Benign Heme feels like a punch to the groin!

[DrVanNostran]

How common is it for people in heme/onc to hate benign heme? Heme/Onc can give a lot of pathways (i.e. benign heme, malignant heme, solids), but I don't know if I can survive benign heme lol. How much of training is dedicated to benign usually? I also found out that my residency program basically nut punches residents if they want to do research.

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[texashemonc]

When I was a fellow in hem/Onc, I initially disliked the heme portion and considered doing a 2 year fellowship. But in the end, I did my 3 years. Now looking back, I'm glad I did. I see quite a bit of benign heme in practice. Some days it's a a fairly sized percentage. Keeps a good balance with solid malignancies. I'd feel quite depressed if I see only onc patients all day. The most common heme problems i see include everything from pregnant women with low platelets, iron def anemia, and all types of coagulopathies. Majority of these patients get better with treatment so that's gratifying.
Also, make sure to get experience doing bone marrows during fellowship. Now lot of the younger grads come out not knowing how to do marrows and send patients to have interventional radiology to do the procedure, which seems to me a waste of resources and time for vast majority of patients.

 

[CanIMakeIt]

FWIW, when I was considering heme/onc, I liked benign heme the most. Lot more thinking involved (saying that as a non-heme/onc person) than the protocol driven onc or throw-the-kitchen-sink liquid-heme.

 

[gutonc]

I too dislike benign heme. And I am only Onc trained/boarded. That said, since I practice in a general hem/onc setting now, I see a fair amount of it (it's probably 25% or so of my practice). But the vast majority of it is pretty straightforward (and gets better with treatment), and the weird stuff is actually pretty cool, even if I do have to go ask one of my mentors about it.

To answer the training question, unless you go to NYU (in which case benign heme will make up half of your training), it will generally be 1/4 - 1/3 of your clinical time.

 

[gls5377]

Are you out in the community or still academics?

 

[gutonc]

Are you out in the community or still academics?

I have a hybrid job.

 

[gls5377]

Oh. I have heard about them. How do you like it? What are some pros and cons?

 

[DrVanNostran]

I too dislike benign heme. And I am only Onc trained/boarded. That said, since I practice in a general hem/onc setting now, I see a fair amount of it (it's probably 25% or so of my practice). But the vast majority of it is pretty straightforward (and gets better with treatment), and the weird stuff is actually pretty cool, even if I do have to go ask one of my mentors about it.

To answer the training question, unless you go to NYU (in which case benign heme will make up half of your training), it will generally be 1/4 - 1/3 of your clinical time.

I think I can take 25% of benign heme. I'm starting to like malignant heme more and more.

 

[carrigallen]

I agree. A sizable proportion of oncologists view this stuff as a nuisance and a drain on clinic resources. You aren't getting much for the practice considering how much time it sucks up.
In medical oncology, there is often a team on your side helping with treatment, diagnosis, and education - radiologists, tissue pathologists, radiation oncologists, surgical specialists, endoscopists, therapists, infusion center staff, advocacy groups, etc. Whereas in benign hematology, the "team" doing all of this is you.

And the term "benign" is a misnomer - there is often nothing benign about it. These conditions can be every bit as disabling & horrendous as a solid tumor or blood cancer.

One aspect of medical oncology is that patients often have a 'coming to jesus' moment which makes them motivated and take things seriously. The same cannot always be said for benign hematology, often it does not get the respect it deserves.