Academic Clinician in Medical Oncology?

[thisampgoestoeleven]

Is there a role for someone who has no interest in designing clinical trials, getting grants, or publishing in academic medical centers? Or should such a person basically assume they are only fit for PP?

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[gutonc]

Is there a role for someone who has no interest in designing clinical trials, getting grants, or publishing in academic medical centers? Or should such a person basically assume they are only fit for PP?

Meat needs to be moved everywhere.

But if you have no interest in the academic pursuits available at AMCs, why would you want to take what amounts to a community style job (PP as your grandfather knew it is more or less going away in Oncology, particularly in major cities) for a 25-60% pay cut compared to what you could get at the community office/hospital 2 miles away from the University?

 

[thisampgoestoeleven]

Point well taken. I am a sucker for prestige, although, more and more I'm finding I'm disillusioned with academia (political BS, self-absorbed faculty, etc.) and pursuits that go nowhere or are worth nothing (publishing crap, working on a trial only to find that it falls apart, grant application that is a pipe dream). I'd rather spend what little free time at home that I'm not spending catching up on notes on my EMR, playing with my kids and watching them grow up.

The only think I like / would miss is teaching.

Also, I would feel some inferiority working at a private practice and having all my patients say they want to be seen at the major cancer center down the road.

Maybe this is not good enough reason to pursue academics.

 

[gutonc]

Point well taken. I am a sucker for prestige, although, more and more I'm finding I'm disillusioned with academia (political BS, self-absorbed faculty, etc.) and pursuits that go nowhere or are worth nothing (publishing crap, working on a trial only to find that it falls apart, grant application that is a pipe dream). I'd rather spend what little free time at home that I'm not spending catching up on notes on my EMR, playing with my kids and watching them grow up.

This was me. It took me one year of trying to make this work post-fellowship (which was already extended by 1 year because I did the research pathway) for me to realize it was not what I really wanted. When I realized that I dreaded going to the lab and missed going to clinic, my decision was made.

The only think I like / would miss is teaching.

Well that's easy to fix. In my mid-sized West Coast city, there are 4 community oncology groups:
Mine (academic/community hybrid) - I have med students, IM residents and fellows rotating in my clinic all the time.
Hospital employed community group - Has IM residency program and is a core DO school site. They have med students and residents.
Kaiser - Core MS and IM rotation site for the AMC. Has students and residents all the time, I rotated here as a resident.
PP Group (US Oncology affiliated) - Rotating IM residents from the other local community IM program (same one we have)

Also, I would feel some inferiority working at a private practice and having all my patients say they want to be seen at the major cancer center down the road.

Why? Most of the time, my patients go there for 2nd opinions or for trials I don't have available. There's another group that are prestige ****** and I'm happy to be rid of. More than half that do go there come back once they realize they only see their actual oncologist once every 3-6 months at scan review time.

Maybe this is not good enough reason to pursue academics.

Your reasons are your own. But I would say they're pretty terrible reasons to pursue academics.

 

[gdiggs]

Hey @gutonc would you mind sharing what you see as the pros and cons of working in those practice settings? Ill give it a shot and you can let me know if you agree. I think the hybrid might offer the best of all worlds for me but im still feeling it out. I want to see patients 2-3 days a week and have another 1-2 days to do practice management and QI activities.

academic/community hybrid - Better pay then straight academics, easier to get people in trials, can still have time to work on projects or research you like but no pressure to do so. There may be decent opportunity for other administrative roles. Maybe most laid back out of the 4. Less acuity because those sick people go to the mother ship
Hospital employed community group - Better pay than hybrid, probably work a little bit more and feels more like a business. Other administrative roles likely available.
Kaiser - same as above. Pros of working at one hospital employed group probably depend on culture of hospital.
PP Group (US Oncology affiliated) - Pay starts low but has highest ceiling if you get partner in 3-5 years. Maybe work the most? Less opportunity for other administrative roles. Main focus is on moving meat.

 

[Phase1Phase2]

Is there a role for someone who has no interest in designing clinical trials, getting grants, or publishing in academic medical centers? Or should such a person basically assume they are only fit for PP?

Many universities have a dual track system - one at the flagship medical center and another at satellite locations which are university branded but essentially private practice. If you want to be associated with a university health system, whether for perceived prestige or other benefits of association with that health system, that is reasonable. At a former university where I worked, employees at the flagship received college tuition benefits for kids while satellite employees did not. But the satellite employees had better compensation otherwise.

In general, teaching is a labor of love. You will have to earn revenue to support your existence - that can be done from patient care (clinical RVUs), grants, or alternative pathways (ie government, industry). If you want to be a "clinician educator," you will pay for your salary by seeing patients, and then teach students/residents/fellows on your own time.

The main benefit I see of being a strictly clinical oncologist at a large academic center is the ability to specialize. I believe there are simply too many therapies available in the world of oncology and that a practice which allows specialization offers the best patient care. Just not everyone has access to a major university center where this kind of specialization is possible.

 

[gutonc]

Hey @gutonc would you mind sharing what you see as the pros and cons of working in those practice settings? Ill give it a shot and you can let me know if you agree. I think the hybrid might offer the best of all worlds for me but im still feeling it out. I want to see patients 2-3 days a week and have another 1-2 days to do practice management and QI activities.

academic/community hybrid - Better pay then straight academics, easier to get people in trials, can still have time to work on projects or research you like but no pressure to do so. There may be decent opportunity for other administrative roles. Maybe most laid back out of the 4. Less acuity because those sick people go to the mother ship

Aside from transplant and CAR-T, the patients I get at the community hospital 3 miles away from the mothership are as/more sick than the ones I used to take care of when I was a fellow there. This may not be universally true of course. I have more opportunities for admin roles here and more opportunities for clinical trials simply by virtue of having a generalist practice (I'm PI on 6 studies across 4 different disease states).

Hospital employed community group - Better pay than hybrid, probably work a little bit more and feels more like a business. Other administrative roles likely available.

Roughly equal in my market (+/- 5%). The only hospital employed group "private" group here has a pseudo-academic bent with a "research institute" and half a dozen translational science labs funded by a single wealthy donor.

Kaiser - same as above. Pros of working at one hospital employed group probably depend on culture of hospital.

Again, in my market, their pay is similar to mine. More restrictive formulary. Less access to cutting edge trials for your patients but they have a robust clinical research program and industry loves them because their IRB is a joke.

PP Group (US Oncology affiliated) - Pay starts low but has highest ceiling if you get partner in 3-5 years. Maybe work the most? Less opportunity for other administrative roles. Main focus is on moving meat.

Pretty much. Becoming harder to find in major metro areas these days but still around in small markets/rural areas. Definitely the best option for making bank if you're already/almost a partner but I'm not sure I'd be interested in joining a group like this in a big city with anything more than a 1y partner track and a $0 buy in to become partner.

YMMV of course and all of this can be as much or more dependent on the city/region you are in than it is the practice type.