As crazy as it may seem, i'm thinking of applying for a residency or fellowship in another area after finishing my hematology/oncology fellowship. I'm currently in the middle of my last year of hem/onc fellowship and am really dreading having to practice this for the rest of my life, or even for a few years.

I think the thing that bothers me most is the therapeutic nihilism that exists in this field. I'm just tired of treating patients that i know will never improve. It's the rule rather than exception. The other thing that bothers me is that i miss not being able to do many procedures.

Thinking of doing a few different things- radiation oncology residency, in which you're more more involved with definitive therapy for these same patients (rather than adjuvant therapy or palliative therapy.) However this is another 4 yrs, and spots are very competetive.
Other option is GI fellowship, which is also competetive, but would only be 3 more yrs.
Lastly, and the most inane of the three, is applying for a surgical residency, which would be at least 5 more yrs, much more grueling, but would at least satisfy my desire to do some procedures and to be able to see patients instantly improve (depending on situation.)

Would appreciate any advice.
Thanks.

I'm just a med student...but out of curiosity, why not cards? I hear that's the most procedural of the medicine fellowships...

cardiology doesn't have to be procedure-oriented. main procedures are card cath and i guess placement of pacemakers and ICDs, but there are many non-interventional/non-invasive cardiologists out there, who don't really do procedures.

whereas with GI, for the most part, the main part of your practice involves endoscopy (unless of course you're a hepatologist in academics.)

what made you pick heme/onc to begin with? Kind of an odd choice for someone who wants to see patients "instantly improve."

yes Bjolly, it would have been an odd choice if i had the same views and experience five years ago when i chose hem/onc. things change.

Agree with bjolly.
Cancer patients epitomize "patients who won't get better fast, if at all".
How about pulm/critical care? They def. do a lot of procedures and I'd think you would be competitive.
GI you can definitely give it a shot, but it seems like everybody now does GI research to try and get in.

I think your best bet would be another medicine fellowship @the same institution where you are now doing hem/onc, and/or where you did residency, assuming they liked you.

Surgery?! I think you're off your nut. Or you must not have any student loans...

thanks to everyone for input.

also, just to clarify, i don't hate the field of hem/onc. in fact, i think it can be a great field to go into. and there are many positive things about it. in fact, if i were to go into another specialty, i still would prefer to focus on onc patients. i think what's hard (but also can be a great thing) about med onc is that you're the main doc for the metastatic patients. with most of the cases, you often have to be the "bad guy" by telling them every few months that their dz is progressing, etc.

If you do critical care only, it's one additional year of training. Critical care is officially a 2 year fellowship, but you get to skip the research year if you've already completed another fellowship.

As crazy as it may seem, i'm thinking of applying for a residency or fellowship in another area after finishing my hematology/oncology fellowship. I'm currently in the middle of my last year of hem/onc fellowship and am really dreading having to practice this for the rest of my life, or even for a few years.

I think the thing that bothers me most is the therapeutic nihilism that exists in this field. I'm just tired of treating patients that i know will never improve. It's the rule rather than exception. The other thing that bothers me is that i miss not being able to do many procedures.

Thinking of doing a few different things- radiation oncology residency, in which you're more more involved with definitive therapy for these same patients (rather than adjuvant therapy or palliative therapy.) However this is another 4 yrs, and spots are very competetive.
Other option is GI fellowship, which is also competetive, but would only be 3 more yrs.
Lastly, and the most inane of the three, is applying for a surgical residency, which would be at least 5 more yrs, much more grueling, but would at least satisfy my desire to do some procedures and to be able to see patients instantly improve (depending on situation.)

Would appreciate any advice.
Thanks.

I would suggest that since you have already spent 6 years training for something that you do not want to ultimately do, figure out what you want to do and do it. I wouldn't worry too much about the number of years involved. After all what is the difference between 3 or 5 years at this point. Figure out what you want to do and do it. The last thing you would want is to spend another 3 years on a fellowship and then decide that is not what you want to do.

Good luck.

boF

yes Bjolly, it would have been an odd choice if i had the same views and experience five years ago when i chose hem/onc. things change.

I didn't mean it in a snide way - I was wondering what drew you to the field initially and what changed for you. It sounds like what you want now is very far from what you originally wanted or thought you did. Knowing what you liked about oncology might give some insights into what career path would be a better fit.

Wow. I read your post and cringed inwardly with recognition. Our system of medical training is strange in that we are expected to choose a career (usually) from a mere 4-8weeks of exposure to a given field. We are asked to do so at a time when we are still growing into adulthood and may not know what our goals/ideal lifestyle will be in 3-6 yrs when we finish training. What is important to us at the beginning of our career may not matter as much at the end.

with most of the cases, you often have to be the "bad guy" by telling them every few months that their dz is progressing, etc.
On the other hand, don't forget that many patients and families do understand it's not your fault that the cancer is progressing and are grateful to physicians who are compassionate while breaking bad news or talking about painful subjects like the decision to go to hospice care. On many of my rotations I had terminal patients of a particular oncologist, and in spite of their terrible illnesses they all loved him. He had an amazingly compassionate demeanor and a lot of insight into the issue of quality of life vs. the hope for more time. A physician who understands those kinds of issues and can communicate well with patients about tough topics can be a real hero.
Of course, best of luck if you decide it's really not for you.

If you do critical care only, it's one additional year of training. Critical care is officially a 2 year fellowship, but you get to skip the research year if you've already completed another fellowship.

This is what I was thinking... a good skillset, and you often get instant gratification, clinically speaking. It would be one year of added qalification for you, rather than starting over.

The term "nihilism" should never be used when considering patients - don't allow it into your brain. People are people and have feelings and fears of "what will happen to them" - this must be accounted into their treatment.

You're just in the same place as any other doc that deals with cancer. Rise above the "death sentence" of it all - you can always do research, teach, or enter the public policy arena.

Many others have spent a lot of time, effort, and money teaching and mentoring you. Your skills are valuble and soon you need to/will give back to the next generation of physicians.

Deal, doctor. And get back to work.

The term "nihilism" should never be used when considering patients - don't allow it into your brain. People are people and have feelings and fears of "what will happen to them" - this must be accounted into their treatment.

You're just in the same place as any other doc that deals with cancer. Rise above the "death sentence" of it all - you can always do research, teach, or enter the public policy arena.

Many others have spent a lot of time, effort, and money teaching and mentoring you. Your skills are valuble and soon you need to/will give back to the next generation of physicians.

Deal, doctor. And get back to work.

I'm not sure I buy that. We all "deal with" cancer. I dx it on a regular basis. I provide palliative procedures to relieve suffering and even treat it with curative intent through a scope. But I'm not the PCM for all incurable cancer patients. I personally don't think I could "deal and get back to work" and still be happy. The OP doesn't have to make himself unhappy for life because he made a bad 3 year choice. I remember as a resident an oncologist telling me that 50% of the new patients he sees each week will be cured. What he didn't say was that 90% of his time was spent on the other 50%.

That being said, what's the hurry? Go be an internist/hospitalist/oncologist/whatever for a year or two and try to sort out what you like. The grass isn't necessarily greener and you certainly have only one more shot at getting it right. Good luck.

The term "nihilism" should never be used when considering patients - don't allow it into your brain. People are people and have feelings and fears of "what will happen to them" - this must be accounted into their treatment.

You're just in the same place as any other doc that deals with cancer. Rise above the "death sentence" of it all - you can always do research, teach, or enter the public policy arena.

Many others have spent a lot of time, effort, and money teaching and mentoring you. Your skills are valuble and soon you need to/will give back to the next generation of physicians.

Deal, doctor. And get back to work.

On the contrary, I think the original poster cares enough about his/her patients to not want to treat terminal patients with toxic chemotherapy, only to extend their "quality adjusted life years" by weeks to months.

Telling the poster to "deal" & get back to work, puts the doctor & his/her patients at risk of burnout & being cared for by an impaired physician. No one benefits from that.

As crazy as it may seem, i'm thinking of applying for a residency or fellowship in another area after finishing my hematology/oncology fellowship. I'm currently in the middle of my last year of hem/onc fellowship and am really dreading having to practice this for the rest of my life, or even for a few years.

I think the thing that bothers me most is the therapeutic nihilism that exists in this field. I'm just tired of treating patients that i know will never improve. It's the rule rather than exception. The other thing that bothers me is that i miss not being able to do many procedures.

Thinking of doing a few different things- radiation oncology residency, in which you're more more involved with definitive therapy for these same patients (rather than adjuvant therapy or palliative therapy.) However this is another 4 yrs, and spots are very competetive.
Other option is GI fellowship, which is also competetive, but would only be 3 more yrs.
Lastly, and the most inane of the three, is applying for a surgical residency, which would be at least 5 more yrs, much more grueling, but would at least satisfy my desire to do some procedures and to be able to see patients instantly improve (depending on situation.)

Would appreciate any advice.
Thanks.

What about rad onc? That's semiprocedural, they'd recognize your intern year (so 4 years), well compensated, and having the heme/onc as well would probably make you a great asset to many a practice.

If cancer's the problem, then you could try switching to something like derm (explain that you are fascinated with melanoma) and therefore avoid extremely ill patients with a poor prognosis.

Have you considered a non-clinical career in oncology? The opportunities are endless in the industry of pharma and biotech. Of course, there are careers outside of that too.

Having been in private practice in medical hem/onc for a little over 5 years, I can understand your frustration. Burnout is rampant in this specialty. However, I don't know if it's such a wise idea to jump to another field at this point. First of all, everyone works hard at what they do. The cardiologists, pulmonologists, GI , even internists work as hard, if not harder. I don't think there is a cush lifestyle for any IM subspecialty. Even rad onc can be tiring!

Actually, the nice thing about heme/onc is that the benign heme portion is a welcome respite from the malignancies. Nothing is more gratifying than diagnosing iron-def. anemia in a young women, and having them come back in 6 weeks with their hgb up 3gm.

It also depends on how much you're on call- if you're with a large group, being on call every 4-6 weeks is quite nice. Also, our practice requires us to see patients in office 4 days, not 5, to prevent burnout.

I do think in general for any profession, starting up as a solo practice or joining a 1-2 doc practice is extremely stressful and something not to consider if lifestyle is important to you.