A Few Heme/Onc Questions...

[Frazier]

I've been reading this forum for a little while and had a few questions -- I hope some of you will offer up your wisdom.

A few years ago, @gutonc mentioned in a thread about heme/onc & pathology: "I still look at a lot of smears, marrows and biopsies, but its for my own edification and education..."

I think the opportunity to do this is pretty awesome. I enjoyed my pathology course, histology, and identifying CA under the scope. That said, I have no intent of pursuing pathology as a specialty. Nevertheless, gutonc's quote made me happy that some of the visual-based aspects of other fields can still be appreciated in Heme/Onc.

In that same light, is it common for oncologists to view/review their patient's films and imaging? Not necessarily for billing or anything, but more so for the oncologist's own "edification and education"?

Another question: as hematologists/oncologists, do you feel that you "lost your medicine skills"? For example, from orthopedic surgeons to psychiatrists, a somewhat common regret that specialists have is that they lost their medicine skills/knowledge after specializing/subspecializing. I understand that since all heme/onc's have gone through either IM or peds, their medicine training is more extensive than many of these other fields. Nevertheless, I am curious to those practicing if you feel much of your knowledge/skills from residency have been retained through the years.

Last issue (and perhaps most political of this post), when I hear people talk about specialties that are intrinsically protected from "midlevel encroachment" -- I often hear about surgical specialties, radonc, rads, and path. However, given the sheer breadth of knowledge and training required to competently practice as heme/onc's, wouldn't your specialty also have a solid layer of protection?

Thanks.

---

Members don't see this ad.

 

[gutonc]

I've been reading this forum for a little while and had a few questions -- I hope some of you will offer up your wisdom.

A few years ago, @gutonc mentioned in a thread about heme/onc & pathology: "I still look at a lot of smears, marrows and biopsies, but its for my own edification and education..."

I think the opportunity to do this is pretty awesome. I enjoyed my pathology course, histology, and identifying CA under the scope. That said, I have no intent of pursuing pathology as a specialty. Nevertheless, gutonc's quote made me happy that some of the visual-based aspects of other fields can still be appreciated in Heme/Onc.

In that same light, is it common for oncologists to view/review their patient's films and imaging? Not necessarily for billing or anything, but more so for the oncologist's own "edification and education"?

Every patient, every scan. I probably look at 20 or 30 scans a week. And not just for my "edification and education" but for patient care.

Another question: as hematologists/oncologists, do you feel that you "lost your medicine skills"? For example, from orthopedic surgeons to psychiatrists, a somewhat common regret that specialists have is that they lost their medicine skills/knowledge after specializing/subspecializing. I understand that since all heme/onc's have gone through either IM or peds, their medicine training is more extensive than many of these other fields. Nevertheless, I am curious to those practicing if you feel much of your knowledge/skills from residency have been retained through the years.

I'm not sure how that would even happen. I do "medicine" every day. Am I up-to-date on the latest oral DM meds or which BB and statin some drug company paid to be the "best" this month? No...don't care. But you'd be surprised how many PCPs throw their hands up and say "not it" as soon as one of their patients is diagnosed with cancer.

Last issue (and perhaps most political of this post), when I hear people talk about specialties that are intrinsically protected from "midlevel encroachment" -- I often hear about surgical specialties, radonc, rads, and path. However, given the sheer breadth of knowledge and training required to competently practice as heme/onc's, wouldn't your specialty also have a solid layer of protection?

There are mid-levels everywhere. Without mine, I'd be working 50% more than I am now or my patients wouldn't see a provider prior to every chemo visit. But they don't do initial consults, don't discuss re-staging and don't make treatment decisions. They will work differently in every practice setting but I'm reasonably happy with the way it has worked in mine.

 

[gutonc]

Again, what you say makes a lot of sense. I have heard how in certain specialties mid-levels can greatly improve care by helping the physician increase efficacy. I guess my question should have been re-worded as "Some specialties today are truly afraid that they are going to be replaced in their profession by folks other than physicians. Some PCPs worry about NPs, some psychiatrists worry about psychologists/NPs, some anesthesiologists worry about CRNAs, some ophthalmologists worry about optometrists, etc -- does heme/onc practitioners feel largely protected from those possibilities (of encroachment) given the nature/breadth of knowledge/power of treatments in their field?" I just have a hard time imagining a NP program could produce graduates that are allowed to independently practice, make the decisions in heme/onc, and be taken seriously while they do it ...Would I be correct in guessing it doesn't keep you guys up at night?

Again...every practice scenario will be different. But my institution does not allow mid-levels to sign chemo orders. So...no MDs, no chemo. The mid-levels that I work with (my group of 12 docs has 3 NPs) don't actually want primary responsibility, which is fine with me. This will vary widely and I definitely know some mid-levels who think they're "just as good as a doctor" and they scare the s*** out of me.

Thanks for bearing with me. My last question for now: I remember a post where you said that your expertise is in GI cancers (maybe I am remembering incorrectly). I have heard others mention their expertise being "breast", "sarcomas", etc. In fact, I've heard one say "My expertise in in breast. All I do is breast day in and day out". Is this (only seeing a certain type/set of cancers) more common in academic hospitals than community hospitals?

Thanks.

Yes, much more common in academics than PP. That said, a large PP group with 1 or 2 locations can afford to do this too. If my group of 12 docs all shared one or 2 offices (rather than 6, soon to be 7), then we could easily do this. As it is, we're known for our interests but we see whatever comes our way.

But if you haven't figured it out by now, oncology is not that hard.

 

[Frazier]

Again...every practice scenario will be different. But my institution does not allow mid-levels to sign chemo orders. So...no MDs, no chemo. The mid-levels that I work with (my group of 12 docs has 3 NPs) don't actually want primary responsibility, which is fine with me. This will vary widely and I definitely know some mid-levels who think they're "just as good as a doctor" and they scare the s*** out of me.

Yes, much more common in academics than PP. That said, a large PP group with 1 or 2 locations can afford to do this too. If my group of 12 docs all shared one or 2 offices (rather than 6, soon to be 7), then we could easily do this. As it is, we're known for our interests but we see whatever comes our way.

But if you haven't figured it out by now, oncology is not that hard.

You're certainly a valuable asset to the forum. Thanks for sharing all the info/insight!