Confused about career choices.

[DNMT3A]

I’m an IMG, new mom, graduated from a "clinically strong" university residency program and burnt out a little although I feel I did benefit from my strong clinical training in residency. I had some research on BMT/malignant heme and was planning to go for malignant heme in academics, as I didn’t really have much exposure to solid onc as a resident so I don’t know which I like better. Last few months due to various events I started doubting whether I should go into hemonc fellowship or do Hospitalist or PCP. I read a lot on SDN and I’m getting more confused. I found I don’t specifically enjoy doing research, it may sound bad but I don’t want to get paged at the middle of the night. I like outpt and monotony doesn’t bother me. I still feel it’s hard to talk to pt about prognosis. It may sound like I’m not a hemonc material? I still applied and interviewed but I really don’t know if I should keep moving forward or stop. My current mindset is just I want an easier life style. Prestige, pay don’t matter as much. I know it might be too late to have a cold feet now. But maybe someone had the same struggle and confusion? about hemonc vs Hospitalist vs PCP? hematology vs oncology? Academic vs private? Is fellowship really that bad?

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[QuizzicalApe]

When I was going into residency I figured I wanted to do either Heme/Onc or primary care. I liked the longitudinal relationships one forges in either field, and with the former I've always liked to tell people that I enjoy taking care of serious illness... just not critical illness. I prefer my prognoses to be greater than a few hours. I've been happy with my decision to go Heme/Onc because I scratch that itch, but I get to do it in a specialized field and don't have to worry about the 1000s of other things a PCP has to.

Anyway, I truly hate research so I understand your thought process. I hate the deadlines and the monotony and the scrabbling for grants and prestige. I've squeaked out the bare minimum needed of me to graduate, and was very upfront with my fellowship director about my thoughts... you know, after I matched. We figured out what I had to do to get out of fellowship intact and that was that.

The difficulty of fellowship will be very dependent on where you go. Some places are very intense with a lot of covering inpatient teams full of sick folks, others are a more chill and outpatient focused experience. You can probably find a place that is more in line with your expectations and career goals. Overall I enjoyed fellowship and outside of things that are unavoidably challenging, like busy heme or onc consult services or a busy inpatient leukemia service, found my fellowship to be relatively chill.

I joined a private group affiliated with the local academic center and am very much enjoying my job. I'm fortunate in that the other docs in the practice have a similar mindset to me and everyone gets along.

For what it's worth, by the way, during my fellowship, perhaps a quarter of our program were either new parents coming in or became new parents during fellowship and they managed and did OK (one of the two minifridges in the office was even a dedicated breast milk fridge!); your own mileage may vary depending on the culture of your program.

 

[DNMT3A]

When I was going into residency I figured I wanted to do either Heme/Onc or primary care. I liked the longitudinal relationships one forges in either field, and with the former I've always liked to tell people that I enjoy taking care of serious illness... just not critical illness. I prefer my prognoses to be greater than a few hours. I've been happy with my decision to go Heme/Onc because I scratch that itch, but I get to do it in a specialized field and don't have to worry about the 1000s of other things a PCP has to.

Anyway, I truly hate research so I understand your thought process. I hate the deadlines and the monotony and the scrabbling for grants and prestige. I've squeaked out the bare minimum needed of me to graduate, and was very upfront with my fellowship director about my thoughts... you know, after I matched. We figured out what I had to do to get out of fellowship intact and that was that.

The difficulty of fellowship will be very dependent on where you go. Some places are very intense with a lot of covering inpatient teams full of sick folks, others are a more chill and outpatient focused experience. You can probably find a place that is more in line with your expectations and career goals. Overall I enjoyed fellowship and outside of things that are unavoidably challenging, like busy heme or onc consult services or a busy inpatient leukemia service, found my fellowship to be relatively chill.

I joined a private group affiliated with the local academic center and am very much enjoying my job. I'm fortunate in that the other docs in the practice have a similar mindset to me and everyone gets along.

For what it's worth, by the way, during my fellowship, perhaps a quarter of our program were either new parents coming in or became new parents during fellowship and they managed and did OK (one of the two minifridges in the office was even a dedicated breast milk fridge!); your own mileage may vary depending on the culture of your program.

Thank you so much for replying. Really appreciate your kindness. Sounds like you really enjoyed your fellowship that’s awesome. People say big academic center has less busy clinical duties. However a few places I interviewed, like CCF, primary on inpt floor for 20-30 pts; q5 call covering all attending’s clinic pts as well. Sounds like IM residency all over again. I’m not afraid to spend time learning, but I don’t want to spend all my energy dealing with noneducational duties again. people tell you great things about each program but I guess it’s kind hard to get a real grasp? Also, what would you say has a better lifestyle over the others in future? Maybe I should shift to solid onc like GU as pts are less sick and generally happier compared to leukemia? I assume as an oncologist probably not much emergency calls at the middle of the night?

 

[gutonc]

Thank you so much for replying. Really appreciate your kindness. Sounds like you really enjoyed your fellowship that’s awesome. People say big academic center has less busy clinical duties. However a few places I interviewed, like CCF, primary on inpt floor for 20-30 pts; q5 call covering all attending’s clinic pts as well. Sounds like IM residency all over again. I’m not afraid to spend time learning, but I don’t want to spend all my energy dealing with noneducational duties again. people tell you great things about each program but I guess it’s kind hard to get a real grasp? Also, what would you say has a better lifestyle over the others in future? Maybe I should shift to solid onc like GU as pts are less sick and generally happier compared to leukemia? I assume as an oncologist probably not much emergency calls at the middle of the night?

Why stay in academics at all after fellowship unless you have a significant research interest?

I am in a community based academic-hybrid position where I can do as much or as little in terms of academic involvement (running trials, teaching students/residents/fellows, etc) as I want. There are 15 (soon to be 16) physicians in the group, and call is shared equally among us, which means 1-2 weeknights a month (last week I got a total of 4 calls, only 1 between the hours of 10p-5a), and 3-4 weekends a month (last time I was on call I had exactly 1 patient to round on, despite covering 8 different hospitals).

Also, most of the large fellowship programs that have heavy call responsibilities do it all during the first year. Many others spread call out over the entire fellowship group. So while I did have to take call all during my fellowship, it was pretty similar to my current setup (albeit a little busier).

 

[Oncolizumab1]

Why stay in academics at all after fellowship unless you have a significant research interest?

I am in a community based academic-hybrid position where I can do as much or as little in terms of academic involvement (running trials, teaching students/residents/fellows, etc) as I want. There are 15 (soon to be 16) physicians in the group, and call is shared equally among us, which means 1-2 weeknights a month (last week I got a total of 4 calls, only 1 between the hours of 10p-5a), and 3-4 weekends a month (last time I was on call I had exactly 1 patient to round on, despite covering 8 different hospitals).

Also, most of the large fellowship programs that have heavy call responsibilities do it all during the first year. Many others spread call out over the entire fellowship group. So while I did have to take call all during my fellowship, it was pretty similar to my current setup (albeit a little busier).

That hybrid type of job is exactly what I'm looking for once I finish. Are they becoming more common?

 

[gutonc]

That hybrid type of job is exactly what I'm looking for once I finish. Are they becoming more common?

Yes and no. I've commented on this here.