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Hem/Onc Lifestyle/Salary/Satisfaction

Discussion in 'Hematology / Oncology' started by mdeast, 02.23.11.

  1. mdeast

    mdeast

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    I'm thinking about Hem/Onc more seriously recently....particular bone marrow and blood diseases (both cancer and otherwise). I was just wondering what people's general thoughts were on salary/lifestyle options/happiness in this specialty.

    There's definitely some death (which I'm not afraid of particularly), but it also seems to me in my shadowing efforts than many patients are surviving on new, better treatments. I also like the idea of compliant patients, having longer-term relationships, working in an academic, exciting setting, lots of opportunities to get involved in the biotech/pharm world. Was just wondering from any IM residents/fellows/attendings what their perception of hem/onc was. How's the lifestyle? Compensation? I'm also interested in pediatric hem/onc as well.

    I'd definitely prefer a life outside of medicine and good compensation. Though, I'm not opposed to working hard for my patients as long as the work is meaningful.
  2. mdeast

    mdeast

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    anybody?
  3. Rheumella

    Rheumella

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    I'm just an MS4 (and an idealist so please keep that in mind), but I have done 3 heme/onc months, 2 palliative electives and have volunteered with hospice throughout med school. I would recommend doing such selectives/electives. Keep the hours of the fellows/attendings and you will get a good feel for it.

    Think about doing a palliative elective if your school offers one. Death is not something to be nonchalant about. I can't tell you how many heme-onc docs I've seen push patients too far and then call for a palliative consult literally when the patient is actively dying. They say "there is nothing else I can do" and then walk out the door. The patient is shocked. It's abandonment. Please find an end-of-life care experience/elective and see if you can dig it. Are you able to stay with your patients for the entire journey?

    As for compensation, there is always a flux - regionally - temporally. You will make money someday. As for lifestyle, you make those choices by deciding where you work and who you work for after fellowship.

    Try to go into 3rd year with an open mind. Find your calling/passion. When you find it, you will know because the money question won't be so important. Good luck. :luck:
  4. AuroraK

    AuroraK

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    The above post has nothing to do with oncology, and everything to do with someone going into palliative care-- which essentially evolves a team of doctors who never took care of the patient until about 2 days ago acting like everything the patient's oncologist has done is a complete travesty, and then putting the patient on some pain regimen that no hospice or SNF is able to replicate.

    I do enjoy hearing an MS4 on an inpatient palliative care service, whose experience with the patient is limited to their most recent consult, talking about an academic oncology team "taking it too far" when they've never seen the patient healthy, or know what the patients kids are like, or know that the patient just wanted one more cycle of something to see if he could make his reunion...

    Anyway, back to the original question, the lifestyle is fine-- the days are busy, but you get to stay at home at night. Compensation is good for now, but no one knows what Obamacare is going to do (the proceduralists like Cards and GI are already being hit). Its the most scientific field in medicine from the way in which basic science research is done to being translated into clinical trials and practice. No field will change more for the better in the next 40 years than oncology.

    Back to earlier though, I actually do appreciate a good palliative care consult as anyone, but more often than not, you just get preached at even though they just met the patient-- well that, and pain mgmt recs that cant be executed by hospice. The one's who realize that things are way more complicated than they seem at first glance and give you reasonable, executable recs, are worth their weight in gold, for sure.
  5. Rheumella

    Rheumella

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    Thanks for your opinion. You put this MS4 in her place. And, we heard you the first time.

    There is quite a bit of evidence showing that starting palliative care the day of a cancer diagnosis improves many outcome measures (I can post references if you like). And you dont have to have a new team overwhelm the patient and family at the end. I also think heme/onc docs are better equiped to do this if they have some palliative training (there are some combined fellowships emerging).
  6. mdeast

    mdeast

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    Just curious, what's "good" compensation? And how does it differ if you want to do research, etc.?
  7. Brachyury

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    If you log into careers in medicine, they breakdown the numbers in private practice and academics. CIM also cites sources you can follow-up with for additional infomration (you use the same ID and password you used for AMCAS) https://services.aamc.org/careersinmedicine/
  8. HealthHare

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    Is $300K+ still doable in hem/onc???
  9. gutonc

    gutonc No Meat, No Treat Administrator SDN Senior Moderator

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    Yes. Not pleasant but do-able.

    Of course, you're listed as "pre-medical" so it will be at least 10 years before you get the chance to find out. Things will be different then. How? I have no idea.
  10. heathen

    heathen New Member

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    What do you mean when you say unpleasant? I thought in private practice and especially with an infusion center, it's not very unreasonable to make 300k+. but I haven't really looked at salaries a whole lot fwiw.
  11. pntgrd

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    Yes, in private practice. Although things may change with Obamacare and other changes in chemo reimbursement.
  12. gutonc

    gutonc No Meat, No Treat Administrator SDN Senior Moderator

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    I mean that even with those things, you're going to be seeing 30+ patients a day to pull down that cash.
  13. DrVanNostran

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  14. gutonc

    gutonc No Meat, No Treat Administrator SDN Senior Moderator

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    Yes.

    I personally know people who make ~$175K (academics) and others who make ~$750K (PP - sees 40-60 patients a day), all within a 1h drive.
  15. staup

    staup

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    I personally know many people who work in academics and make 130k, while one of my fellow residents' father in law makes over 1 million in private practice, although i think it's been less in recent years.
  16. gutonc

    gutonc No Meat, No Treat Administrator SDN Senior Moderator

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    One other think to keep in mind is that academic salaries in particular are (roughly) inversely proportional to the prestige of the place or desirability of the location.

    I'm pretty sure you have to pay to work at the Farber.
  17. DrVanNostran

    DrVanNostran

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    Definitely. I have a family member at MDACC and they took a significant paycut. However, he mentioned that with lower cost of living in Houston it doesn't feel to significant. That was one of the selling points of taking a job at MDACC over MSK, the cost of living.

    OOC: Does anyone know the salary range right now in chicago? Academic vs PP?
    Last edited: 04.22.11
  18. gutonc

    gutonc No Meat, No Treat Administrator SDN Senior Moderator

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    Houston vs NYC? The COL would have to be about 30,000% lower to make that a worthwhile move.
  19. mama

    mama

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    How would the Republican budget bill impact future payments when they win back the white house in 2012? Don't private insurers use Medicare payment scale to determine their own payment scale?

    Under the Republican plan, Medicare would essentially become a voucher program i.e. almost non-existent IMO. So would it be correct to presume that physicians would completely be at the mercy of private insurers and will have to accept whatever the private industry pays them? No doubt it would be peanuts compared to what they pay now probably.

    I guess most MD's would start voting Democrat for the first time, perhaps?:D
  20. DrVanNostran

    DrVanNostran

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    I meant the pay cut to take the academic position at MDACC was pretty significant in comparison to some of the PP job offers he was getting in Chicago. When deciding between MDACC and MSK, they pay difference was 50-100K> in NY, but living in or near manhattan was not worth it for him and the family. Plus there are great neighborhoods near MDACC (i.e. West U).

    After visiting both, MSK seemed to have a more energetic feel. I am wondering if that was just the NY vibe:)
  21. texashemonc

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    Compensation is steadily declining each year in private practice for hem/oncs. But it is a complicated formula and varies by the market you practice in. The technical side (chemo drugs) has definitely hit everyone hard as erythropoietin use is practically non-existent now except for CKD patients. With many medicare pts going into medicare HMO plans, many oncologists are not taking these patients as these tend to be lower income patients with much more chronic problems and difficult for them to come up with their copays. So even there may be more cancers being diagnosed, many patients do not have either adequate insurance, no insurance, or are medicare/medicaid (which we lose or break even at best).

    Am definitely working harder than 10 years ago even though income declining. Often am always one of the last doctors to leave in the medical office building parking lot each evening so that can be depressing at times.

    Most solo practices have consolidated and joined larger groups or got bought out by hospital chains. For a solo doctor to survive, either have to have a great referral base, or work in small rural town with no other competition. But the trade off is less time off. Hard to go on vacation worrying about your coverage as only you know your patients the best. I dread coming back from a week off vacation as that following week will always be a torture as you end up double booking patients routinely.

    Starting salary at academic centers usually run between 150-200K,although somewhat slightly more for "community" academic docs, who do strictly clinic/office/hospital work 5 days/week with no free research time. Problem for that sort of job is that the administrators can pile as many patients on to your schedule beyond your control even though you are strictly salary based with very little if any productivity bonus.

    Private practice starting will usually run 200-275K depending on geography. If partnership is made, then can certainly make 400-800K although income strictly proportional to how many patients you see in the office and hospital. Biggest problem I see are new doctors who enter a congested market (any mid to large metro city) and stay for not more than 1-2 years before leaving.
  22. asprin81

    asprin81

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    Looking at stats and posts from last few years, It looks like for last 10 years every one is saying Onc reimbursement is gone down (crushed/etc etc due to medicare rules etc), But different surveys says Hemonc starting salaries are going up each year, and people are still getting upto 500k / yr is south (recently a friend got offer of 500k in a far town of Michigan). And the new market of hospital emplyed spots for hemonc are also offering 350k-500k in south (though seiling will not go up, and 3 yr guarentee is given)

    The story of reimbursement going down.........its confusing
  23. staup

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    Honestly, once you get above 300 to 500k, does it even matter how much money it is? It's a lot. Enough to say the taxes taken out of your pay check is probably more than the paycheck of 95% of americans.

    But, what I would like to hear form texashemeonc, is how hard is it in private practice? How many patients are you seeing and when you say you get out late, how late is late? To me, onc is one of the most emotionally challenging specialty, from the doctor and the patient's point of you. You become one of the patient's most important people in their lives and have to handle a lot of extra calls and "talks" because of it. How easy is it to handle that seeing so many patients in private practice?
  24. DrVanNostran

    DrVanNostran

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    I've been confused by this as well. Looking at the chart I posted above, it seems like the compensation has risen, while probably not at the rate of inflation. The discrepancy between PP and academia seems insane.
  25. asprin81

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  26. asprin81

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  27. asprin81

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  28. asprin81

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  29. asprin81

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  30. asprin81

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  31. asprin81

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  32. asprin81

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  33. asprin81

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  34. asprin81

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  35. asprin81

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  36. asprin81

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  37. asprin81

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  38. asprin81

    asprin81

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    Above tables/graphs from Medscape survey show most recent trends in Oncology. This Oncology numbers. Combined hematology oncology salary may be little higher. Numbers are very satisfactory. I hope this helps for furture oncologist who are still scared to go into this field due to rumors of low reimbursement.

    Gutonc and others comments on this survey are welcomed and awaited........
  39. asprin81

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  40. asprin81

    asprin81

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  41. DrVanNostran

    DrVanNostran

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    Thank you for the posts! Some very interesting information.

    http://www.medscape.com/viewarticle/741760
    Oncologists Are Among the Best Compensated Physicians

    April 28, 2011 — Oncologists in the United States are earning an average of $285,000 per year, and are among the best compensated specialties, according to new figures from Medscape's 2011 Compensation Survey.

    However, among oncologists, there was a huge variation in reported income, with 9% reporting that they earned less than $100,000, and 14% reporting that they earned more than $500,000.

    The top earning oncologists work in a hospital or healthcare organization (where the median salary was $375,000), in a multispecialty group ($355,000), or in a single specialty group ($352,500).

    Oncologists were in the top half of specialties for compensation. At the very top were orthopedic surgeons, with an average salary of around $350,000 per year, followed by radiologists, anesthesiologists, and cardiologists.

    At the other end of the scale, compensated at less than half these levels, were pediatricians and primary care physicians, with average salaries of around $150,000 per year.

    Also at the lower end, with reported earnings of less than $200,000 per year, were endocrinologists, rheumatologists, infectious disease specialists, and psychiatrists. Neurologists were marginally higher, at just over $200,000.



    The Medscape Compensation Survey collected information from more than 15,000 physicians across 22 specialties. Survey respondents were 68% male, and 40% were employed. The majority (23%) were in primary care, and oncologists comprised 2% of the survey respondents (i.e., approximately 300 oncologists were surveyed).

    For employed physicians, compensation consists of salary, bonus, and profit-sharing contributions. For partners, compensation consists of earnings after tax-deductible business expenses but before income tax. Nonpatient-related activities, such as speaking engagements and expert witness fees, were not included in these compensation reports.

    Impact of Recession

    Despite the poor economic climate, half of all physicians — and about half of all oncologists — reported that their income remained the same in 2010 as it was in 2009. Of the remainder, 27% of all physicians said their income had increased, whereas 23% reported a decrease. Among oncologists, there was an equal split between those who reported an increase and those who reported a decrease (about 23% each).

    Most oncology practices have not reduced office operating costs, but 38% of oncologists reported that they managed to reduce practice overheads by 10% to 30% during the past year. Likely explanations include the use electronic health records and the streamlining of pharmaceutical inventory. Joining a community oncology network, merging with a larger group, or becoming a hospital-owned practice might also have helped to reduce overhead.

    Is Compensation Fair?

    More than half of all the physicians surveyed said that overall, they felt that they were fairly compensated. A notable exception was primary care — more than half of those surveyed said they would not choose this specialty if they had it to do over again.

    In contrast, oncologists were overwhelmingly positive about their career choice, with 75% of respondents saying they would choose medicine again, and 80% saying they would choose oncology again.

    Just more than half of oncologists (55%) felt that they were being fairly compensated. Employed oncologists were slightly more likely than those in private practice to feel that they were being paid fairly.

    "Don't we all at times feel undercompensated?" asked Kathy Miller, MD, associate professor of medicine, Indiana University School of Medicine, Indianapolis. Dr. Miller, who posts a regular videoblog, Miller on Oncology, on Medscape Medical News, commented on the survey findings in a slide show.

    "We are not paid for some of the most critical aspects of what we do," she said. "Time spent educating patients and their families, detailed discussions about treatment options, potential benefits and toxicities, and planning end-of-life care are all daily aspects of an oncologist's life. They take real time, but they are reimbursed poorly, if at all."

    One of the oncologists who responded to the survey, Robin Zon, MD, from South Bend, Indiana, pointed out that the economic downturn has created problems getting compensated for some work.

    "In areas hit by the recession, the rate of uninsured and underinsured patients has increased dramatically, yet those patients still need care," Dr. Zon said. "There is a considerable time donated trying to find resources for these patients who may never qualify for government aid."

    Paperwork Takes Time

    Paperwork and other nonpatient-care obligations, including billing, administrative issues, managerial work, and clinical reading, take up a significant amount of time, the survey reveals. About 20% of oncologists reported that they spend 5 to 9 hours each week on such professional but nonpatient-care activities; a further 20% said this took 20 to 25 hours each week.

    One physician respondent, reflecting his frustration at reimbursement issues, said that he was tempted to abandon medicine and would like to become "an assassin of insurance company executives."

    The majority (64%) of oncologists in the survey reported working 30 to 50 hours each week. However, nearly 20% on oncologists reported working 51 to 65 hours each week, and 5% reported that they were seeing patients for more than 65 hours each week.

    Most oncologists reported that they saw patients for 30 to 40 hours each week, although this differed by practice setting, with more oncologists who are employees than those who are in private practice putting in that kind of time.

    The average number of patients seen during a week was around 50 to 75, although 6% of respondents said that they saw 125 to 200 patients each week.

    About half of the oncologists surveyed said that they spent between 13 and 20 minutes with each patient.

    Women Earn Less

    Across all specialties, female physicians reported earning 41% less than men, although this difference fell to 21% in primary care.

    "The vast majority of women physicians are in primary care or obstetrics, so it's natural that they would earn less," said Travis Singleton, senior vice president of AMN Healthcare, a physician staffing firm in Irving, Texas, who commented on the survey findings. There are fewer women in some of the higher-paying specialties, he added.

    In addition, many women physicians are more likely to work fewer hours than their male counterparts, choosing part-time schedules to balance work and family/lifestyle needs, he noted.

    The sex difference seen in oncology reflects that seen in all specialties. The pay gap was substantial, with male oncologists reporting an average salary of $320,000 and female oncologists reporting $225,000.
    Last edited: 04.29.11
  42. DocOfDocs

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    Do they group Rad Onc and Heme/Onc under "Oncology" ?
  43. asprin81

    asprin81

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    Only Medical Oncologist/Chemo Docs
  44. gutonc

    gutonc No Meat, No Treat Administrator SDN Senior Moderator

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    No. Just like they don't include cardiologists with CT surgeons. Different jobs.
  45. asprin81

    asprin81

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    Tags: compensation | MGMA | physician compensation
    Physician compensation can vary widely by specialty, hospital ownership, geographic location and many other factors. Here are five factors currently affecting physician compensation, according to various reports.


    5. Rate of income growth.
    While some specialties are traditionally compensated at higher levels than others, physician compensation is also affected by the rate of income growth over several years. Here are the five medical specialties with the highest average gains in income offers between 2008/9 and 2009/10, according to data from Merritt Hawkins' 2010 Review of Physician Recruiting Incentives:

    1. Hematology and oncology income offers increased 14.9 percent on average between 2008/9 and 2009/10, moving from $335,000 to $385,000.
    2. Neurology income offers increased 8.9 percent, from $258,000 to $281,000.
    3. Orthopedics income offers increased 7.9 percent, from $481,000 to $519,000.
    4. Radiology income offers increased 6.6 percent, from $391,000 to $417,000.
    5. Dermatology income offers increased 5.7 percent, from $297,000 to $314,000.
  46. asprin81

    asprin81

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    By Lynne Peeples
    NEW YORK | Mon Oct 25, 2010 4:16pm EDT

    NEW YORK (Reuters Health) - Primary care physicians earn as little as half what their colleagues who specialize in areas such as surgery and oncology are taking home, according to a new study of doctors' salaries.
    The study's authors suggest that this wage gap might be contributing to the current shortage of general-practice doctors in the U.S., as well as driving the nation's rising costs of medical care.
    Looking at salaries among 41 specific subspecialties, however, they found neurologic surgery and radiation oncology to be the most lucrative at $132 and $126 per hour, respectively. These were followed by medical oncologists and plastic surgeons, both making around $114 per hour; immunologists, orthopedic surgeons and dermatologists also took in more than $100 an hour. At the low end of specialist pay, child psychiatrists and infectious disease specialists made around $67 an hour.
    The disparities held after accounting for age, race, sex and region of the country.
    Further, the researchers found no evidence of salary disparities between racial groups. However, a gender salary gap remained, with women earning an average of $9 less per hour.
  47. HO2011

    HO2011

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    Very informative. Thanks a lot! I indeed feel Hem/Onc fellowship application is getting more and more competitive. And There is a rumor that most oncologists in practice now are over 50 years old, so it is a good time to go into this field.


  48. texashemonc

    texashemonc

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    You have to be cautious of those flyers sent to you.
    They will not say where the location is but when u delve in, it's often in middle of nowhere. But as you may guess, although money may be good, will your family be happy? How often is call? Are u going to join a senior partner who will then take a lot of time off and then u have to cover practice yourself? What if they will never make u a fulltime partner and you will remain an employee? What if the buy in for partnership is 500k? No one can afford that!
    Also, if u leave early in many practices where there is income guarantee from hospital, u may have to repay a huge amount.

    I think if u are doing this for money, don't go into this specialty as chemo income is only going to drop. And do not go into hem/onc if you are going to take advantage of patients when they are in their most fragile state by promising cure or long term remission. There r too many docs that r doing this currently. But if you r interested in establishing long term relationships with pts in all walks of life, including dealing with elderly people most of the time, then please consider.
  49. staup

    staup

    Joined:
    02.15.07
    Messages:
    173
    SDN 5+ Year Member
    great post texas, thanks for all of your wise input into this thread.
  50. mdeast

    mdeast

    Joined:
    06.22.09
    Messages:
    2,352
    Status:
    Medical Student
    SDN 5+ Year Member
    Thanks guys for all the info! I lost track of this thread but it has been really interesting. I care much less about income than I do about potential for a good lifestyle. I'm OK about working hard, but wouldn't mind more normal hours (not working on weekends, etc.). I'm hoping to start a family and eventually enjoy life after medical school.

    Hem/onc really attracts me because I like the patients, they are obviously motivated to follow treatments, it's intellectual and there is a lot of room for research (both clinical and basic science).

    I was also curious to what exact a fast-track route to Hem/Onc (or other specialties) is? (i.e. 5 years of residency and fellowship instead of 6). I'm thinking about doing internal medicine (2 years) and then hem/onc fellowship (3 years), with the intention to do some sort of clinical research in addition to my normal practice.

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