ABIM short track, single boarding impact on career flexibility

[oncdoc.]

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I am a resident short-tracking into heme/onc fellowship. I was curious as to whether short-tracking is viewed negatively if ultimately I decide not to go into academics and want to pursue community practice, as well as how much single-boarding vs. double boarding in this context makes a difference as well. I hope to pursue academics but also would ideally like to keep open as many doors open as possible should that not work out. Thanks!

 

[ONC2023]

Hey. Short-tracker/single boarded med onc here. Very smart of you to think ahead so as to not close doors. As a happily failed MD-PhD in community practice, I’d advise everyone to think about that.

As for short tracking, no one will care about that whatsoever.

Single boarding may be relevant. The vast majority of places I talked to didn’t care, even if they were general heme onc jobs, but there were a few places that explicitly wanted double boarding.

I would keep in mind two things:

1) If you’re double boarding, short tracking isn’t actually shorter. If you short track IM, fellowship becomes 4.5 years total. If you’re single boarding, it’s 4 year fellowship which is the same length as IM/hem-onc without short tracking. The true short track is 3 year IM and 2 year med onc fellowship, but that depends if your program allows it.

2) Much more important than whether you double board or not is the type of program you go to. If you end up at a big academic place with all sub speciality faculty, that’s great in some ways but it also means it will be harder to become familiar with all heme-onc. And fundamentally, the main limiting factor on your ability to get jobs is what tumor types and what benign heme conditions you’re comfortable treating. My best advice is get the broadest training you can and specialize after if you want, not the other way around.

 

[gutonc]

Like @ONC2023, I am a happily failed out research pathway graduate. I even did a 1 year "super fellowship" trying to make the academic thing work and it only taught me that it wasn't what was going to make me happy.

I am onc-only trained and boarded and have spent my whole career in general practice, and the last 2+ years in a rural CAH where I'm the only one for 60-200 miles in any direction. I'm doing fine.

Try not to let your program pigeon hole you into super focused clinical rotations (all GI for example) and be sure you get broad clinical exposure. I agree that if you wind up at a zebra ranch like NIH or MDACC, it will be harder to get exposure to the bread and butter, but not impossible.

95% of heme consults in the community can be handled by a moderately competent M3 (that number goes closer to 98% if you work somewhere with a lot of PAs and NPs in primary care). Maybe 1-2% will require you to phone a friend or refer out. For me, in a busy solo practice, that means 1-2 cases a quarter where I need some help. I'm fortunate to have a world renowned classical hematologist in my phone contacts who responds immediately, so I rarely worry about these.

Bottom line, you can do it. It might take a little more work in fellowship (if your program has a community rotation option, take it) and a little more time to get super comfortable once you're in practice, but it's not impossible, or even all that difficult to do.