help me decide: PCP vs heme/onc

[HemeOncBound87]

Hi everybody,
I am a current PGY2 and am struggling between solid oncology vs primary care. Inpatient medicine burns me out due to heavy page burden and having to direct my attention to many different things at once. I feel more relaxed when I can devote myself to one thing at a time. Thus, hospitalist work is out of the question for me.

I need help figuring out what is the best fit for me. I want a job where I can feel fulfilled and not burnt out. I don't care about salary/ prestige. I can go through the stress of fellowship but want decent quality of life afterwards.

About me :
- I like continuity with patients
- I like emotionally meaningful encounters and don't get easily burnt out by sad situations
- I am an average communicator at best ( makes me worry I won't do a good job with oncology patients)
- I love the subject of oncology/ basic science / reading journal articles
- I can deal with the mundane and sometimes prefer it ( URIs , disability paperwork, etc)
- I don't mind writing notes/ administrative work
- I don't do well with a lack of sleep ( somewhat worried about having to take overnight call in oncology) and long hours definitely burn me out ( I am soft, I know)
- I don't do well with hostile patient encounters ( anger burns me out)/ hostile people in general .
- I am worried I won't find PCP work meaningful
- I find it stressful when patient's question everything I recommend / distrust me or see me as someone who is there to just order whatever lab or vitamin supplement they researched online.

Can anyone share what they see as the pros and cons of being in oncology and based on what I have shared if oncology is a good fit for me? I am leaning towards it but my biggest fear is that the work will be too stressful for me. Has anyone else decided between the two ?

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[DoctorDontStop]

Of the character traits you've listed, the only ones that could be problematic is communication skill, hostile patients, and patients questioning you. Communication is big in oncology. People hear the C word and it sparks a million questions, second opinions, and occasionally anger, most of it misguided as you may be the bearer of bad news and there is nobody else for them to lash out at. I'd argue that you'd deal with angrier patients as a PCP but that would be a broad generalization.

 

[HemeOncBound87]

Thanks for the perspective I don’t mind millions of questions. Just my pet peeve when they don’t take me seriously/doubt me when I answer their questions.

 

[gutonc]

Thanks for the perspective I don’t mind millions of questions. Just my pet peeve when they don’t take me seriously/doubt me when I answer their questions.

Welcome to medicine.

 

[HemeOncBound87]

Thanks I guess that will occur in whatever specialty I go into.

 

[HemeOncBound87]

Maybe a better way to frame this post:

To the oncologists-

Why did you choose oncology over being a pcp?

What is your least favorite part about being an oncologist ?

Would you consider being a pcp if you had to do it over again?

I think I am getting a biased view of onc clinic as a resident because all I see are stable cancer patients on chemo.....

 

[gutonc]

Maybe a better way to frame this post:

To the oncologists-

Why did you choose oncology over being a pcp?

The only reason I went into medicine at all was to be an oncologist.

What is your least favorite part about being an oncologist ?

Insurance companies. But I suspect PCPs (and everyone else who takes insurance) have the same complaint.

Would you consider being a pcp if you had to do it over again?

No

I think I am getting a biased view of onc clinic as a resident because all I see are stable cancer patients on chemo.....

These are what we call "boat payments". Stable patients on chemo pay the mortgage (and the private school tuition for your kids, and the alimony). If you want excitement, try critical care.

 

[HemeOncBound87]

Actually, I didn’t mean it as a negative sorry. I prefer the stable chemo patients and I just wasn’t sure if that is reflective of real oncologic practice.

How do insurance companies effect your day to day work? As a resident, this hasn’t come up that often.

 

[RainerMaria]

Inpatient medicine burns me out due to heavy page burden and having to direct my attention to many different things at once. I feel more relaxed when I can devote myself to one thing at a time

Fortunately or unfortunately, multitasking is part of the job. I'm not sure primary care or hematology have an advantage in this department. My attendings in hematology are paged constantly for mundane tasks which could be answered by a RN. My friends in primary care are similarly distracted multiple times per 15 minute slot. Patients get equally upset when told they have incurable advanced cancer as when they are told that you will not be prescribing opiates for their chronic back pain. Arguably I would say IM hospitalists have the easiest time in terms of distractions. If they have difficult patients, they can rest assured they won't have to deal with them in 2 weeks time.

You may feel overwhelmed from being a PG2, but realize you are an indentured servant, still, and that the attending life is still a lot better (although in other ways worse). If you're feeling burned out now, I would try to address this now in terms of your own wellness and your approach to work, rather than sweeping it under the rug. PCP and fellowship are hard in their own right and these problems will only fester if unaddressed.

As for career choice: Do you want to take care of cancer patients in a moment of need, for usually a finite period of time, and then well-baby checks in survivorship, or patients with internal medicine problems (DM, heart failure, asthma, COPD, preventive medicine) throughout their lifecycle?

If you are really drawing a blank, then I would spend some elective time with PCPs and oncologists and see which one feels more your speed.

 

[HemeOncBound87]

Fortunately or unfortunately, multitasking is part of the job. I'm not sure primary care or hematology have an advantage in this department. My attendings in hematology are paged constantly for mundane tasks which could be answered by a RN. My friends in primary care are similarly distracted multiple times per 15 minute slot. Patients get equally upset when told they have incurable advanced cancer as when they are told that you will not be prescribing opiates for their chronic back pain. Arguably I would say IM hospitalists have the easiest time in terms of distractions. If they have difficult patients, they can rest assured they won't have to deal with them in 2 weeks time.

You may feel overwhelmed from being a PG2, but realize you are an indentured servant, still, and that the attending life is still a lot better (although in other ways worse). If you're feeling burned out now, I would try to address this now in terms of your own wellness and your approach to work, rather than sweeping it under the rug. PCP and fellowship are hard in their own right and these problems will only fester if unaddressed.

As for career choice: Do you want to take care of cancer patients in a moment of need, for usually a finite period of time, and then well-baby checks in survivorship, or patients with internal medicine problems (DM, heart failure, asthma, COPD, preventive medicine) throughout their lifecycle?

If you are really drawing a blank, then I would spend some elective time with PCPs and oncologists and see which one feels more your speed.

Appreciate the reply! I have done elective time in outpatient oncology and have PCP continuity clinic regularly. I love both!

 

[HemeOncBound87]

I hate to be that guy but can anyone comment on the relative lifestyles of both?
I feel like the hours as a PCP are a lot better than private practice Heme/onc. Is this true?

 

[gutonc]

I hate to be that guy but can anyone comment on the relative lifestyles of both?
I feel like the hours as a PCP are a lot better than private practice Heme/onc. Is this true?

I don't know. The parking lot is pretty full when I roll in and when I leave, suggesting I'm working less than most other folks.

 

[Server10]

Hi everybody,
I am a current PGY2 and am struggling between solid oncology vs primary care. Inpatient medicine burns me out due to heavy page burden and having to direct my attention to many different things at once. I feel more relaxed when I can devote myself to one thing at a time. Thus, hospitalist work is out of the question for me.

I need help figuring out what is the best fit for me. I want a job where I can feel fulfilled and not burnt out. I don't care about salary/ prestige. I can go through the stress of fellowship but want decent quality of life afterwards.

About me :
- I like continuity with patients
- I like emotionally meaningful encounters and don't get easily burnt out by sad situations
- I am an average communicator at best ( makes me worry I won't do a good job with oncology patients)
- I love the subject of oncology/ basic science / reading journal articles
- I can deal with the mundane and sometimes prefer it ( URIs , disability paperwork, etc)
- I don't mind writing notes/ administrative work
- I don't do well with a lack of sleep ( somewhat worried about having to take overnight call in oncology) and long hours definitely burn me out ( I am soft, I know)
- I don't do well with hostile patient encounters ( anger burns me out)/ hostile people in general .
- I am worried I won't find PCP work meaningful
- I find it stressful when patient's question everything I recommend / distrust me or see me as someone who is there to just order whatever lab or vitamin supplement they researched online.

Can anyone share what they see as the pros and cons of being in oncology and based on what I have shared if oncology is a good fit for me? I am leaning towards it but my biggest fear is that the work will be too stressful for me. Has anyone else decided between the two ?

I was exactly in your boat when applying to heme/onc fellowship. I knew that I would quickly be burned out by hospitalist medicine as a profession, and I was debating on doing primary care vs heme/onc fellowship. I want to give you my thoughts in depth, because when I was in your boat, no one could relate to my situation (most people in internal medicine are either going for hospitalist or fellowship) and thus couldn't really give me good advice.

The first thing I can say is that it's a very tough decision. The fact that you're considering both indicates you could legitimately see yourself doing either field. No field in medicine is perfect, and there will always be a part of yourself that might second guess your decision a little, and that's normal.

I ended up going into heme/onc, and I love it. True yes there is some aspect of being pulled in many directions, but on the flip side I would say it's a million times better than being a hospitalist and getting hit with 5 new admissions at once, while still having 15-20 others to round on, consulting a plethora of services, and juggling all of these things at once (literally just trying to get through the day). In heme/onc you also have a lot of resources in the clinic setting (medical assistants, chemo nurses, chemo pharmacists, social workers, chemo educators, research coordinators, etc) who I feel are there to make your work life legitimately better. Yes there are some mundane tasks that you get stuck with, but it's not too bad.

On the other hand, primary care won't have the same complexities and complications, so it's easier in that regard, but seeing patients with basic complaints which aren't very intellectually stimulating can become very mundane, and can certainly lead to burn out.

The fact that you like emotionally meaningful encounters, continuity with patients, and reading basic science / oncology literature all indicate that you could do well with oncology, because that's the bulk of it right there. There's a tremendous amount of learning / reading in oncology compared to primary care (and really compared to all other fields of medicine), and you have to be ready for a lifetime of keeping up with literature and new studies, for the sake of your patients and for your board certifications. You also have to be ready to commit to a 3 year fellowship, at a time where many people are settling down, earning money, etc, you're still in "training mode".

I wouldn't worry too much about the overnight call - in fellowship it can be busy, but I would say it's definitely not as rough as medicine residency (especially if you trained at a busy academic medical center), and after fellowship you can choose your practice environment - some private practice oncologists in larger groups are on overnight home call only ~3x/month (and maybe 1 in 5 weekends), and even then, they aren't called very much when they are on (although of course you have to be ready to come in to the hospital on those nights - primary care you may never be on at night in many practices).

The fact that you feel you may not find PCP work meaningful and find it stressful when patients question everything you recommend is a negative for going into primary care. Because there will be a decent amount of that. You have to be ready to communicate things in a way which makes the patient trust your recommendation. You might recommend a test/procedure/medication for them, but if they don't feel comfortable they might not follow your instructions. And that in turn leads to frustration for you. That being said, one thing that you don't experience in residency is having true "continuity". In residency you see new/different patients all the time, even in the clinic environment. In private practice primary care, once you've seen a patient 2-3x, they see you as a friend. They trust your recommendation. I would say in primary care, 8 of out 10 interactions will involve patients trusting your recommendation, and maybe 2 out of 10 will require more in depth counseling. Whereas in oncology, the diagnosis of cancer can of course be very overwhelming for patients. They may have looked up some information on their own, but because of the complexities of the field of oncology, they by default want to trust what you have to say. There's more counseling too of course, but in general patients are very willing to listen to you, and you have assistance from your staff / chemo-educators / clinic coordinators with that as well.

In the end I would say if you feel comfortable doing another 3 years of training, reading oncology literature consistently for the rest of your career, and having call / after hours responsibilities for the rest of your career (although the call is not bad at all, it's still a factor), go for heme/onc, because it's very rewarding being able to make a huge difference in patients' lives, and it's very interesting from an intellectual standpoint.

However, if you're not about that schedule and prefer M-F 8-5, no nights, no weekends, you like reading literature but maybe not THAT much, not really super enthusiastic of doing another 3 years of training, and you feel like you may not want to deal with all of the complexities of cancer/chemotherapy (especially after hours), go for primary care. You get great continuity with patients and especially if you like talking to people it will be a great career. It will be a little bit more chill compared to oncology, straight up. But in the end, you can't go wrong with either field. Best of luck in your decision.