Is Hem-Onc fellowship worth it?

[Bendamustine]

Hi this post is not to underestimate the importance of Hem-Onc (which is my dream branch), but just to get an idea about life after fellowship.

I am a second year Internal Medicine resident in a community hospital in mid-west. I am an IMG on a J1 visa with decent Step scores but no research. My hospital does not have in house fellowships. However I did go to the top med school in my country and hence have a lot of contacts in Hem-Onc.

My dream is to work as an Oncologist, but with my background I know I wouldn't match in my first attempt. So I am thinking of doing a 1 year fellowship in Palliative/Hospice care and re-apply again.

My main concern is my age, I'm already 33 and would be 34 when I finish residency. So that would be another 4 years of fellowship, so I would be 38 when I finish Hem-Onc. I am kinda confused whether to pursue this pathway.

Honestly money is also an important factor, if I chose this pathway, I would lose 4 years of salary as an Hospitalist and live on minimum wage during fellowships.

Do you guys think it is worth pursuing it, from money and my age stand point? Will I be able to earn well and more than a hospitalist after fellowship?

Sorry if the post is long. Your opinion is appreciated.

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[spacegun]

Random thoughts in no particular order:

* Since you haven't applied even once, just apply and see if you can get in first of all. If not, then you can consider doing a pall care fellowship or not.

* Maybe doing a hospitalist year (if possible primarily in hem and/or onc and at a place with a hem-onc fellowship) plus doing research during that time might be better than doing a pall care fellowship? Not only to pad your CV for hem-onc but to pad your wallet too.

* According to places like White Coat Investor it's probably not worth doing a fellowship if it's only for the money (eg opportunity costs, time value of money, accruing interest on loans). Then again, as an IMG maybe you don't have student loans to worry about.

* As far as age, do you mean is it a concern in getting accepted like unofficial age discrimination? For what it's worth I once met a hem-onc fellow in their 40s so I guess age wasn't an issue in getting in. This was a mid tier academic program. Anyway unofficial age discrimination is probably program dependent.

* Or do you mean age in years left to work and earn money? If so, late 30s is still young.

* I think according to MGMA a year or two ago hem-onc median around $400-$450k give or take. Hospitalist just under $300k.

* Consider whether you can have a longer and more fulfilling career as a hospitalist or as hem-onc. For example, if you are neutral about being a hospitalist and quit after a few years vs. if love hem-onc and work for decades, then it'd be worth it to do hem-onc. Lots of other possibilities, but you have to know yourself. (And I say this as I'm trying to figure things out too!)

 

[Bendamustine]

Random thoughts in no particular order:

* Since you haven't applied even once, just apply and see if you can get in first of all. If not, then you can consider doing a pall care fellowship or not.

* Maybe doing a hospitalist year (if possible primarily in hem and/or onc and at a place with a hem-onc fellowship) plus doing research during that time might be better than doing a pall care fellowship? Not only to pad your CV for hem-onc but to pad your wallet too.

* According to places like White Coat Investor it's probably not worth doing a fellowship if it's only for the money (eg opportunity costs, time value of money, accruing interest on loans). Then again, as an IMG maybe you don't have student loans to worry about.

* As far as age, do you mean is it a concern in getting accepted like unofficial age discrimination? For what it's worth I once met a hem-onc fellow in their 40s so I guess age wasn't an issue in getting in. This was a mid tier academic program. Anyway unofficial age discrimination is probably program dependent.

* Or do you mean age in years left to work and earn money? If so, late 30s is still young.

* I think according to MGMA a year or two ago hem-onc median around $400-$450k give or take. Hospitalist just under $300k.

* Consider whether you can have a longer and more fulfilling career as a hospitalist or as hem-onc. For example, if you are neutral about being a hospitalist and quit after a few years vs. if love hem-onc and work for decades, then it'd be worth it to do hem-onc. Lots of other possibilities, but you have to know yourself. (And I say this as I'm trying to figure things out too!)

Thank you very much for the reply.

1.) Problem of doing a year of hospitalist is that, I am on a J1 Visa and it's not possible for me to just work for a year as an hospitalist, if I have to work as an Hospitalist, then I would have to work for a minimum of 3 years.
2.) Yeah to be frank as an IMG I do not have any loans to repay, I am single with no dependents, so even during residency I am able to save around 50% of my stipend.
3.) I am not worried about age discrimination, just feel that I my education is getting prolonged ( I got into med school when I was 19 years old and since then its just been academics with no break).
4.) I'm willing to sacrifice another 3-4 years and work life long in some field I'd love then work as an Hospitalist.

 

[HemeOncHopeful19]

If money is a factor then you will make well above MGMA median *IF YOU WANT* and *IF THINGS STAY THE SAME* which are some big IFs.

Onc is currently very in demand but that can change in 5-10 years who knows. It is much easier to find a job for $5-600+ today in Oncology than it is to find $4-450+ as a hospitalist IMO. Also while the threat of big academic/Wall Street buy out is similar in Onc the midlevel threat is lower in the long term.

I find a lot of people especially IMGs feel a need/social or spouse pressure to work in da big city and bring average salaries down. If that is you then you may very well be better off a hospitalist financially.

I have no idea but I don’t know how helpful palliative care is for Heme/Onc. You might consider doing 3 years of hospitalist at a smaller academic place with a Heme Onc fellowship where you could make connections but I honestly don’t know what the best advice is so maybe don’t listen to me.

 

[gutonc]

Hi this post is not to underestimate the importance of Hem-Onc (which is my dream branch), but just to get an idea about life after fellowship.

I am a second year Internal Medicine resident in a community hospital in mid-west. I am an IMG on a J1 visa with decent Step scores but no research. My hospital does not have in house fellowships. However I did go to the top med school in my country and hence have a lot of contacts in Hem-Onc.

My dream is to work as an Oncologist, but with my background I know I wouldn't match in my first attempt. So I am thinking of doing a 1 year fellowship in Palliative/Hospice care and re-apply again.

You don't know unless you try. Apply and see how it goes. HPM or a hospitalist year or two could help springboard you into oncology, or perhaps you could find a new clinical passion.

My main concern is my age, I'm already 33 and would be 34 when I finish residency. So that would be another 4 years of fellowship, so I would be 38 when I finish Hem-Onc. I am kinda confused whether to pursue this pathway.

I was 40 when I finished fellowship. Never even crossed my mind that it was an issue. I was doing what I wanted to do.

Honestly money is also an important factor, if I chose this pathway, I would lose 4 years of salary as an Hospitalist and live on minimum wage during fellowships.

3-4 years, yes. But fellowship is NOT a minimum wage job. With moonlighting, which I did all throughout fellowship, I was making (just barely) 6 figures as a fellow, and I was probably on the low end, some of my co-fellows were in the $150-200K range...but they worked for it.

Do you guys think it is worth pursuing it, from money and my age stand point? Will I be able to earn well and more than a hospitalist after fellowship?

That's not the right question to ask. The question is, which path will bring you more happiness in your career. Since the median oncologist makes almost double what the median hospitalist makes, your opportunity cost isn't nearly as bad as you think it is. Sure, you're giving up $150-200K/y for 3 years if you go the fellowship route instead of hospitalist...but if you skip fellowship, and stick with hospitalist, you're giving up that same amount of money each year for the rest of your career.

Bottom line, if you want to be an oncologist, then yes, fellowship is worth it. If you think oncology would be OK, but so would being a PCP or a hospitalist, then maybe not. that's a decision that only you can make.