiency is nice, but as we have discovered, seeing 35 patients per day now, you eventually reach the point beyond which no one can reasonably go. Entering into initiatives with non-physician oncology professionals and general practice physicians is probably a good idea, because general practice physicians and RNPAs are the people who going to be giving cancer care in the near future. The only modification to the oncology Fellowship training programs that you are going to be able to make is getting rid of two-thirds of them for lack of interest. I cannot see how collecting any more data to monitor trends to help prevent shortfalls would be even a worthwhile thing to think about. The trend is for less and less money every year until there are none of us left in the community. What this means, of course, is that medical oncology will be confined to the universities and two or three of the large national groups, and of course, the nature extent and implications of this are already well known. All one has to do is to glance at Japan or Canada for five minutes to figure this one out. As the next round of cuts in reimbursement and increase in operating overhead, which is euphemistically called “Pay for Performance” takes effect, most of us in Small Town, America will be out of business. At that point, access to care is going to diminish logarithmically. At which point, society will have to decide whether it wants cancer care or not. If the answer is yes, then I suggest they pay us. You do the math. David C. Tabor, MD Crossville Medical Oncology Crossville, TN
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,012 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,002 | 0,000 |
| Communication savante | 0,004 | 0,002 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,007 | 0,005 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,131 | 0,104 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».