Life after fellowship...

[Oncmudphud]

I'm a second year fellow single-boarding in medical oncology at a very research-intensive fellowship program. The vast majority of the patients I see in our clinics are on clinical trials. Even my continuity clinic is largely made up on trial patients. I've gotten fairly comfortable managing clinical trial complications... but I'm worried about how well that's going to translate to being employable as an oncologist. I did get some (~4 months) of dedicated standard-of-care rotations during first year. We also have a pretty flexible curriculum after first year, and I've tacked on an additional six months each of GU onc (lots and lots of prostate cancer) and breast oncology. I feel comfortable with breast cancer and pretty solid with prostate cancer... but there are still lots of areas where I lack prolonged clinical exposure.

I came into fellowship thinking academics or bust. I'm leaving fellowship with the firm knowledge that I do not want to do straight academics, and I most certainly do not want to solely see clinical trial patients. Too depressing. I'm starting to look at jobs now, and think a hybrid position is the best fit for me. I'd love to see only breast in that situation, but the more likely scenario is that I'll be seeing general onc. What I'm trying to figure out is where should I put most of my clinical effort next year. I assume lung and GI would be the two biggest bang-for-my-buck areas. Any other areas I should consider?

I'm also just trying to figure out how comfortable people are with their clinical oncology exposure on graduation, especially coming out of more clinical-heavy fellowships. Like, did you graduate feeling like you knew how to treat everything that might pop up? When you think about it, 1.5 years of clinical training isn't exactly a lot of time... I'm assuming there's a lot of learning that takes place during the first few years (and beyond) of practice. I'm kind of an anxious person at baseline, so it's hard for me to differentiate my baseline anxiety over stuff that doesn't matter from things that are actually important.

TL;DR: if I'm gonna practice general onc, what're the areas I should attempt to master during fellowship?

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[gutonc]

I think you've got a pretty good handle on what you should be spending your time on next year if you're looking for a community or hybrid job. Positions where you just see breast or GU (or whatever) are out there in the community, but they are less common than in academics. So you'll definitely set yourself up better for the job market if you have broader experience, but it's unlikely people in community practice will be turned off by a disease interest/focus, as long as you've got the chops for the rest of it.

As for being comfortable, I'm 9 years out. I'll let you know when I get comfortable with it all.

Honestly, for at least the first 2 years I double and triple-checked everything. Even the stuff I was 100% certain about. I'd spend an hour or more prepping each new patient the day before clinic and even reviewed all of my follow-up patients ahead of time. Now I take 30 seconds before I walk in the room and feel pretty good about things.

 

[beyondbethany]

I'm also just trying to figure out how comfortable people are with their clinical oncology exposure on graduation, especially coming out of more clinical-heavy fellowships. Like, did you graduate feeling like you knew how to treat everything that might pop up?

I'm in my first year of community practice. I came from a clinical heavy program and I sought as much clinic experience as I could in every area knowing I wouldn't have a future in academics or research. I feel like I have a good broad base but I look up things all day every day. There's so much going on in every disease site it's impossible to feel like you're ready to treat everything - its constantly changing. Learn basic concepts and be adaptable.

I assume lung and GI would be the two biggest bang-for-my-buck areas. Any other areas I should consider?

Good choices to go with your GU and breast experiences already mentioned. Make sure you get some mal heme in a clinic setting as its far different than the wreckage you see in the inpatient setting as a fellow.

 

[onconconconconc]

I am in my first year out of fellowship with a very similar background, now in a job very similar to what you describe (hybrid academics, mostly disease-specific). I didn't have my own continuity clinic in fellowship, and I did not feel clinically prepared to be an attending. I am learning a lot on the fly, leaning heavily on NCCN and UTD. It is fairly anxiety provoking. However, I am told that many new attendings go through this, regardless of their background. Personally, I wasn't able to do as many extra clinics as I had planned after I was conscripted into unpaid COVID hospitalist coverage during the second half of my third year.

If you are sure you want a clinical career, I recommend learning to ignore the priorities of your institution a little (research, grants) and to not feel guilty about seeking extra clinical experiences. You might not want to burn your bridges in academia entirely, though, keeping in mind that you may want exit opportunities to pharma or back to academics in the future.

Many hybrid jobs are moving toward disease-specific focus (depends on your geographic area) - so it might be helpful to see what sort of jobs are out there for you before cycling though every single clinic. I wouldn't worry as much about lack of clinical experience hindering you in the job search since academic hybrid jobs like to see candidates who are focused, come from good names, have research credentials etc. Feel free to PM me