Allergy/Immunology vs Heme Onc for Fellowship?

[tomedwego]

Hi Folks,

I am a US MD currently in a solid mid-tier IM residency program. Not really sure what to do here. I like research, QOL, and a decent enough salary.

Feel like allergy might not have a lot of job prospects, plus a lot of job offerings are for ~200k which after all that training does not seem like much :/. Plus diversity in the field is truly lacking (Very much Derm 2.0). Competition has been getting increasingly fierce each year, yet it appears that we might be heading in a direction where there is oversaturation(already happening in the major cities). QOL seems amazing, but I am not really sure if it's at the expense of job flexibility and salary to be honest.

For heme/onc, QOL is what you make of it. It seems like there are plenty of opportunities to do research vs academia vs industry vs PP or even a combo of all of them. Oncologists are needed all throughout the country and salary is practically double what you make as an allergist. Demand is high and there is a lot of flexibility with jobs and salary. Also you're certified in Hematology AND Oncology so there is a lot of variety in the field, acuities, and complexities. Originally I thought I might not be able to stomach tough onc cases, but the dynamic and changing field has success stories that balance out the tear jerkers.

I have no obvious red flags, other than lack of onc research at the moment and it's really because I discovered it quite late in training. What are your thoughts?

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[HemeOncHopeful19]

You're probably not going to get very useful answers here because very few non-A/I physicians know details about the Allergy/Immunology job lifestyle/market beyond what we think we observe from the outside.

Oncology has higher pay (for now) but that could easily change with legislation. If both jobs paid the same I would say A/I >>>>>>> H/O simply because of no need to take hospital call whatsoever and I would think there is minimal "bad news" delivery in A/I. That being said the job market in H/O is fantastic as hospitals everywhere are trying to maximize that 340b $$$.

You can never know where a field will go... GI wasn't that competitive in the 90s before Medicare started reimbursing for the screening scope. I have similarly heard that Nephrology used to be a relatively competitive fellowship before Fresenius/DaVita gobbled up literally 75% of the dialysis market and cratered the field.

 

[Ubba]

There are so many factors to consider. I think your 200k figure is off. Check out the A/I threads also and ask those attendings.

But let me ask you a broader question: If you had to choose between making 700k but being married to medicine such that your job is your personality and on your mind 24/7 vs making 400k but living like a "normal" person and having actual mental time off, which would you pick? And remember that taxes make the difference significantly smaller than the pre-tax number, and that when you take call and weekends into account, the $/hr is closer than you might think.

(P.S. I happen to disagree with you on diversity within dermatology. Look through a derm textbook... there are thousands of conditions with plenty of visual overlap, and I'm continually impressed by derms' knowledge bases.)

 

[tomedwego]

There are so many factors to consider. I think your 200k figure is off. Check out the A/I threads also and ask those attendings.

But let me ask you a broader question: If you had to choose between making 700k but being married to medicine such that your job is your personality and on your mind 24/7 vs making 400k but living like a "normal" person and having actual mental time off, which would you pick? And remember that taxes make the difference significantly smaller than the pre-tax number, and that when you take call and weekends into account, the $/hr is closer than you might think.

(P.S. I happen to disagree with you on diversity within dermatology. Look through a derm textbook... there are thousands of conditions with plenty of visual overlap, and I'm continually impressed by derms' knowledge bases.)

I think a huge problem to your question is that often times on SDN, there are extreme examples. But I'm a middle of the pack kind of person from a mid tier residency. At the end of the day, I want a job that pays well, gives me solid job prospects, and has a decent enough QOL. Allergy being as niche and as coveted as it is makes it VERY hard to really know much information about it and what is really happening behind closed doors. That's why I'm concerned. Every year, there are more H/O fellows who match than A/I understandably so, so it's clear what the outcomes of training are. I think NO question, QOL in A/I >>>>> H/O, but I wonder if this is honestly enough? Plus, I'm not entirely sure what the A/I personality is. From my experience, H/O tend to be wickedly brilliant and empathetic and I do get along with them in my institution. The A/I fellows are usually hiding lol, so I don't really know much about them.

 

[MHYDE]

 

[HemOncCheng]

View attachment 392632

Here you go, OP can ask questions.

 

[MHYDE]

I came to allergy through pediatrics, so I don't have a lot of insight into adult heme/onc, though it sounds like your job prospects and pay are pretty great in that field. Obviously huge diversity between benign hematology and all the oncology stuff, though I thought most h/o docs specialized even within the field (maybe that's mostly just true in peds). We do see a lot of different things in our practice too, I guess it just depends too on what you find interesting. While I do work hard and it does feel like I am spending lots of time either at work or thinking about work, I do stop and remind myself pretty frequently that I am in the office 7:30-5:30, 4 days a week, and call entails after-hours on the phone (average one page a week) and hospital curbsides (same). So, lifestyle has been what I hoped. Coming out of fellowship in 2022 I was able to land several interviews and offers, as did all the other fellows I've known, but the only one in the $200k range was an academic program that had a lot of other perks and benefits. Other offers in employed or private-practice land were definitely higher to start and with room for growth. From reading this thread though it does seem like starting pay, average pay, and even ceilings are a lot higher in h/o. Seems likely you'd end up happy in either. If you're a PGY1 or 2 you still have time to do an elective rotation, right?

Most A/I fellowships are 2 years, which is also nice.

 

[tomedwego]

I came to allergy through pediatrics, so I don't have a lot of insight into adult heme/onc, though it sounds like your job prospects and pay are pretty great in that field. Obviously huge diversity between benign hematology and all the oncology stuff, though I thought most h/o docs specialized even within the field (maybe that's mostly just true in peds). We do see a lot of different things in our practice too, I guess it just depends too on what you find interesting. While I do work hard and it does feel like I am spending lots of time either at work or thinking about work, I do stop and remind myself pretty frequently that I am in the office 7:30-5:30, 4 days a week, and call entails after-hours on the phone (average one page a week) and hospital curbsides (same). So, lifestyle has been what I hoped. Coming out of fellowship in 2022 I was able to land several interviews and offers, as did all the other fellows I've known, but the only one in the $200k range was an academic program that had a lot of other perks and benefits. Other offers in employed or private-practice land were definitely higher to start and with room for growth. From reading this thread though it does seem like starting pay, average pay, and even ceilings are a lot higher in h/o. Seems likely you'd end up happy in either. If you're a PGY1 or 2 you still have time to do an elective rotation, right?

Most A/I fellowships are 2 years, which is also nice.

What is the private practice starting salary and range through your career for A/I?
My gut feeling is telling me that it seems that H/O training might be more grueling in the short term but offers better opportunities and pay.
Also there are A/I fellowship programs that are also pretty tough academically and clinically where you are caring for some of the sickest immunodeficiency cases and zebra cases that get dumped on you because no other specialty knows what to do...... so it just has me thinking is it really worth it at the end?

 

[osprey099]

What is the private practice starting salary and range through your career for A/I?
My gut feeling is telling me that it seems that H/O training might be more grueling in the short term but offers better opportunities and pay.
Also there are A/I fellowship programs that are also pretty tough academically and clinically where you are caring for some of the sickest immunodeficiency cases and zebra cases that get dumped on you because no other specialty knows what to do...... so it just has me thinking is it really worth it at the end?

H/O private practice is very grueling. If you want to make a lot of money, you will be working very hard for it. But sky is the limit in terms of how much money you want to make in heme onc.

 

[MHYDE]

What is the private practice starting salary and range through your career for A/I?
My gut feeling is telling me that it seems that H/O training might be more grueling in the short term but offers better opportunities and pay.
Also there are A/I fellowship programs that are also pretty tough academically and clinically where you are caring for some of the sickest immunodeficiency cases and zebra cases that get dumped on you because no other specialty knows what to do...... so it just has me thinking is it really worth it at the end?

I can’t comment much on national or long-term trends or anything, I just know my experience and a few colleagues coming out of training in the last few years. Offers in the 300s guaranteed were common, and a reasonably productive allergist can make 500 or so, again with 4 days a week of normal office hours. Obviously that varies a lot depending on how you work, where you work, etc. As you established, there is more money in H/O, but no free lunch. And we are a smaller field so you can’t just find a job anywhere. That said, I had plenty of opportunities, many interviews, and several offers.

That description doesn’t really fit my fellowship, for sure. We did not have the sickest or most complicated patients. Our consult service was 90% hives and drug allergies. Again I can’t speak for other programs.

I get the sense you just like h/o more, so that should be reason enough!