Medical Oncology fellowship (2y) vs Heme Onc (3y)

[sallyhasanidea]

Can anybody comment on pros/cons of doing a 3 year heme onc fellowship over a 2y medical oncology fellowship?

I've seen posts around of people saying they don't use much of the heme training?

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[HOIV]

Can anybody comment on pros/cons of doing a 3 year heme onc fellowship over a 2y medical oncology fellowship?

I've seen posts around of people saying they don't use much of the heme training?

When starting private practice, I did a ton of complicated benign heme referred to the practice that no one else wanted to see. I have built up my oncology portion but I still get asked to see benign heme consults that are complicated and enjoy them. In my practice model, we are reimbursed per RVU and that doesn’t vary based on heme or onc thus from a productivity and profitability standpoint being that I like benign heme it is a positive. Some partners shy away from more complicated heme due to not being boarded but they do iron deficiency and the basics. The extra year will make you more marketable overall but I think most importantly keeps you in academics around the newest data for an extra year growing in the oncology arena which I think is most important. So much oncology is judgment and approach that I know I grew a lot in year three and was more prepared in practice than people who started at the same time having only done two years.

 

[RainerMaria]

This has been discussed elsewhere, but most hospitals would not allow you to see a hemophilia consult or HLH or (name any of the 100 other disorders) without being heme boarded. Most hospital groups and PP groups don't want to have to create a "hammock" for you in case a heme disaster rolls in. It definitely limits you in all but the most ivory of towers. Not to mention the litigation risks with VTE consults. After 4 years of college, 4 years of medical school, 3 years of residency, and 2 years of fellowship, you don't want to say in 20 years, man, I shouldn't have cut my training short 12 months.

 

[gutonc]

This has been discussed elsewhere, but most hospitals would not allow you to see a hemophilia consult or HLH or (name any of the 100 other disorders) without being heme boarded. Most hospital groups and PP groups don't want to have to create a "hammock" for you in case a heme disaster rolls in. It definitely limits you in all but the most ivory of towers. Not to mention the litigation risks with VTE consults. After 4 years of college, 4 years of medical school, 3 years of residency, and 2 years of fellowship, you don't want to say in 20 years, man, I shouldn't have cut my training short 12 months.

This might seem like the case but it's really not. I'm not heme boarded and see all that stuff.

That said, I agree that, barring the Research Pathway (which I did), everyone should do Heme and Onc training. Whether you sit for/renew your boards in both is up to you. But the training is super helpful.

 

[RainerMaria]

Real or not, our group will not put on a Onc-only person on a weekend by him/herself for this reason. Similarly for someone who let their heme training lapse.

Also I get a little skeptical about these programs that practically force their 1st years do choose a 2 year program. I wonder if this is in the best interest of the program and not the fellow. If the PD can get all their fellows to be on a two year track, then you increase the percentage of fellows doing hard manual labor from 33% to 50% (e.g., a 10 fellow program, with a hard cap set by the ACGME, will have 5 first years instead of 3 or 4 first years). Works for covering busy services, but not sure it's in the best interest long term of someone who is not sure they want to do academics the rest of their life.

 

[Square[]]

I chose to single board in oncology. Planning to do early phase clinical trials in academia or at one of these large private research institutes. Will consider industry in the future. Can’t see myself doing community practice - seems like a lot of hard work.

 

[gutonc]

Real or not, our group will not put on a Onc-only person on a weekend by him/herself for this reason. Similarly for someone who let their heme training lapse.

Can I work with your group then? I'd love to only cover half as much on the weekends.

 

[Phase1Phase2]

It is one year of your life. You will get additional training during that year that I believe is valuable. You will be eligible for another board exam, which you can always choose not to take (which would be a mistake). These years are your building years. Build now and put the time in.

 

[sallyhasanidea]

Real or not, our group will not put on a Onc-only person on a weekend by him/herself for this reason. Similarly for someone who let their heme training lapse.

Also I get a little skeptical about these programs that practically force their 1st years do choose a 2 year program. I wonder if this is in the best interest of the program and not the fellow. If the PD can get all their fellows to be on a two year track, then you increase the percentage of fellows doing hard manual labor from 33% to 50% (e.g., a 10 fellow program, with a hard cap set by the ACGME, will have 5 first years instead of 3 or 4 first years). Works for covering busy services, but not sure it's in the best interest long term of someone who is not sure they want to do academics the rest of their life.

So is the 2 year oncology path a good way to avoid working weekends for the rest of your life?

 

[gutonc]

So is the 2 year oncology path a good way to avoid working weekends for the rest of your life?

No. Why would it be? Somebody's got to take call, and you're not getting out of it just because you're not heme boarded. Sure, @RainerMaria's group may not let you be on call by yourself, but you're still taking call.

My group recognizes that 98% of heme issues can be managed by a moderately competent M3 with access to UpToDate and the other 2% need to get shipped out anyway.

 

[HemeOncHopeful19]

No. Why would it be? Somebody's got to take call, and you're not getting out of it just because you're not heme boarded. Sure, @RainerMaria's group may not let you be on call by yourself, but you're still taking call.

My group recognizes that 98% of heme issues can be managed by a moderately competent M3 with access to UpToDate and the other 2% need to get shipped out anyway.

I’m curious if you do a lot of anticoagulation consults?

My impression (admittedly not experienced here just a fellow) is that bleeding/clotting is a higher risk area for malpractice and I would think having the board certification wouldn’t hurt but then again maybe it wouldn’t help much either.

 

[gutonc]

I’m curious if you do a lot of anticoagulation consults?

My impression (admittedly not experienced here just a fellow) is that bleeding/clotting is a higher risk area for malpractice and I would think having the board certification wouldn’t hurt but then again maybe it wouldn’t help much either.

Chest has guidelines for a reason.

The stuff that falls outside of that gets an ivory tower video visit or a bus ride over there.

I'm not saying that there aren't complicated non-malignant heme cases. Nor am I pretending to be able to manage the total edge case s***shows that crop up now and then.

But that's literally 1 or 2 pages a year for me, in a relatively large, busy group. I'm also fortunate to have easy access to a very competent and easy to consult academic hematology group that will answer my questions day or night via text, email or Inbasket.

 

[solidonc2020]

So is the 2 year oncology path a good way to avoid working weekends for the rest of your life?

Just an easier way to make you less marketable to many private groups.