Would you go into hem onc if you were a med student?

[TexasMed22]

We hear a lot about the doom and gloom for rad onc as a field, but as a med student, I hear very little about hem onc and its future. Overall, it seems like a solid field with a decent lifestyle, great compensation, and large future growth. Was just wondering what everyone on here thought?

Thanks

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[OTN]

I agree with those points. I prefer to do stuff rather than just write prescriptions or infusion regimens, so I wasn't as interested, but it's a great field to consider.

 

[RickyScott]

We hear a lot about the doom and gloom for rad onc as a field, but as a med student, I hear very little about hem onc and its future. Overall, it seems like a solid field with a decent lifestyle, great compensation, and large future growth. Was just wondering what everyone on here thought?

Thanks

cart cell and other modalities are probably going to be huge

 

[Fpg1245]

We hear a lot about the doom and gloom for rad onc as a field, but as a med student, I hear very little about hem onc and its future. Overall, it seems like a solid field with a decent lifestyle, great compensation, and large future growth. Was just wondering what everyone on here thought?

Thanks

Why are you posting here then? Why not start with the Heme onc board?

No one is gonna broadcast a good field.

 

[grenz]

The future is bright in terms of new treatments, but ultimately the vast majority of their patient panel dies from their disease and your bread and butter is prescribing medicines and managing side effects. The anatomical/surgical-like aspects are what drew me to rad onc. There will always be a role for radiation in the foreseeable future, but probably not a need for more of us like there is in Heme onc.

If rad onc wasn’t an option, I don’t think I would have done med onc. Probably cardiology or ortho or something. Would be tough because honestly nothing interested me as much as rad onc

 

[metallica81788]

I would look strongly into it, as most of us here probably enjoy the science behind it and also working with cancer patients. The field likely has a bright future.
But the day-to-day would drive me away. That grind would get old quickly.

If not in Radonc I would do radiology

 

[HemeOncHopeful19]

Any field in medicine is a gamble, H/O is a couple of reimbursement reforms away from being gutted just like anyone else.

Pick a field that interests you, doesn’t require a hospital, and preferably has little to no emergencies or is strictly 9-5 M-F.

 

[RickyScott]

Any field in medicine is a gamble, H/O is a couple of reimbursement reforms away from being gutted just like anyone else.

Pick a field that interests you, doesn’t require a hospital, and preferably has little to no emergencies or is strictly 9-5 M-F.

Some fields are more of a gamble than others.

 

[DebtRising]

Would have done Heme onc had I know rad onc would turn into this.

Heme onc is a great field in terms of geographic flexibility, compensation, and new treatments. And it has a default huge lobbying arm in Pharma that is a behemoth and every time the pharma lobby wins that’s a % win for Heme onc take home pay.

Clinic is clinic. Future is infinitely brighter than any other onc specialty.

 

[thecarbonionangle]

The time for HO in the grinder/guillotine of cuts will come. The gravy train cannot last forever.

 

[HemeOncHopeful19]

Some fields are more of a gamble than others.

That’s true, but in 2023 I would consider H/O more of an outlier in that it’s a non-procedural field that has relatively good pay (as unpopular as it is to say this in this part of the forum… I’m still waiting for an MGMA where it is higher than Rad Onc btw), and therefore definitely a bigger gamble than say any surgical subspecialty (although obviously these fields are completely different as far as daily activities). I hope I’m wrong for obvious reasons.

For example, Radiology is another field I would consider really attractive in 2023 but the No Surprises Act and a couple of reimbursement cuts later could be a completely different story by 2028-2033.

 

[thesauce]

cart cell and other modalities are probably going to be huge

If not these, then it’ll be the next thing that comes around.

Hem/Onc has the backing of the Pharma industry, so they will be in good shape.

Radonc still has a chance if we can get some better leadership.

 

[medgator]

The time for HO in the grinder/guillotine of cuts will come. The gravy train cannot last forever.

Hospital heme onc still paying well. Even if the reimbursement gets cut there's enough hospital demand I'm guessing to her salaries up compared to RO

 

[Ubba]

The fields are extremely different. H/O is an IM subspecialty, which means that you are expected to deal with everything that entails - UTIs, pneumonias, hyponatremia, hypomagnesemia, renal failure, transaminitis, fatigue, hypothyroidism, diabetes management to an extent, blah, blah, blah - in addition to having to master hematology and medical oncology and dealing with chemo toxicities and emergencies, endless calls about pts with hemoglobin 6.5 or platelets of 3k whom you now have to call to recommend ER visit for transfusion (and then they ask whether it can wait until the morning and you're in the pickle of having to choose, in awkward silence, between medicolegal safety vs coming off as a worrywart CYA practitioner), etc. In truth, the field leaves little time for other hobbies or having much of a life. At least that's how it seems as a fellow whose attendings spend their "days off" prepping for patient visits, doing admin work, catching up on notes, research, etc. It is a terrible grind for a "normal" person who wants to have much of a life, IMO. Kind of looking for an eventual path out, TBH.

Whereas when I did my RO rotation in med school, it was a cool combination of clinic and drawing cool 3D simulations or maps on computer screens; basically, medical sci-fi. And I'm pretty sure ROs don't have to stick stethoscopes in their ears (I hate those things!). RO is NOT going to disappear. The geographic flexibility is limited, no question about it. But the oversupply issue will be solved once the academic elites have a collective panic and "oh sh**" moment, which they will have at some point this decade. From there, it's a simple matter of slashing spots by 60-70% for several years to re-establish supply/demand equilibrium.

Of course, the right answer is neither of these. Do Radiology.

 

[deleted1111261]

The fields are extremely different. H/O is an IM subspecialty, which means that you are expected to deal with everything that entails - UTIs, pneumonias, hyponatremia, hypomagnesemia, renal failure, transaminitis, fatigue, hypothyroidism, diabetes management to an extent, blah, blah, blah - in addition to having to master hematology and medical oncology and dealing with chemo toxicities and emergencies, endless calls about pts with hemoglobin 6.5 or platelets of 3k whom you now have to call to recommend ER visit for transfusion (and then they ask whether it can wait until the morning and you're in the pickle of having to choose, in awkward silence, between medicolegal safety vs coming off as a worrywart CYA practitioner), etc. In truth, the field leaves little time for other hobbies or having much of a life. At least that's how it seems as a fellow whose attendings spend their "days off" prepping for patient visits, doing admin work, catching up on notes, research, etc. It is a terrible grind for a "normal" person who wants to have much of a life, IMO. Kind of looking for an eventual path out, TBH.

Whereas when I did my RO rotation in med school, it was a cool combination of clinic and drawing cool 3D simulations or maps on computer screens; basically, medical sci-fi. And I'm pretty sure ROs don't have to stick stethoscopes in their ears (I hate those things!). RO is NOT going to disappear. The geographic flexibility is limited, no question about it. But the oversupply issue will be solved once the academic elites have a collective panic and "oh sh**" moment, which they will have at some point this decade. From there, it's a simple matter of slashing spots by 60-70% for several years to re-establish supply/demand equilibrium.

Of course, the right answer is neither of these. Do Radiology.

Lol!

You have more faith than anyone of us about a correction.

Thanks for showing that everything isn’t roses.

I could not handle the onslaught of a day in the life of a medonc

 

[Fpg1245]

Lol!

You have more faith than anyone of us about a correction.

Thanks for showing that everything isn’t roses.

I could not handle the onslaught of a day in the life of a medonc

As much as I love the idea of med onc. I’ve had MOs come up to me that have only been out 2-3 years and can’t stop talking about how they’re gonna get “out of the game” in the next 15 years. Good luck with that

 

[RickyScott]

The time for HO in the grinder/guillotine of cuts will come. The gravy train cannot last forever.

Cuts in pharm prices wont impact heme onc salaries. Supply and demand does. Even if drug prices were cut in half, they will still be huge (or astronomical in case of CART or adenovirus, vaccines, dna/rna silencing) and heme oncs will still be scarce. (i know of nearby hospitals in a very desirable area offering 400k for psych grads and the 3000 RVUS and almost no drugs that they bring to the table )

 

[RickyScott]

"RO is NOT going to disappear. The geographic flexibility is limited, no question about it. But the oversupply issue will be solved once the academic elites have a collective panic and "oh sh**" moment, which they will have at some point this decade. From there, it's a simple matter of slashing spots by 60-70% for several years to re-establish supply/demand equilibrium."

totally disagree with this. Once an RO is created, they stay in the workforce for 30+ years. It is not just a matter of cutting spots when indications and fractions are declining. Moreover, cutting spots would take a minimum of 10-15 years to impact the job market. Even Ralph agreed that cutting spots would not impact the job market for a generation.

 

[grenz]

The fields are extremely different. H/O is an IM subspecialty, which means that you are expected to deal with everything that entails - UTIs, pneumonias, hyponatremia, hypomagnesemia, renal failure, transaminitis, fatigue, hypothyroidism, diabetes management to an extent, blah, blah, blah - in addition to having to master hematology and medical oncology and dealing with chemo toxicities and emergencies, endless calls about pts with hemoglobin 6.5 or platelets of 3k whom you now have to call to recommend ER visit for transfusion (and then they ask whether it can wait until the morning and you're in the pickle of having to choose, in awkward silence, between medicolegal safety vs coming off as a worrywart CYA practitioner), etc.

Yep this is what I knew and reaffirms why I wouldn’t have done med onc. I like the problem-focused aspect of rad onc, and would have picked something similar in that respect. My IM prelim year just felt like lasix’ing water off the titanic all the time.

 

[RickyScott]

Yep this is what I knew and reaffirms why I wouldn’t have done med onc. I like the problem-focused aspect of rad onc, and would have picked something similar in that respect. My IM prelim year just felt like lasix’ing water off the titanic all the time.

medonc seems much better today than 10-15 years ago. Most have a physician extender, and inpatient work covered by hospitalists.

 

[pikachu]

The fields are extremely different. H/O is an IM subspecialty, which means that you are expected to deal with everything that entails - UTIs, pneumonias, hyponatremia, hypomagnesemia, renal failure, transaminitis, fatigue, hypothyroidism, diabetes management to an extent, blah, blah, blah - in addition to having to master hematology and medical oncology and dealing with chemo toxicities and emergencies, endless calls about pts with hemoglobin 6.5 or platelets of 3k whom you now have to call to recommend ER visit for transfusion (and then they ask whether it can wait until the morning and you're in the pickle of having to choose, in awkward silence, between medicolegal safety vs coming off as a worrywart CYA practitioner), etc. In truth, the field leaves little time for other hobbies or having much of a life. At least that's how it seems as a fellow whose attendings spend their "days off" prepping for patient visits, doing admin work, catching up on notes, research, etc. It is a terrible grind for a "normal" person who wants to have much of a life, IMO. Kind of looking for an eventual path out, TBH.

Whereas when I did my RO rotation in med school, it was a cool combination of clinic and drawing cool 3D simulations or maps on computer screens; basically, medical sci-fi. And I'm pretty sure ROs don't have to stick stethoscopes in their ears (I hate those things!). RO is NOT going to disappear. The geographic flexibility is limited, no question about it. But the oversupply issue will be solved once the academic elites have a collective panic and "oh sh**" moment, which they will have at some point this decade. From there, it's a simple matter of slashing spots by 60-70% for several years to re-establish supply/demand equilibrium.

Of course, the right answer is neither of these. Do Radiology.

This is right on

Med onc offers tremendous geographic flexibility and if you're interested in academics, many more opportunities to work on early phase clinical trials given the heavy investment by industry. If you don't like IM you may (will) be unhappy. It seems that community med oncs have less inpatient demands than typical academic med oncs, but think about how you feel about weeks (as in, entire weeks) on inpatient service as well.

Rad onc has some fun technical stuff and less IM if that's not your bag, but it's a crapshoot on where you'll get a job.

In both rad onc and med onc there's a lot of patient contact. Do you enjoy this or would you prefer to be left alone?

Radiology has been brought up here as an alternative to rad onc. Interesting field but really nothing like rad onc or med onc as you are not expected to be involved in patient evaluation and management over the course of their illness or treatment. Potentially, the day to day in rads could be a little more stressful than rad onc with expectations about volume of scans read per day. However, you don't have to interact with patients as much. One of the unsung advantages of radiology is that when you're done reading for the day, you're done (since studies are dictated out in real time). No bringing documentation or contouring home. Also it seems like given the demand for radiologists at the moment, there are lots of jobs with generous scheduling and leave policies.

Finally I would caution you to avoid picking your field based on reimbursement where landscapes can change quickly. What happens when medicare starts negotiating chemo prices?

 

[fwillison]

Rad Onc is a far superior field, IMHO, for the actual work. More interesting, more creative, better connection between your hands-on skills and the quality of the treatment, much better lifestyle, and historically better compensation. Until recently it has been a near Goldilocks scenario, though geographic flexibility has always been challenging.
However, Med Onc is certainly the field to enter today, sorry to say (for obvious reasons related to geographic flexibility and future job prospects). Med Onc is a good and interesting field, taking care of patients who have real and serious medical problems where you can make a difference. The compensation is excellent, and appears likely to overtake rad onc, if it hasn't already, on this metric. With the advent and rapid rise of targeted therapies and immunotherapy, the future is very bright.
The only bright spot on rad onc's future is the (somewhat surprising) value seen with treatment of oligometastatic disease of various types. Whether or not this continues to play out favorably for rad onc is probably the most important thing there is to the field as a whole.

 

[medgator]

medonc seems much better today than 10-15 years ago. Most have a physician extender, and inpatient work covered by hospitalists.

💯

 

[Fpg1245]

💯

They’ll literally bend over backwards to accommodate them. Each MO usually gets an NP who takes care of the bull****.

Also you think they’re covering a billion satellites? Hell no. Even if they have patients they don’t show up and have the NP deal with it.

Much better job and more respect both within oncology and throughout the hospital really

 

[NotMattSpraker]

Any field in medicine is a gamble, H/O is a couple of reimbursement reforms away from being gutted just like anyone else.

Pick a field that interests you, doesn’t require a hospital, and preferably has little to no emergencies or is strictly 9-5 M-F.

Totally agree. I hate rounding so I couldn't be a clinical medical oncologist.

If you like oncology, surgery, hem/onc, and rad onc are radically different. See them all and pick the field that fits your personality.

You can't predict the future, but you might consider surgical or hem/onc if you are anxious about the future of medicine. Both have an out where you can go do something else if the field "crashes". Crash is a squishy term, it's unlikely any of these fields will disappear. But if stability and mobility worry you then Rad Onc is the least safe of the 3 IMO.

 

[DoctwoB]

Cuts in pharm prices wont impact heme onc salaries. Supply and demand does. Even if drug prices were cut in half, they will still be huge (or astronomical in case of CART or adenovirus, vaccines, dna/rna silencing) and heme oncs will still be scarce. (i know of nearby hospitals in a very desirable area offering 400k for psych grads and the 3000 RVUS and almost no drugs that they bring to the table )

This. There are two big components to physician salary in an increasingly physician employee driven healthcare system: supply and demand of your specialty, and the revenue you generate. In the past, the second factor was more important. In the new world, the former is becoming more important as healthcare systems control patient flow.

For some fields this sucks. In radonc or EM you can easily make great money through your own billing/collections. But supply/demand of physician labor is not in your favor, which places downward pressure on salary and working conditions, with limited recourse to fight it due to not controlling patient flow.

on the other hand, this is good for hemeonc. It's hard for a Heme onc to generate crazy RVUs through office billing alone. They do fine, but similar to any other clinic based field. They could generate ancillaries from infusion centers and buy and bill, but far less now then previous, and to do It well requires scale.

On the other hand, supply and demand for heme/onc labor favors hemeonc. Supply remains low for an aging population. Demand is sky high since oncology care drives a TON of ancillary system revenue with imaging, labs, biopsies, surgeries, buying/billing meds, you name it. Hospital systems are happy to subsidize hemeonc salaries to get that downstream revenue. So until or unless oncology care becomes not profitable (which will take a lot more then keytruda being generic), or supply of hemeoncs goes way up, they will continue to do very well.

 

[sloh]

Cuts in pharm prices wont impact heme onc salaries. Supply and demand does. Even if drug prices were cut in half, they will still be huge (or astronomical in case of CART or adenovirus, vaccines, dna/rna silencing) and heme oncs will still be scarce. (i know of nearby hospitals in a very desirable area offering 400k for psych grads and the 3000 RVUS and almost no drugs that they bring to the table )

This. There are two big components to physician salary in an increasingly physician employee driven healthcare system: supply and demand of your specialty, and the revenue you generate. In the past, the second factor was more important. In the new world, the former is becoming more important as healthcare systems control patient flow.

For some fields this sucks. In radonc or EM you can easily make great money through your own billing/collections. But supply/demand of physician labor is not in your favor, which places downward pressure on salary and working conditions, with limited recourse to fight it due to not controlling patient flow.

on the other hand, this is good for hemeonc. It's hard for a Heme onc to generate crazy RVUs through office billing alone. They do fine, but similar to any other clinic based field. They could generate ancillaries from infusion centers and buy and bill, but far less now then previous, and to do It well requires scale.

Can you expand on how it is much more difficult now for MO to generate ancillaries from infusion centers and buy and bill? What has changed?

On the other hand, supply and demand for heme/onc labor favors hemeonc. Supply remains low for an aging population. Demand is sky high since oncology care drives a TON of ancillary system revenue with imaging, labs, biopsies, surgeries, buying/billing meds, you name it. Hospital systems are happy to subsidize hemeonc salaries to get that downstream revenue. So until or unless oncology care becomes not profitable (which will take a lot more then keytruda being generic), or supply of hemeoncs goes way up, they will continue to do very well.

What is very well? What kind of incomes?

 

[dieABRdie]

How much of it is due to the inbox burden, prior authorizations etc? Would an inpatient heme-onc job have less of these things

Would you have done another IM sub speciality if you could go back?

"In truth, the field leaves little time for other hobbies or having much of a life. At least that's how it seems as a fellow whose attendings spend their "days off" prepping for patient visits, doing admin work, catching up on notes, research, etc."

Key words bolded above. I am assuming this is a reference to an academic environment.

Community or private practice med onc is a different beast altogether. I bolded "med" because in the private world they really don't do a whole lot of heme. Obviously they do some; but anyone who's going to get really sick from chemo or is getting transplant.... off to the University hospital. Its probably 85% solid tumors being treated by the med onc group in our town. Their life doesn't resemble the one you are thinking of.

They don't "round" at the hospital. Sure they go occasionally for a consult but everything else is managed by the hospitalists. They have an NP who's sole job is to take care of scut at the hospital. They rotate call so between the 12 of them; call is four weeks a year.

I will admit their clinics are busy and they deal with more awful problems than we do; but I can't remember a time when I left in the afternoon and their cars were still there. And they sure as hell aren't working on the weekends.

I love working with cancer patients, and think surgery is boring. So for me it was either rad onc or med onc. I'll admit that perception drove me away from considering it, but if you aren't dead set on academics you should shadow or speak with some private medical oncologists. I'll admit I am very happy where I am today... but I would not go back to the job search I had to go through to be here.

 

[Reaganite]

"In truth, the field leaves little time for other hobbies or having much of a life. At least that's how it seems as a fellow whose attendings spend their "days off" prepping for patient visits, doing admin work, catching up on notes, research, etc."

Key words bolded above. I am assuming this is a reference to an academic environment.

Community or private practice med onc is a different beast altogether. I bolded "med" because in the private world they really don't do a whole lot of heme. Obviously they do some; but anyone who's going to get really sick from chemo or is getting transplant.... off to the University hospital. Its probably 85% solid tumors being treated by the med onc group in our town. Their life doesn't resemble the one you are thinking of.

They don't "round" at the hospital. Sure they go occasionally for a consult but everything else is managed by the hospitalists. They have an NP who's sole job is to take care of scut at the hospital. They rotate call so between the 12 of them; call is four weeks a year.

I will admit their clinics are busy and they deal with more awful problems than we do; but I can't remember a time when I left in the afternoon and their cars were still there. And they sure as hell aren't working on the weekends.

I love working with cancer patients, and think surgery is boring. So for me it was either rad onc or med onc. I'll admit that perception drove me away from considering it, but if you aren't dead set on academics you should shadow or speak with some private medical oncologists. I'll admit I am very happy where I am today... but I would not go back to the job search I had to go through to be here.

Med Oncs in my neck of the woods do a TON of heme. For some, it's >50% of their practice. It is very location and contract dependent. Med oncs get a ton of anemia calls from what I hear.

To the OPs question, would rather die than do MedOnc or anything even remotely related to internal medicine.

 

[sam1234567]

Just imagine if someone like dr burzynski succeeded in discovering a real badass class of Cancer drugs in the next couple years.
it’s a gamble but med onc is the safer bet for sure right now.

 

[TexasMed22]

"In truth, the field leaves little time for other hobbies or having much of a life. At least that's how it seems as a fellow whose attendings spend their "days off" prepping for patient visits, doing admin work, catching up on notes, research, etc."

Key words bolded above. I am assuming this is a reference to an academic environment.

Community or private practice med onc is a different beast altogether. I bolded "med" because in the private world they really don't do a whole lot of heme. Obviously they do some; but anyone who's going to get really sick from chemo or is getting transplant.... off to the University hospital. Its probably 85% solid tumors being treated by the med onc group in our town. Their life doesn't resemble the one you are thinking of.

They don't "round" at the hospital. Sure they go occasionally for a consult but everything else is managed by the hospitalists. They have an NP who's sole job is to take care of scut at the hospital. They rotate call so between the 12 of them; call is four weeks a year.

I will admit their clinics are busy and they deal with more awful problems than we do; but I can't remember a time when I left in the afternoon and their cars were still there. And they sure as hell aren't working on the weekends.

I love working with cancer patients, and think surgery is boring. So for me it was either rad onc or med onc. I'll admit that perception drove me away from considering it, but if you aren't dead set on academics you should shadow or speak with some private medical oncologists. I'll admit I am very happy where I am today... but I would not go back to the job search I had to go through to be here.

I'm not sure if its accurate to say most private practice med oncs aren't working weekends. I've spoken to a few recently, and it seems like Q4 or Q5 weekend inpatient coverage is pretty standard, which definitely hurts from a lifestyle perspective. On top of taking overnight home call once a week by phone.

Otherwise, based on everything I've read and people I've talked to, it seems like hem onc has a medium tier lifestyle. Definitely worse than derm, rads, etc, but certainly better than cards/GI.

 

[RickyScott]

I'm not sure if its accurate to say most private practice med oncs aren't working weekends. I've spoken to a few recently, and it seems like Q4 or Q5 weekend inpatient coverage is pretty standard, which definitely hurts from a lifestyle perspective. On top of taking overnight home call once a week by phone.

Otherwise, based on everything I've read and people I've talked to, it seems like hem onc has a medium tier lifestyle. Definitely worse than derm, rads, etc, but certainly better than cards/GI.

Ours do weekend rounds every 6 weeks with their nps (who write all notes and orders) and work 4 days a week, and are constantly inundated with offers from competing centers.

 

[OTN]

Just imagine if someone like dr burzynski succeeded in discovering a real badass class of Cancer drugs in the next couple years.
it’s a gamble but med onc is the safer bet for sure right now.

Lol he should be in prison

 

[HemeOncHopeful19]

Lol he should be in prison

I was thinking the same thing.

 

[temujim]

Lol he should be in prison

Cleaned up so many messes from this guy. I think he moved on from the shark bs, but kind of shut down when patients tell me what he was doing.

 

[medgator]

Lol he should be in prison

Never heard of this guy until this thread.

Wow

To help cancer patients, lawmakers pushed access to a controversial doctor

Many members of Congress have sought to help constituents by trying to help them gain access to a doctor who has attracted wide controversy, documents show.

www.statnews.com

 

[Mandelin Rain]

Came up on my news feed today.

This Rapping Preacher Is Selling Bleach to Parents Trying to ‘Treat’ Autism in Kids

Joe Salant, an evangelical pastor and rapper, is the new spokesman for Safrax, which makes bleach tablets that are popular with those who belief ingesting the industrial cleaner can cure a range of ailments.

www.vice.com

No shortage of malicious dirt bags willing to take desperate peoples' money.

 

[sirspamalot]

Coffee enemas, laetrile from Mexico, Burzyski "eons" or whatever it is, the stem cell of the month club... magnetic therapy... it never ends.

And then, you have MDACC doing the lord's work (marketing to extend market share and destroy local practice, regulatory capture, unnecessary proton bs).

The clown show must go on.

Tired of it all. The hypocrisy makes me realize nothing I have ever done, or ever will do, could ever approach the systemic harm that the above has and continues to do.

 

[A_DeMichele]

HemOnc >> RadOnc

 

[fiji128]

Asking this question in 2023 is like asking should I put $100k in Amazon (market cap $19B) or Sears (market cap $14B) on January 1, 2007. Super obvious answer in retrospect.

 

[Ubba]

HemOnc >> RadOnc

Explain your reasoning.

 

[RickyScott]

Explain your reasoning.

Gainful employment.

 

[sirspamalot]

Gainful employment.

Actual employment for actual pay

 

[Ubba]

How much of it is due to the inbox burden, prior authorizations etc? Would an inpatient heme-onc job have less of these things

Would you have done another IM sub speciality if you could go back?

Just saw this.

Decent amount of inbox burden. Prior auths are a non-issue - usually taken care of by support staff and I do maybe one every 2 months. Theoretically, an inpatient job (rare in H/O) might be spared some of the above, but inpatient H/O is like running a step-down unit except that you're often the one causing the morbidity/toxicity, which is enormously stressful from a medicolegal POV. And if you're an inpatient H/O in the sense of being a transplant oncologist, you are an intensivist who has to have memorized 1000 different mutations, 500 different study results, and the dozens and dozens of medications with new indications every year, along with their toxicities, metabolic details, indications with respect to line of therapy (which differs by malignancy!), etc. etc. etc. etc. etc. Oh, and you also have to manage electrolyte derangements, pain, pneumonitis, pneumonia, neuropathy, and 3000 other potential IM issues.

I wouldn't have done IM at all. IM should be honestly presented to med students as one of the three the bottom-of-the-barrel "specialties" (the other two being family med and Peds) - the ones you use as safeties if all else fails. The golden grail of the internist is to achieve a remuneration/effort ratio that's in the same universe as those of most other medical specialties. The competitiveness of the subspecialties like Cards, GI, and H/O reflects a desperate collective attempt at such, but when you factor in the opportunity costs, liabilities, and patient issues, the achievement is about as attainable as catching smoke in your fist.

Become a consultant - i.e., a specialist - right out of med school. That's the path to happiness.

 

[grenz]

Just saw this.

Decent amount of inbox burden. Prior auths are a non-issue - usually taken care of by support staff and I do maybe one every 2 months. Theoretically, an inpatient job (rare in H/O) might be spared some of the above, but inpatient H/O is like running a step-down unit except that you're often the one causing the morbidity/toxicity, which is enormously stressful from a medicolegal POV. And if you're an inpatient H/O in the sense of being a transplant oncologist, you are an intensivist who has to have memorized 1000 different mutations, 500 different study results, and the dozens and dozens of medications with new indications every year, along with their toxicities, metabolic details, indications with respect to line of therapy (which differs by malignancy!), etc. etc. etc. etc. etc. Oh, and you also have to manage electrolyte derangements, pain, pneumonitis, pneumonia, neuropathy, and 3000 other potential IM issues.

I wouldn't have done IM at all. IM should be honestly presented to med students as one of the three the bottom-of-the-barrel "specialties" (the other two being family med and Peds) - the ones you use as safeties if all else fails. The golden grail of the internist is to achieve a remuneration/effort ratio that's in the same universe as those of most other medical specialties. The competitiveness of the subspecialties like Cards, GI, and H/O reflects a desperate collective attempt at such, but when you factor in the opportunity costs, liabilities, and patient issues, the achievement is about as attainable as catching smoke in your fist.

Become a consultant - i.e., a specialist - right out of med school. That's the path to happiness.

Thank you for sharing your experience. Nice to have a counterbalance to mostly part-informed opinions here

 

[sirspamalot]

Medoncs: Rural outpatient job paying north of 1.3m+ no inpatient call 4 day reasonable load work week and plenty of jobs available. But it's horrible.

Radoncs: Sorry, you were saying what again?

 

[fiji128]

Mid/latter career Med Onc that I directedly work with just quit. It took about two plus years to recruit her. She was 4 days a week with no call. All out patient. Incompetent management wouldn't do anything she requested (all very reasonable stuff) to try and improve the clinic. She told me once she decided to quit after coming back from a week long vacation it took about a week for her to get another offer at an established practice that was closer to her home. Med Onc have a plethora of opportunities and practice set ups (no one has to do in patient bone marrow transplants unless that what they want to do) to pursue.

This does not happen for radiation oncologist. Not really that hard to understand there is severe lack of quality opportunities in this field. There is zero out there to suggest this will be improving. There is a reason why the specialty is now dead last in the match.

 

[RickyScott]

Mid/latter career Med Onc that I directedly work with just quit. It took about two plus years to recruit her. She was 4 days a week with no call. All out patient. Incompetent management wouldn't do anything she requested (all very reasonable stuff) to try and improve the clinic. She told me once she decided to quit after coming back from a week long vacation it took about a week for her to get another offer at an established practice that was closer to her home. Med Onc have a plethora of opportunities and practice set ups (no one has to do in patient bone marrow transplants unless that what they want to do) to pursue.

This does not happen for radiation oncologist. Not really that hard to understand there is severe lack of quality opportunities in this field. There is zero out there to suggest this will be improving. There is a reason why the specialty is now dead last in the match.

A lot of the “burnout” in radonc isn’t from workload, but lack of a control and being treated like sht relative to other specialties. Having no mobility due to oversupply is the underlying cause. Like a school bully, hospitals and xrt leadership smell the fear. Treat someone badly and they don’t complain or threaten to leave and things get worse. Everyone knows radoncs will put up with a lot because now the only recourse is to move to another part of the country and it will be easy to fill the position. Your hospital will learn quickly to treat the medoncs with golden gloves after paying 5k a day for locums and 20% +more for her replacement.

 

[sirspamalot]

 

[HemeOncHopeful19]

Medoncs: Rural outpatient job paying north of 1.3m+ no inpatient call 4 day reasonable load work week and plenty of jobs available. But it's horrible.

Radoncs: Sorry, you were saying what again?

Still waiting on someone to PM this rural $1.3m job. Highest I’ve seen is 8-900 in WV.

Still agree that the Med Onc job market is clearly better than Rad Onc but some of the stuff you guys post about Med Onc is a little pie in the sky.

I would bet a fair sum of money that less than 5% of Med Oncs make $1.3m a year and none of those people work 4 days a week UNLESS they are old “super partners” who are abusing their partner track docs or have other income streams.