day to day question

[McPoyle]

Hey all, I was curious what the day to day is like in heme-onc. For instance, when you acquire a new patient and begin therapy do you decide on a protocol and then see the patient once a week or month or so to check in, otherwise follow them from afar via lab results. Is it similar to peds where induction may take place int he hospital and you would be their provider while inpatient? As far as complications go (fever, infection, side effects, etc), do you manage those as well or do the hospitalists manage those?

Just kinda tryin to get a feel for how much inpatient v. outpatient work there is, and how the continuity is. Also curious what the relationships with the patients is like.

Any insight is appreciated.

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[texashemonc]

Vast majority of cancer treatment is done in the office these days in private practice. Only patients who get treated as inpatients are high-grade lymphomas, leukemias, and bone marrow transplants. In fact, outside of major academic centers, very few community hospitals offer inpatient chemotherapy due to declining reimbursements.
Generally, I see patients at least once a month while on cytotoxic chemotherapy. If they are on milder treatment (aromatase inhibitors, LHRH agonists for example), it may be anywhere between 4-6 months, or even yearly if the patient is off active therapy.
For any complications, I generally comanage with the admitting doctor or hospitalist. I never admit patients to myself. The hospitals in the area I work in require that the attending physician have to respond to any emergencies within 1 hour and need to write H and P within 6 hours of admission. In private practice, when you are going to 2 different offices and 3 different hospitals, that is impossible. And you don't want to put any more burden on your partners if they are on call for you.
Stress level depends on how busy the practice is. Generally, the hematology portion can be tougher due to the need to do inpatient consults, sometimes emergently. In past week alone, I have taken care of HELLP syndrome, TTP, VWF bleeds, ITP, and even someone who developed a large GI ulcer bleed after being anticoagulated for a SMV thrombosis.
So private practice hem/onc is generally not a cush job. When you are in the office, you also have to provide incident to coverage, which means you can't leave the office until the last chemo patient is gone(usually close to 5pm) due to Medicare rules. So only time to see hospital consults is either early in the morning or in the evenings. I usually leave my home before 6:45am and don't usually get back until 7pm most weekdays. So certainly no tee times at the golf course at 2pm on a friday, like most other specialties.
The patient interaction is the best part of this specialty. You get to know patients and their families quite well. If you are not a people person, then please choose something else. It can be heartbreaking though and easily can get quite depressing when your patients progress on therapy.
In summary, this is one job that keeps me on my toes and each day is unique, full of surprises, never a boring day.

 

[asprin81]

Vast majority of cancer treatment is done in the office these days in private practice. Only patients who get treated as inpatients are high-grade lymphomas, leukemias, and bone marrow transplants. In fact, outside of major academic centers, very few community hospitals offer inpatient chemotherapy due to declining reimbursements.
Generally, I see patients at least once a month while on cytotoxic chemotherapy. If they are on milder treatment (aromatase inhibitors, LHRH agonists for example), it may be anywhere between 4-6 months, or even yearly if the patient is off active therapy.
For any complications, I generally comanage with the admitting doctor or hospitalist. I never admit patients to myself. The hospitals in the area I work in require that the attending physician have to respond to any emergencies within 1 hour and need to write H and P within 6 hours of admission. In private practice, when you are going to 2 different offices and 3 different hospitals, that is impossible. And you don't want to put any more burden on your partners if they are on call for you.
Stress level depends on how busy the practice is. Generally, the hematology portion can be tougher due to the need to do inpatient consults, sometimes emergently. In past week alone, I have taken care of HELLP syndrome, TTP, VWF bleeds, ITP, and even someone who developed a large GI ulcer bleed after being anticoagulated for a SMV thrombosis.
So private practice hem/onc is generally not a cush job. When you are in the office, you also have to provide incident to coverage, which means you can't leave the office until the last chemo patient is gone(usually close to 5pm) due to Medicare rules. So only time to see hospital consults is either early in the morning or in the evenings. I usually leave my home before 6:45am and don't usually get back until 7pm most weekdays. So certainly no tee times at the golf course at 2pm on a friday, like most other specialties.
The patient interaction is the best part of this specialty. You get to know patients and their families quite well. If you are not a people person, then please choose something else. It can be heartbreaking though and easily can get quite depressing when your patients progress on therapy.
In summary, this is one job that keeps me on my toes and each day is unique, full of surprises, never a boring day.

Thanks for another post full of real experience which always benefit us....Are you able to make 300k with this life style? Do you work 5 days with weekend hours? Are you in Northeast?

 

[MG78]

Vast majority of cancer treatment is done in the office these days in private practice. Only patients who get treated as inpatients are high-grade lymphomas, leukemias, and bone marrow transplants. In fact, outside of major academic centers, very few community hospitals offer inpatient chemotherapy due to declining reimbursements.
Generally, I see patients at least once a month while on cytotoxic chemotherapy. If they are on milder treatment (aromatase inhibitors, LHRH agonists for example), it may be anywhere between 4-6 months, or even yearly if the patient is off active therapy.
For any complications, I generally comanage with the admitting doctor or hospitalist. I never admit patients to myself. The hospitals in the area I work in require that the attending physician have to respond to any emergencies within 1 hour and need to write H and P within 6 hours of admission. In private practice, when you are going to 2 different offices and 3 different hospitals, that is impossible. And you don't want to put any more burden on your partners if they are on call for you.
Stress level depends on how busy the practice is. Generally, the hematology portion can be tougher due to the need to do inpatient consults, sometimes emergently. In past week alone, I have taken care of HELLP syndrome, TTP, VWF bleeds, ITP, and even someone who developed a large GI ulcer bleed after being anticoagulated for a SMV thrombosis.
So private practice hem/onc is generally not a cush job. When you are in the office, you also have to provide incident to coverage, which means you can't leave the office until the last chemo patient is gone(usually close to 5pm) due to Medicare rules. So only time to see hospital consults is either early in the morning or in the evenings. I usually leave my home before 6:45am and don't usually get back until 7pm most weekdays. So certainly no tee times at the golf course at 2pm on a friday, like most other specialties.
The patient interaction is the best part of this specialty. You get to know patients and their families quite well. If you are not a people person, then please choose something else. It can be heartbreaking though and easily can get quite depressing when your patients progress on therapy.
In summary, this is one job that keeps me on my toes and each day is unique, full of surprises, never a boring day.

Thank you for sharing your experience !