Heme/Onc

medstudent13 said:

Can anyone give me information on heme/onc? What is the lifestyle, compensation, competition like? What is the difference between heme/onc and medical oncology? There doesn't seem to be much info out there about this field.

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i can give you what i know from my research and my experiences working at a heme/onc clinic for 2 years... take it for what it's worth.

lifestyle: work all the time! the guys (5) that i worked with rounded at the hospital every morning between 5 and 5:30 went from there to the clinic and worked until 5:30-6:00 after which they went back and did rounds at the hospital again. they were putting in 14-15hr days at least 4 days a week + a half day the other day of the week. i want to do heme/onc and have gotten to be good friends with one of those guys. he told me that the vast majority of his life is spent working and that he regrets not seeing his family much, but loves his job and that's the only reason he keeps doing it.

compensation: right now it's pretty good. unless something changes between now and 2006, it's going to drop because of the new medicare bill that passed last year. reimbursement for drugs will fall of significantly making treating patients in the clinic much less profitable and in many cases not profitable at all. from what i was told by the heme/onc doc i'm friends with is that heme/onc grads are coming out demanding $375K-400K/year. that's in the south where compensation is a little higher than average because no one wants to live there really.

competition: i'm not sure about this. i would assume it's competitive since the pay is good right now... but most subspecialties are competitive.

from my research the difference between heme/onc and med onc is pretty easy. the fellowship is supposed to be 3 years. after that you're board eligible in hematology and oncology. if you leave the fellowship after two years, you're a medical oncologist (you lose the heme) and you're only board eligible for oncology. i was told that it's worth the extra year for the heme/onc because docs will refer heme patients to you whether you've got it or not, so you need to know what to do with them.

hope this helps... if anyone has corrections, please post them.

john

Just an addition: the lifestyle is variable, but in general, the heme/onc lifestyle is much better than that of some of the other medical subspecialties such as cardiology, critical care or even gastroenterology. In general. your patients are sicker, so you might have to take calls, but usually there is someone there to take care of them.

Reimbursement is as described. At present, it is one of the more competitve medicine fellowships (probably after cards, GI and AI, it's up there), but with some good research and good letters, its highly achievable. Most of the fellowship programs have also moved to a common offer date, which also favorable to aplicants.

Good thread - I feel like there's not enough stuff out there about this field. As an intern at a decent East Coast program, I want to get back to where my family is on the West Coast. Any input as to how competitive heme-onc is out West? Also, what's the applicant-spot ratio? Thanks in advance for some/any guidance!!!!

Hello Guys,
Time to kick up some action. It will be real nice if we can have a heme/onc database for the upcoming 'match'.
We all are still uncertain (and also some prgms!!) as to how the new approach will be (definitely the applcn process is not monoclonal, it has to be a conventional multiapplication process....
Let us keep each other informed if anybody started or any pgms are accepting paper applcns, and also if anybody gets any heme/onc interviews in the coming days!
GL to all.

Any insight as to whether or not a chief year helps you in the fellowship application process (and in heme-onc specifically)? Just wondering if it's worth the extra year, considering it doesn't look like that valuable of a way to spend a year of your life...

Why doesn't it seem like a valuable way to spend a year of your life? I think there are a plethora of major benefits to be gained by doing a chief year.

Practically speaking, it provides great experience in managing people, as you'll often be the one dealing with issues that come up among interns and residents. It's also a great way to further hone your medicine skills, as you may be the one approving certain costly lab tests, and the residents will often be going over their patients and care plans with you. You'll also get paid a bit more than you would as a resident, and it can make a big difference in terms of your marketability for competitive fellowship spots. It may also make a difference careerwise. And it gives you time to do research and maybe get a few more things published before you start looking for a more permanent job. Plus, it provides ample opportunities for you to hone your teaching skills, to prepare for being an attending.

Being a chief is a big deal, and I think it's an exceedingly valuable opportunity.

I think being a chief is much more important for those who wish to persue an academic career than those who wish to move to private practice.

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docslytherin said:

that's in the south where compensation is a little higher than average because no one wants to live there really.

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heh heh heh

clueless1 said:

Good thread - I feel like there's not enough stuff out there about this field. As an intern at a decent East Coast program, I want to get back to where my family is on the West Coast. Any input as to how competitive heme-onc is out West? Also, what's the applicant-spot ratio? Thanks in advance for some/any guidance!!!!

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Wanting to start this thread back up. I am on a Heme/Onc rotation now, and it's one speciality, especially the Heme side, where it's not necessarily the patient's lifestyle that caused them a horrible disease. I went into the rotation thinking no way, but it's growing on me. It's not as procedure based as the others, but how much research emphasis is placed in Heme/Onc. Obviously, new chemo drugs appear all the time, but in teh fellowship, is there more research time needed than other fellowships like GI?

Jackie1. said:

Wanting to start this thread back up. I am on a Heme/Onc rotation now, and it's one speciality, especially the Heme side, where it's not necessarily the patient's lifestyle that caused them a horrible disease. I went into the rotation thinking no way, but it's growing on me. It's not as procedure based as the others, but how much research emphasis is placed in Heme/Onc. Obviously, new chemo drugs appear all the time, but in teh fellowship, is there more research time needed than other fellowships like GI?

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All of the programs that I am aware of are three years total. For med onc only, the breakdown is 1 year of clinical duty and 2 in the lab. At least one of the 2 lab years include a weekly outpatient clinic. Heme will add an additional 6 months of clinical duty, with 1.5 years for research.

There are several fellowships in BMT which are 1 year in length. Almost all BMT fellowships recommend Onc/ Heme-onc first. A substantial portion of that year can be dedicated to clinical/bench research.

Pain and palliative care is something I am less familiar with. I am also not familiar with the structure of GI fellowships.

Most of the Med-Onc fellows I've interacted with are very data driven and evidence-based, but this is likely institution dependent.

-PB.

...

PickyBicky said:

For med onc only, the breakdown is 1 year of clinical duty and 2 in the lab. At least one of the 2 lab years include a weekly outpatient clinic.

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I was under the impression that most Med onc fellowships are usually 2 yrs total.

HDMTX said:

I was under the impression that most Med onc fellowships are usually 2 yrs total.

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You're correct. Heme/onc is usually 3 years total, but medical oncology is generally 2 years. That said, there are fewer programs that offer this option; most are heme/onc. According to FREIDA, there are only 19 programs in medical oncology, and 18 of 19 are only 2 years. However, I've heard that some programs will allow you to just do onc once you're in the program.

Yep, most programs don't advertise the option of allowing u to skip out after 2 yrs and just board in med onc, but it's an option at some programs.

Soooo...what's the good word? Anyone heard back? Any input as to how competitive the "match" is looking for heme-onc? Should I be concerned about getting a decent spot back in Cali when I apply in the next few years? Dish, please!

Hey is the compensation figure up there correct? 375-400k for a first year fellowships grad? If so does anyone have an idea of what the older guys are making? The above poster also said that people dont want to move south, was this true for the fellowships too?

Applications this year have spiked tremendously. Even with medicare cutbacks, it is still a very well compensated specialty with a relatively nice lifestyle. I don't believe the banner posters thoughts are typical about the lifestyle. In fact many larger groups now hire hospitalists to admit their patients leaving the heme/onc to consult. Also, when the patients get real sick, they go the units where a critical care physician is usually in charge. Add the biological revolution, and you have a highly competitive field. The numbers we are seeing so far are historical highs. Good luck.

Celsus said:

Hey is the compensation figure up there correct? 375-400k for a first year fellowships grad? If so does anyone have an idea of what the older guys are making? The above poster also said that people dont want to move south, was this true for the fellowships too?

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Not typical across the board, but there are certainly many regions where this number is commanded and beyond. The main payoff is the short partnership track with its commensurate salary. Usually 2 yrs and 500k+ is typical in many of the stronger and larger groups.

heme onc often participates in rad onc tumor boards

What is typical hours like? Do all oncologists work as many hours as stated above? Is it possible to work 40-50 hrs/week?

fun8stuff said:

What is typical hours like? Do all oncologists work as many hours as stated above? Is it possible to work 40-50 hrs/week?

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is this like a forbidden question or something??

fun8stuff said:

is this like a forbidden question or something??

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I think it depends on the whole supply and demand thing. I rotated through a practice here is Louisville that had 9 physicians. Most had 2 half days, weekends off, and 2 mo vacation. They rotate weekends, ward work, etc... I think their longest day was 9-5:30, but that's just seeing pts, they oftened reviewed charts from pts they saw the week previous.

But really, if you only want to work 40-50 hrs q week, you can, but your not going to bring in your earning potential, of course.

So to answer your question, yes.

astro-pilot said:

I think it depends on the whole supply and demand thing. I rotated through a practice here is Louisville that had 9 physicians. Most had 2 half days, weekends off, and 2 mo vacation. They rotate weekends, ward work, etc... I think their longest day was 9-5:30, but that's just seeing pts, they oftened reviewed charts from pts they saw the week previous.

But really, if you only want to work 40-50 hrs q week, you can, but your not going to bring in your earning potential, of course.

So to answer your question, yes.

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thanks for the answer..

just out of curiosity, any guess as to how much this would decrease salary? am i crazy for wanting to work less??

fun8stuff said:

thanks for the answer..

just out of curiosity, any guess as to how much this would decrease salary? am i crazy for wanting to work less??

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Anything I say would be a guess, but I would think that if you goto a smaller town, that you could work less while still maximizing your earning potential.

As for you being crazy, no, I don't think so. I think the cultural of medicine is changing towards a more family friendly one. There are things more important than work...more important than medicine.

ap

Is there any way i could enter hemo/onc directly and not as a subspecialty of internal medicine or Pedo.,,As far as i understood it's possible in MRCPath in Britian and Australia .I'm a Foreigner and i want to do my Residencey Program in the States or Canada.

olio said:

Is there any way i could enter hemo/onc directly and not as a subspecialty of internal medicine or Pedo.,,As far as i understood it's possible in MRCPath in Britian and Australia .I'm a Foreigner and i want to do my Residencey Program in the States or Canada.

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...not to my knowledge (i normaly wouldn't have posted, but it seems few people post here). you may want to ask this question in the internal med forum... but i 90% sure you have to do IM first.

olio said:

Is there any way i could enter hemo/onc directly and not as a subspecialty of internal medicine or Pedo.,,As far as i understood it's possible in MRCPath in Britian and Australia .I'm a Foreigner and i want to do my Residencey Program in the States or Canada.

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You need to do internal medicine first (for adult Heme/Onc). If you already have MRCP, I have heard of people getting waiver for the intern year - that means you only have to do 2 years of internal medicine. However, doing so, you will have to apply for your Heme/Onc fellowship during your first year in the USA - hence, it may not be as easy - as you do need to get people to write recommendation letters, including your program director, and it might not be easy for people to do that when you are only around for a few months. I suppose you get get people you had previously worked with to write you letters, but as far as I know, fellowship program will still want a letter from your IM program director.

I'm sure this question is practice-dependent, but:

Can anyone break down the % outpatient visits that a generic heme-onc sees of:

1. Metastatic solid tumors
2. Non-met solid
3. Benign heme (red cell/platelet dz)
4. Malignant heme


(My current guess is that it is like this)
1. Metastatic solid tumors (40%)
2. Non-met solids (30%)
3. Benign heme (red cell/platelet dz) (10%)
4. Malignant heme (20%)

Any advice on applying to Hem/Onc? (Process, deciding what programs to choose, timeline, etc) Gracias.

olio said:

Is there any way i could enter hemo/onc directly and not as a subspecialty of internal medicine or Pedo.,,As far as i understood it's possible in MRCPath in Britian and Australia .I'm a Foreigner and i want to do my Residencey Program in the States or Canada.

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I had a friend who completed a fellowship in ID at a US institution without doing a US IM residency. So I think it may be possible. Although, you will not be able to practice in the US unless you complete a US IM residency. My friend initially thought that he would go back to his country, but decided that he would want to practice in the US. So he is now completing a residency in the US. I would think about your ultimate plans and then contact the programs and see what their policy is

Dear Colleagues and Friends,
could please someone advise me where to do my IM residency (starting 2008) in the North-East in order to have higher chances afterwards entering Oncology+Hematology ?
I would like to do clinical research in one of the top cancer centers in the North-East.
I am a European 3rd year resident in radiation oncology in my home country, with high step scores and research activity.
Thank you.
Any advice would be appreciated.

I know that the residents from these IM programs have, overall, great matches into Heme/Onc fellowships:

1. Cornell IM (http://www.cornellmedicine.com/res_pro/lif_aft_res.html?name1=Life+after+Residency&type1=2Active)

2. Beth Israel Deaconess IM (Harvard University),(http://bidmc.harvard.edu/display.asp?leaf_id=13875 or http://bidmc.harvard.edu/display.asp?node_id=6948)

3. Brown IM (http://www.brownmedicine.org/education/cat_choices.asp?section=education)

4. Columbia IM (http://www.columbiamedicine.org/education/r_alum.shtml)

5. Brigham & Women's IM (Harvard University, Partners in Health)

6. Massachusetts General Hospital IM (Harvard University, Partners in Health)

7. University of Pennsylvania IM (http://www.uphs.upenn.edu/medicine/education/residents/resappinfo/fellowshipPlacement.html)

I'm not sure about Mount Sinai, Boston University, Tufts, Yale, Pittsburg, Univeristy of Maryland, John Hopkins, etc.

Thank you for your answer!
Unfortunately, most of the programs you have posted, have additional requirements for IMGs, like 1 year US hands-on clinical experience, and have low no. of IMGs in general.
What would be the 2nd "line" of programs, or what programs should I definitely avoid?