Patient demographics

[futuredoc1297]

Hi all,

I'm considering pursuing heme/onc following IM. I'm wondering if it's possible to more or less control the types of patients you see. For instance, I'm much more interested in the younger patients, though not necessarily pediatrics - it's not so much that I want to be with very young patients as much as it is I don't want to be with older patients. Given that most patients in this specialty are older (≥ 60 y/o I believe), I'm wondering how many patients will be younger (25-60 y/o). I just see myself enjoying working with patients whose lives have yet to be lived fully (not that older patients have less to live for, of course).

Any help would be great.

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[DoctorDontStop]

Your best chance at this age group is to be the ALL or Germ Cell guy in an academic center. Those malignancies typically occur in younger patients but not always. If you go into private practice you will definitively have to see old patients. Transplant patients also tend to be "younger", so you could have a career in BMT. In short, academics is your best bet to carve out a "niche" patient population.

 

[gutonc]

If you want a younger (less adherent, more dramatic) patient population in oncology, agree with germ cell, ALL and sarcoma. None of those are going to be universally young and all will pigeonhole you into academics (or close to it). The good news is that, except for germ cell, most of the rest of us want nothing to do with those cancer types anyway so you shouldn't have a hard time finding such jobs.

But honestly, if you want "young" patients, why not do Peds or Med/Peds and then do AYA oncology?

 

[futuredoc1297]

Your best chance at this age group is to be the ALL or Germ Cell guy in an academic center. Those malignancies typically occur in younger patients but not always. If you go into private practice you will definitively have to see old patients. Transplant patients also tend to be "younger", so you could have a career in BMT. In short, academics is your best bet to carve out a "niche" patient population.

If you want a younger (less adherent, more dramatic) patient population in oncology, agree with germ cell, ALL and sarcoma. None of those are going to be universally young and all will pigeonhole you into academics (or close to it). The good news is that, except for germ cell, most of the rest of us want nothing to do with those cancer types anyway so you shouldn't have a hard time finding such jobs.

But honestly, if you want "young" patients, why not do Peds or Med/Peds and then do AYA oncology?

Thank you both for the responses.

I am hesitant to pursue academics, as I want to have a balance of clinical-work-to-research that weighs heavier on the side of clinical work. I'm far more interested in treating patients than I am research, and I've been told that those who pursue academics wind up having the balance weigh heavier in the other direction.

The reason why I'm hesitant to pursue peds is that I'm not entirely sure I want to limit myself to just pediatric patients. I guess the more accurate way of getting to the point I was trying to make is simply saying that I feel I see myself fitting better in settings where I can fight to give a patient an entire life vs. a few extra years (aka, extending the life of a younger patient so they can reach an older age vs. giving a patient of older age a few extra years at best). Thus, it's not so much that I really enjoy pediatrics patients; it's more that I want to see patients for whom treatment means an entire life vs. a few good years.

If either of you can comment on this, that would be greatly appreciated!

I guess my next question would be what percentage of my patients would belong to the "younger" demographic (20-60 y/o)? Is it the case that the majority of patients will be > 60 y/o, and I'll just see a few younger cases beyond that? And if I were to go academic and, say, carve out a niche, is it unreasonable to expect more clinical work than research?

Also, @gutonc , can you expand more on AYA oncology and the path one takes getting there?

 

[HemeOncHopeful19]

From your post history I see that you’re just finishing up your first year of school. You will discover a lot of your answers of what you like to do during your third year of medical school. Very few people wonder if Peds is right for them they either know it is or it isn’t in my experience!

 

[gutonc]

I guess my next question would be what percentage of my patients would belong to the "younger" demographic (20-60 y/o)? Is it the case that the majority of patients will be > 60 y/o, and I'll just see a few younger cases beyond that? And if I were to go academic and, say, carve out a niche, is it unreasonable to expect more clinical work than research?

The assumption that "old people" can't be given more than just "a few extra years at best" while "young people" can always be given a full lifespan is fairly naive (but typical of an M1, so I'll give you a pass on that). But to answer your question, if you take just age as a factor, using the arbitrary cutoff of 60 which you gave as an example, my last 2 weeks of clinic worked out to 35% <60 (about 2/3 of those 50-60) and 65% 60+.

But now let's look at the metric you actually seem to care about, which is "curability"...AKA, can you take (largely) cancer out of the survival equation for this person. Again for my clinic the last 2 weeks, 67% of my patients were "curative intent" or benign heme and the rest pallaitive/incurable. Of the palliative/incurable set though, almost half (45%) were <60, and half of those <40. Use this data as you see fit.

Also, @gutonc , can you expand more on AYA oncology and the path one takes getting there?

AYA is "Adolescent and Young Adult" and typically covers leukemias, lymphomas and sarcomas. I know 2 folks who do this. One is a leukemia BMT doc and the other does sarcoma. Both are med/peds trained, one did a combined Peds/Adult Hem/Onc fellowship, the other did adult only. Both work in academics.

You can always get a largely clinical job in academics. They need people to move the meat as much as community based practice does.

 

[futuredoc1297]

From your post history I see that you’re just finishing up your first year of school. You will discover a lot of your answers of what you like to do during your third year of medical school. Very few people wonder if Peds is right for them they either know it is or it isn’t in my experience!

Yes I am just finishing up. I know I have a long way to go, it’s just that I’ve recently had a revelation that I want a more intimate and long term relationship with my patients than surgical specialties affords, and the only non-surgical specialty Ive thought about up until now has been oncology. I’ve loved the idea of oncology since I was a kid, and I’ve never wavered in that (I knew that even if I chose surgery, it would precede an onc fellowship). But, as you said, I have a long way to go and I have time on my side. Thanks for the reassurance!

 

[futuredoc1297]

The assumption that "old people" can't be given more than just "a few extra years at best" while "young people" can always be given a full lifespan is fairly naive (but typical of an M1, so I'll give you a pass on that). But to answer your question, if you take just age as a factor, using the arbitrary cutoff of 60 which you gave as an example, my last 2 weeks of clinic worked out to 35% <60 (about 2/3 of those 50-60) and 65% 60+.

But now let's look at the metric you actually seem to care about, which is "curability"...AKA, can you take (largely) cancer out of the survival equation for this person. Again for my clinic the last 2 weeks, 67% of my patients were "curative intent" or benign heme and the rest pallaitive/incurable. Of the palliative/incurable set though, almost half (45%) were <60, and half of those <40. Use this data as you see fit.


AYA is "Adolescent and Young Adult" and typically covers leukemias, lymphomas and sarcomas. I know 2 folks who do this. One is a leukemia BMT doc and the other does sarcoma. Both are med/peds trained, one did a combined Peds/Adult Hem/Onc fellowship, the other did adult only. Both work in academics.

You can always get a largely clinical job in academics. They need people to move the meat as much as community based practice does.

Thanks for being both blunt and patient with me! I’m sure you (and every other doc) hear naive claims from first years every now and again, so on behalf of us all, thanks for bearing through it.

I think I’ll look more into the more into the suggestions you’ve made! I’ll have to do some research and see what I come up with. I guess I didn’t realize all the different paths that exist to get to where I want to be!