How onerous are on-calls in heme/onc?

[Doc mu]

and how much do they impact your life?


and why do heme/onc have some of the lowest wRVUs on MGMA?

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[HemeOncHopeful19]

Not bad but Derm or A/I is better.

Onc has some of the highest $/wRVU in medicine. Your second question makes me think you don’t understand wRVUs enough to ask whatever question you actually have.

 

[gutonc]

and how much do they impact your life?

To broad a question to be meaningfully answered. Depends far too much on your practice type, location, expectations, etc. My old job (academ-ish community group covering 6 hospitals with 14 docs) had a pretty chill call schedule and workload. My current job (rural-ish CAH) has the perfect call schedule (Q Never).

and why do heme/onc have some of the lowest wRVUs on MGMA?

Yeah, you clearly don't know what you're asking here. What's the actual question you're trying to get at?

 

[Doc mu]

Not bad but Derm or A/I is better.

Onc has some of the highest $/wRVU in medicine. Your second question makes me think you don’t understand wRVUs enough to ask whatever question you actually have.

The median compensation per work RVU for oncologists is $96.45, the highest among individual specialties, Oncologists receive a significant share of compensation from Part B drugs like chemotherapy, which are not paid on the basis of work RVUs.

but compared to other outpatient specialties the number of wRVUs done by oncologists is lower than other specialties and I was wondering why since this means they see less pts probably

How frequently do you get called for questions and go to the hospital during on-calls?

 

[Doc mu]

To broad a question to be meaningfully answered. Depends far too much on your practice type, location, expectations, etc. My old job (academ-ish community group covering 6 hospitals with 14 docs) had a pretty chill call schedule and workload. My current job (rural-ish CAH) has the perfect call schedule (Q Never).

Yeah, you clearly don't know what you're asking here. What's the actual question you're trying to get at?

the number of wRVUs done by oncologists is lower than other specialties and I was wondering why since this means they see less pts than others

How common would you say it is for oncos to have a difficult call schedule

 

[gutonc]

The median compensation per work RVU for oncologists is $96.45, the highest among individual specialties, Oncologists receive a significant share of compensation from Part B drugs like chemotherapy, which are not paid on the basis of work RVUs.

Again, you clearly don't know what you're talking about here. While it's true that oncologists in a true PP group will get a direct cut of infusion revenue, the rest of us get it indirectly through that high $/wRVU, because that's where that # comes from. Otherwise, we'd be getting paid the same $50/wRVU everyone else is.

but compared to other outpatient specialties the number of wRVUs done by oncologists is lower than other specialties and I was wondering why since this means they see less pts probably

Because the marginal value of that extra income often isn't worth the work. There are plenty of oncologists out there hustling for 9-10K wRVU a year, but many of us are cool with a calmer and still highly remunerative workload.

How frequently do you get called for questions and go to the hospital during on-calls?

Again, essentially an unanswerable question given the massive number of variables. I've described a number of different call systems in my area in prior posts here. My own personal experience in my old job was that I took 4 weekend calls a year that generally had me seeing 3-6 patients a day on the weekend. On weeknight call (1-2x/month) the call volume varies (I had a number of no hitters) and I can count on 1 finger the number of times I went back to the hospital in 11 years to admit a patient after hours, and that was just because I had to go pick up my kid, take her home and feed her dinner before the patient got to the hospital. Otherwise I probably would have just stayed at the office until the patient arrived.

 

[Doc mu]

Again, you clearly don't know what you're talking about here. While it's true that oncologists in a true PP group will get a direct cut of infusion revenue, the rest of us get it indirectly through that high $/wRVU, because that's where that # comes from. Otherwise, we'd be getting paid the same $50/wRVU everyone else is.

Because the marginal value of that extra income often isn't worth the work. There are plenty of oncologists out there hustling for 9-10K wRVU a year, but many of us are cool with a calmer and still highly remunerative workload.

Again, essentially an unanswerable question given the massive number of variables. I've described a number of different call systems in my area in prior posts here. My own personal experience in my old job was that I took 4 weekend calls a year that generally had me seeing 3-6 patients a day on the weekend. On weeknight call (1-2x/month) the call volume varies (I had a number of no hitters) and I can count on 1 finger the number of times I went back to the hospital in 11 years to admit a patient after hours, and that was just because I had to go pick up my kid, take her home and feed her dinner before the patient got to the hospital. Otherwise I probably would have just stayed at the office until the patient arrived.

LOL count on one finger, sounds like a sweet gig if there really are no emergencies that you need to go in for, would you say advances in therapy have made the "all your pts will die on you" stereotype obsolete?

 

[gutonc]

LOL count on one finger, sounds like a sweet gig if there really are no emergencies that you need to go in for, would you say advances in therapy have made the "all your pts will die on you" stereotype obsolete?

That's what hospitalists are for. My presence in the hospital is meaningless and only adds to cost of care about 95% of the time. The very few oncologic emergencies that exist are either managed by someone else (cord compression) or can be dealt with by a phone call and an order or two in the EMR. I always ask whoever's calling me if they need me to come in right then, to which they inevitably say no, and then tell them not to hesitate to call me back if they need more help or anything changes.

The vast majority of the inpatient work I did in my last job, and 100% of what I do now, can best be described as "social visits".

And just to be clear, everyone's patients will die on them. They just tend to do it on our watch more frequently than, say, the dermatologist.

 

[Doc mu]

That's what hospitalists are for. My presence in the hospital is meaningless and only adds to cost of care about 95% of the time. The very few oncologic emergencies that exist are either managed by someone else (cord compression) or can be dealt with by a phone call and an order or two in the EMR. I always ask whoever's calling me if they need me to come in right then, to which they inevitably say no, and then tell them not to hesitate to call me back if they need more help or anything changes.

The vast majority of the inpatient work I did in my last job, and 100% of what I do now, can best be described as "social visits".

And just to be clear, everyone's patients will die on them. They just tend to do it on our watch more frequently than, say, the dermatologist.

Yeah I think the most common cancers being the most deadly cancers is possibly the biggest downside to onco and I also hypothesize it is the reason they always rank very highly on burnout surveys because in almost every other way it is a very nice chill job

 

[HemeOncHopeful19]

Yeah I think the most common cancers being the most deadly cancers is possibly the biggest downside to onco and I also hypothesize it is the reason they always rank very highly on burnout surveys because in almost every other way it is a very nice chill job

 

[Doc mu]

Breast, lung and bronchus, prostate, and colorectal cancers account for almost 50% of all new cancer cases in the United States.

Lung and bronchus, colorectal, pancreatic, and breast cancers are responsible for nearly 50% of all deaths

Stats don't lie

 

[whoknows2012]

Breast, lung and bronchus, prostate, and colorectal cancers account for almost 50% of all new cancer cases in the United States.

Lung and bronchus, colorectal, pancreatic, and breast cancers are responsible for nearly 50% of all deaths

Stats don't lie

We may have a numerator denominator problem here…


May I ask what level of training you’re at? Have you not had clinical experience in patients with cancer?

Regarding your call question I’m an inpatient leukemia doc, am on call 24/5 (and whatever weekends I work) for my patients and any new leuks that come in. Even that amount of call isn’t particularly burdensome because a) they’re all my patients and I know them well (and new leuks are actually pretty straightforward unless they need urgent cytoreduction) b) I never have to come in and c) I’ve trained my team well and most non emergent calls can be dealt with sans my involvement. The fellows take first call on outpatient calls and inpatient consult (typical academic center)

 

[gutonc]

Breast, lung and bronchus, prostate, and colorectal cancers account for almost 50% of all new cancer cases in the United States.

Lung and bronchus, colorectal, pancreatic, and breast cancers are responsible for nearly 50% of all deaths

Stats don't lie

You are correct that people with advanced cancer tend to die from it. Pretty much everything else you're stating is either patently false or imaginary.

 

[Doc mu]

You are correct that people with advanced cancer tend to die from it. Pretty much everything else you're stating is either patently false or imaginary.

Then how would you justify the consistently high burn out in the field?

 

[HemeOncHopeful19]

Then how would you justify the consistently high burn out in the field?

“Patently false or imaginary.”

 

[MD46]

Then how would you justify the consistently high burn out in the field?

What burn out? Who are u asking this? what level of training r u at? Oblivious to many things it seems like

almost borderline trolling now tbh….

 

[CluvK]

It seems that the OP is a surgical resident in orthopedics in another country (PGY-2 maybe?). To be honest, in my humble opinion, orthopedics is more prone to burnout than hem/onc...

 

[bobsmith]

Honestly, not sure what your goal is here aside from trolling

From my experience, pretty much all of my colleagues seem happy with our choice to go into oncology;

However, it's really not for everyone. Some physicians seem terrified of even saying the word "cancer" around patients (and will consult me to say it instead!)

 

[TexasMed22]

It seems that the OP is a surgical resident in orthopedics in another country (PGY-2 maybe?). To be honest, in my humble opinion, orthopedics is more prone to burnout than hem/onc...

I dunno, many of the private practice orthopods in my metro area work 4 days a week, have their PAs take first call, and make >700 a year. Ortho seems to be a good life (in the US at least). Just have to survive the residency

 

[HemeOncHopeful19]

I dunno, many of the private practice orthopods in my metro area work 4 days a week, have their PAs take first call, and make >700 a year. Ortho seems to be a good life (in the US at least). Just have to survive the residency

And the divorce, and the second marriage to the CRNA or device rep! Nah I mean most Orthos I know are pretty happy.

But the ones that aren’t are super buttheads so nobody hangs out with them so may be some selection going on there

 

[Doc mu]

I dunno, many of the private practice orthopods in my metro area work 4 days a week, have their PAs take first call, and make >700 a year. Ortho seems to be a good life (in the US at least). Just have to survive the residency

PA won't be stuck in the hospital till 11pm doing the fx surgeries that came in after a full day of work...

 

[gutonc]

PA won't be stuck in the hospital till 11pm doing the fx surgeries that came in after a full day of work...

I fail to see how ortho call is relevant to the topic at hand.

I’m also still trying to figure out what your actual question is and how relevant it is to your career as an ortho outside the US.

 

[Doc mu]

I fail to see how ortho call is relevant to the topic at hand.

I’m also still trying to figure out what your actual question is and how relevant it is to your career as an ortho outside the US.

I just wanted to see how lifestyle is like in heme onco bcz I know an IM program director in the US that invited me to apply and so I was consiering it but ortho residency is wearing me down so I wouldn't want to do something with the same kind of life and gastro + heme/onc are the only specialties in IM that interest me

 

[Ubba]

I just wanted to see how lifestyle is like in heme onco bcz I know an IM program director in the US that invited me to apply and so I was consiering it but ortho residency is wearing me down so I wouldn't want to do something with the same kind of life and gastro + heme/onc are the only specialties in IM that interest me

Do not try to enter IM residency with a definitive plan to pursue Heme/Onc or GI. Even for USMDs with reasonably good academic performance, this is not a generally wise bet to make.

 

[Doc mu]

Do not try to enter IM residency with a definitive plan to pursue Heme/Onc or GI. Even for USMDs with reasonably good academic performance, this is not a generally wise bet to make.

I also enjoy IM and endo so not matching my top fellowships is not that big of a deal to me

 

[osprey099]

I just wanted to see how lifestyle is like in heme onco bcz I know an IM program director in the US that invited me to apply and so I was consiering it but ortho residency is wearing me down so I wouldn't want to do something with the same kind of life and gastro + heme/onc are the only specialties in IM that interest me

Matching into Heme-Onc as an international grad is an extremely uphill battle. Most likely, the IM PD you're referring to is probably a PD of a random community hospital. Matching into heme-onc from a community IM program is also an extremely uphill battle. If you have both of these things working against you, let alone switching from a whole other specialty (which can be seen as a red flag), the odds are extremely not in your favor.

 

[Doc mu]

Matching into Heme-Onc as an international grad is an extremely uphill battle. Most likely, the IM PD you're referring to is probably a PD of a random community hospital. Matching into heme-onc from a community IM program is also an extremely uphill battle. If you have both of these things working against you, let alone switching from a whole other specialty (which can be seen as a red flag), the odds are extremely not in your favor.

I also enjoy IM 7 on/off is very very appealing so I don't really mind not matching, i'm not even sure i'll apply tbh but the program has in house heme/onco and in house GI so I think I may have a shot if I really wanted to, can easily hide the pgy 1 in ortho if its a red flag too.
I am also a western european IMG which I think is looked upon more favourably

 

[HemOncCheng]

I just wanted to see how lifestyle is like in heme onco bcz I know an IM program director in the US that invited me to apply and so I was consiering it but ortho residency is wearing me down so I wouldn't want to do something with the same kind of life and gastro + heme/onc are the only specialties in IM that interest me

Here you go, it is better to provide backdrop and real question to avoid some ambiguity from the start