How to Publish Outside of the Academic "Priesthood"

The Rise of Podcasts, Newsletters, and Authentic Storytelling

There is a thriving ecosystem of incredible work being done outside of academia. Podcasts, apps, educational programs, Substacks, start-ups and more. Without the help of societies or academic medical centers, people are creating and teaching and enriching their careers. It’s possible that we could do so much more in collaboration, but it’s also possible that if done together, it may stifle creativity. This is just a short “think-piece” about all of that.

Recently, my podcast (“The Accelerators Podcast”) co-host Matt Spraker received a lovely note from Dr. Stacey Wentworth. She is a radiation oncologist at Duke University, a writer, a podcast creator, a patient advocate and a shining light in our specialty. She complimented our show and wanted to have a conversation, so we had a few - one that we recorded and will come out very soon. I have followed her from a distance - she has a substack called Cancel Culture. She has a piece she wrote that went viral - “Why Your Doctor Is Leaving You”. She has a serial podcast about my cancer hero, Less Radical, about Dr. Bernie Fisher that should be required listening for all PGYs (I will be writing a separate post about this). She is working on a book about him as we speak and that will be published soon.

I am guessing that many of you have never heard of her, but in the world of cancer patients, she is very well known. She is someone that I have followed and wanted to emulate. She creates and makes us think. She reaches patients and physicians and makes an impact. I did a google search and did not find any society mentioning her work (ASTRO, ACRO). I have sent the podcast to dozens of people (academic and community) and they had not heard of it. After listening to it, I simply do not understand why this has not been marketed by Big RadOnc - this story is essential in understanding radiation oncology’s role in medicine and why it is the specialty it is today. I hope that I can bring more attention to her serial, her and to Dr. Fisher.

I told her on the show, “I want to be you when I grow up.” I am not there yet, but I have a fairly popular podcast and a growing Substack. I am a good follow on LinkedIn, a voice for many people in our field and I find I get to connect with many non-physician members of the radiation oncology community. I’m a contributor on TheMedNet and often invited to answer questions (I’m the palliative guy!). I receive phone calls and emails requesting advice and counsel on difficult situations at work, obtaining jobs, evaluating contracts and billing questions. I give talks to multiple practices and residency programs. I’ll be speaking at Mayo Clinic Arizona and the University of Michigan very about billing and prior authorization. I’m somewhat well-known, but in the world of academia, I am a nobody and in the eyes of ASTRO, I’m the one that shall not be named. Yet, I am thriving in my career - creating, writing, advising and having a more successful career than I could have ever imagined. I am eternally grateful to those that have helped me and just as grateful to those that have tried to block me, because it has led me to work harder.

I came across this world-view altering piece by Scott Alexander (pseudonym) on his Substack AstralCodexTen. He is a psychiatrist and a legend in the rationalist community. He is my writing hero. I love the way he thinks and sees the world. I am a paying subscriber and would pay 5x as much to read everything he writes. The piece is called On Priesthoods.

Here is part of his article that caught my eye:

(Of note, those GMU economists are my favorite as well. I said Scott is my writing hero, but Tyler Cowen is my favorite public intellectual)

This piece resonated so much. I, too, was rejected in my first go-around in applying to radiation oncology residency. I completed my training at an institution with a mid reputation, although there were individual faculty superstars there. I’ve realized that although I have a chip on my shoulder, I have a sizable following and have helped many physicians. I always hope that when I do something or write something that maybe the academics will notice and compliment me or ASTRO will change their mind about me and see that I’m a swell guy. But, I don’t publish anything of value in journals. I don’t do any meaningful research. I hardly attend conferences. I have never worked at an academic center. So, I get the sense that to most people at AMCs, I’m just some community doc that runs his mouth. And like Scott, I always think, maybe this time they will see how great I am and how much I do, and I will be recognized for it. Maybe they will include me in their circles, ask me about my thoughts on important policies affecting our field, perhaps say “Hey, we know it’s been rough in the past, but let’s have you back in the family,” but the thing is, it’s not going to happen and even if it does, it isn’t going to change what I wish to do. In fact, it may make it harder to accomplish what I would like to.

There was a Substack in the past that was thriving, It was the best writing on radiation oncology that I had seen in a long time. It was academic level, full of critical thinking and analysis, discussed policy and economics, clinical oncology and I awaited it every week in my inbox. This creator than became more involved with ASTRO and then all of a sudden it stopped. No warning. It just died. The quality had not fallen, the interest level from readers remained - we all wondered what happened. I had hoped that it would spawn many similar publications - maybe discussing other types of cancers or techniques or narrative oncology or the business side or anything else cool in our world. But, nothing ever really came up that I know about (if there are others, please do email me and let me know!) and that Substack remains defunct.

Podcasts in the world of radonc appears to doing better. There is us. There are society ones - ASTRO has one (a bit dry, but informative), At The Beam is an educational one that has improved substantially over time, QuadShot has a pretty good one, NRG has one. Amar Rewari and Anthony Paravati have an interesting one on health care policy and finances that is a good listen. Not sure how many listeners all of us really get, as the analytic data is difficult to come by, but based on people I speak to and our internal data, I estimate we get about 500-1500 listeners per episode, which isn’t bad and does allow us to have advertising and sponsorship.

Jeff Ryckman has done some great work with RadOncReview and he has a pretty great app. David Grew has PRIMR, for educational videos for patients. Krish Jethwa as mentioned in a previous post teaches through social media. TheMedNet is a great Q&A website, but I do have some issues about their valuation of “expertise” where a degree and a title let’s you answer with a “Yes” and then you get to be an “Invited Lecturer” (yes, I will gladly admit I am annoyed that I don’t get that distinction when my answers are well written, evidence-supported and admired by readers). Paul Brown at Mayo has developed these incredible educational posts on LinkedIn.

Some of these get picked up by the societies and journals because they have the right tone and don’t question the dogma of the priesthood, but many others get ignored and don’t necessary develop the following/readership/listenership that they deserve. But, as I’ve seen with that unmentioned Substack and a few other creations, if they do get supported by the priesthood, they may lose their independence, creativity and the “special sauce” that made them so interesting to begin with.

I think the people that will thrive in this space have to have less sensitivity than I do - that they should need the feel for the priesthood’s validation. The more I just do it for myself and my readers and followers, the better the work is. I see many people shooting their shot in their various ways. I would love to hear from those creating and would be happy to showcase their work here, on the podcast and on LinkedIn. We may not be ever be inducted into the priesthood, but we can do our best to inform and enrich patients, physicians and others interested in oncology.

Here are some tips for those interested in creating:

1. Just Do It.

It doesn’t have to be perfect at the start. Our first podcast episode is kinda hard to listen to now, but I am still proud we took the leap. For this Substack, I do love my first piece, but it didn’t get that many reads as compared to others. I am still learning what people want to read and how to best get my points across. It is a work in progress, but it cannot be that until you start.

2. Don’t worry if no one sees it.

At the beginning, this should be for you. Do you like what you’ve created? Do you see value in it? Do you think others would learn from it? Do you think that if you marketed and people saw it, they would tell others about it? If so, then you’re on the right track. In addition, you should want a small, engaged audience rather than a large, disinterested one. If I only reach 10 people, but they are excited to read my work, I feel successful. I wish it were 1,000, but it may not get there. And that’s okay. The joy is in the work.

3. Ask others how they succeed.

Stacey Wentworth is going to get a follow up call from me. For me, it’s not about getting more subscribers at this point. It is about how to make the work as high quality as possible. It is about how to connect with people. Her podcast serial on Bernie Fisher is so f*ckin good, I am in awe. I cannot imagine how much work she did on it. Use their wisdom and experience to guide your way. Ask anyone and everyone that you admire how they got there. You will gain valuable insights on your next steps.

4. Do not worry about external validation.

It’s okay if the big-shots don’t care for it or ignore it. It really isn’t for them. If it is for them, then you have to join the priesthood and follow their rules. If you want to do it your way, you cannot expect them to say “Ah, they may have a point.” They may, but it is far more likely that they will not. I have a difficult time with this, as I am sensitive to this. I always liked to make my parents proud and sometimes the Academy feels like my professional parents. But, alas, they abandoned me in a dumpster.

5. Similarly, ignore the noise.

I have a feeling many close friends and even mentors make fun of what I produce. It really takes a lot to not be defensive of my own work. But, again, I’m not writing for my friends and mentors. I’m writing to other people in health care - not just physicians, but others interested in the intersection of economics and medicine and many other topics. It takes thick skin, as we are vulnerable when we create. If you don’t develop it, you will.

6. Have fun with this.

When I finish a piece I am really proud of, it truly makes me happy. I absolutely adore my financial toxicity piece. It is one of my favorite things I’ve created. It looked at a topic in a new way, in a way that others have not. It is innovative, it is potentially a way to actually affect change. I love our “soft” podcast episodes, narrative pieces, interviews with chairman and small town radiation oncologists. They don’t get the listeners that other episodes get, but I enjoyed the conversations so much. I am so happy when I create. You will be, too.

7. Share your work.

Share it with your colleagues, your staff, your sister, your mom, your romantic partner, your fifth grade teacher. Put it on Facebook or LinkedIn or X. Just as much as I said you should enjoy your work and be proud of it, if you think it is of value, get it out there in the world. Talk it up. Stacey is very proud of her work - as she should be - and if she didn’t talk about it, I wouldn’t know about all that she has done.

8. Put these on your CV

Careerism is rampant in medicine. There is a concern of how one’s work will be validated and accounted for. Particularly for academics whose evaluation and promotion is dependent on academic productivity. Ten years ago, people would not put a podcast or an alternative publication on their CV, but now I see many unique experiences and accomplishments. Whatever you create, it is your choice to put it on your CV - whether people will consider it when considering hiring or promoting you - that is not in your control. I would consider any work outside the clinic as fair game and when enough people do it, it will not be thought of as weird.

Love you all,

Sim