Heme-onc employment question

[mlaza252]

My name is Mark and I'm a 3rd yr IM resident thinking about taking a year off and applying for heme-onc. I've published 5 onc papers, and my resume is pretty solid but I want to see if anyone has insight into academic v. private v. other settings.

I would like to specialize in oncology (i.e just do breast, or just do lung.....any solid tumor really interests me; leukemia/lymphoma and benign heme not so much!!!), and I wonder if this is possible to do and still have a make a good living (i.e. >300k)?

I know that you CAN have an onc speciality in academic medicine and see only breast cancer all day -- but, the salary with these jobs, to me, is NOT worth the additional 3 years of fellowship. To be an onc "super"-specialist and make less than some hospitalists do, despite a vigorous 3 year heme-onc training fellowship, and the additional stressors that come with taking care of cancer patients, would build a lot of resent in my eyes.

Also, while the salary for private practice oncologists is terrific, I wouldn't be interested in seeing the BREADTH of heme and onc that you have to see in a private setting.

So my question is this: Are there positions where one can subspecialize in one cancer (let's say, breast), while at the same time making $$$ and a decent lifestyle. What about doctors at Cancer Centers for America?? Are they any private practices that are SUPER specialized to this extent?? Does university medicine EVER pay well???

PLEASE HELP!!!!

Thanks
-Mark

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[gutonc]

Also, while the salary for private practice oncologists is terrific, I wouldn't be interested in seeing the BREADTH of heme and onc that you have to see in a private setting.

So my question is this: Are there positions where one can subspecialize in one cancer (let's say, breast), while at the same time making $$$ and a decent lifestyle. What about doctors at Cancer Centers for America?? Are they any private practices that are SUPER specialized to this extent?? Does university medicine EVER pay well???

PLEASE HELP!!!!

Thanks
-Mark

So first of all, I'll start off by saying that I think you probably shouldn't go into heme/onc since your motivation is basically money. Let's ignore the money for the time being. Everybody is going to get squeezed and the days of the $350K hospitalist job are going to come to an end soon so choose your career based on what you want to do, not the income potential. If you want to make a huge amount of money you should look outside of medicine.

With that out of the way, the answer to your question is...sort of. There are some larger, mostly integrated healthcare/hospital systems with one or two locations that are able to do this.

Now the "sort of" part. I know a few people who are able to pull this off outside of academics...however, 30-60% of their salary comes from grants and other non-clinical support related to running clinical trials. The rest of their salary is clinical.

If a PP group is going to hire you, you're going to have to earn your pay...the easiest way to do that is to see patients. And there just aren't that many patients with 1 type of cancer in most places to support one person doing this full time.

As an example, my office is downstairs from the busiest breast surgery group in the state. They send 75-80% of their patients to see us (there are 3 docs at my office, 11 in my group). A rough estimate (based on our weekly review of all patients seen in the office in a week which we did this morning) shows that you could fill ~2 clinic days/wk with these patients (new consults and follow-ups). If we saw all the BC patients referred from that practice, it would be ~3 days/wk. In order to see all the BC patients in the metro area, I'd guess would take ~1.5 FTE, maybe 2.5 FTE to see all the BC patients in the state.

So...to answer your original questions.

1. Is it possible?
Sure

2. Is it likely without significant non-clinical salary/compensation support?
No

All that said...I assumed I'd hate anything that wasn't GI oncology. I was wrong.

If you want to be an oncologist, do it. If you just want to make a f***ton of money, choose a different career (like the defense industry, investment banking or drug dealing).

 

[nephappl]

Great answer, love it
We need some more common sense in SDN

 

[mlaza252]

Terrific response, thank you! To clarify, it's obviously not all about the money but in my eyes oncologists are incredibly passionate, dedicated, and hard-working people who deserve to be well-compensated for the incredible and time-consuming work they do.

Just my opinion...

Thanks again!

 

[gutonc]

Terrific response, thank you! To clarify, it's obviously not all about the money but in my eyes oncologists are incredibly passionate, dedicated, and hard-working people who deserve to be well-compensated for the incredible and time-consuming work they do.

Just my opinion...

Thanks again!

And, as an oncologist, I absolutely agree with you. But I got over myself a long time ago and don't feel that I deserve any better compensation (for the time and energy spend) than any other specialist does.

 

[random1234]

Not to hijack the thread, but I'm currently a premed interviewing at med schools, and I'm very interested in heme/onc. I loved that part of my clinical lab experience and so I'm exploring it to see if I can find opportunities early on.

Would you all still recommend this field 10-20 years from now? Also in terms of ped vs adult heme/onc, does adult have more options, employment wise? Also would it be unwise to do something like combined IM/EM if someone were unsure they could find a fellowship position? Is it very hard to find a fellowship position?

 

[gutonc]

Not to hijack the thread, but I'm currently a premed interviewing at med schools, and I'm very interested in heme/onc. I loved that part of my clinical lab experience and so I'm exploring it to see if I can find opportunities early on.

Would you all still recommend this field 10-20 years from now? Also in terms of ped vs adult heme/onc, does adult have more options, employment wise? Also would it be unwise to do something like combined IM/EM if someone were unsure they could find a fellowship position? Is it very hard to find a fellowship position?

I'll let you know how it goes in 10-20 years. I broke my crystal ball last week so I'm not able to peer into the future. But I doubt we're going to rid the universe of cancer in that time so the likelihood of being able to have a job as an oncologist should be pretty high.

As for peds vs adult, choose the group you want to work with. There are a lot fewer pediatric hem/onc jobs than adult, and they pay less. But there aren't many unemployed person hem/onc docs.

 

[random1234]

I'll let you know how it goes in 10-20 years. I broke my crystal ball last week so I'm not able to peer into the future. But I doubt we're going to rid the universe of cancer in that time so the likelihood of being able to have a job as an oncologist should be pretty high.

As for peds vs adult, choose the group you want to work with. There are a lot fewer pediatric hem/onc jobs than adult, and they pay less. But there aren't many unemployed person hem/onc docs.

Haha. Thanks for the input! I'm going to try to add some electives in heme/onc early on and hopefully I can involved in research early as well.

 

[todo]

So first of all, I'll start off by saying that I think you probably shouldn't go into heme/onc since your motivation is basically money.

Yeah, and lets pretend the reason Cards and GI spots are so coveted is b/c everyone just loves these specialties oh-so-much. $ $

 

[qv3755]

Yeah, and lets pretend the reason Cards and GI spots are so coveted is b/c everyone just loves these specialties oh-so-much. $ $

you might be right pretending the reason for GI but totally not for Cards. You really have to like Cards (probably the prestige) to really want to do Cards these days.