Community Heme/Onc: Lifestyle?

[blackcadillacs]

Hi all,

I'm curious about the quality of life of a community Heme/Onc physician. I'm currently deciding between a hybrid community vs academic job. When I discuss the community job with attendings, they act like 4d/week is the end of the world and unsustainable. I know I'm in a biased pool of people who chose academia, but their comments make me nervous/second-guess. Our fellowship continuity clinic was a mess - I was always running around frantically, and spent hours post-clinic catching up on orders/notes, just for a half day clinic.

So I'm curious about QOL in real life/not fellow clinic. QOL/my personal life is extremely important to me and I would take a pay cut for a job with good work-life balance. This job is close to my family, which is why I'm considering it more over the 3d/week academic job.

The hybrid job is 4d/week with a max of 16 pts/day (if all follow-ups; < 16 if there are news). I'd focus in one disease for ~50% of my practice, while being a generalist for the remaining pts. I'm expected to be available for my pts if/when they get admitted to local hospitals and see them as consults if needed, but otherwise no inpatient consults.

I'm wondering if attendings in community can comment on the following:
- Are you generally happy with your work-life balance?
- How much time do you spend outside of work prepping for your clinics?
- How much time do you spend after clinic on notes?
- Is inbox mgmt really draining? How much personal time do you spend on this?
- Does the "cover your patient if they're admitted" thing seem like it could get really busy, or are patients generally not admitted too much/you are able to give recs over the phone without seeing them?

I'm basically asking for reassurance that this is doable and I won't completely burn out haha - greatly appreciate any advice in advance!

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[gutonc]

Hi all,

As the title suggests, I'm curious about the quality of life of a community Heme/Onc physician. I'm currently deciding between a hybrid community vs academic job.

When I discuss the community job with attendings, they act like 4d/week in community is the end of the world and unsustainable. I know I'm in a biased pool of people who all chose academia, but their comments make me nervous/second-guess. Our fellowship continuity clinic was a mess - I was always frazzled/frantically running around frantically, and I'd spend hours post-clinic catching up on orders/notes, just for a half day clinic.

Resident/Fellow continuity clinics (and a lot of academic attending clinics) are a total s***show and bear no resemblance to reality. 4d/wk clinic in a well functioning clinic will be half the workload of 3d/wk in a disaster.

So I'm curious about QOL in real life/not fellow clinic. QOL/my personal life is extremely important to me and I would take a pay cut for a job with good work-life balance. This job is very close to my family, which is why I'm considering it more strongly over the 3d/week academic job.

The hybrid job is 4d/week with a max of 16 pts/day (if all follow-ups; less than 16 if there are news). I'd focus partially in one disease (hopefully ~50% of my practice) while being a generalist for the remaining pts. I'm expected to be available for my patients if/when they get admitted to local hospitals and see them as consults if needed, but otherwise don't do inpatient consults.

When you say "local hospitals", what does that mean? Like the one across the street from your clinic? Or every hospital in a 100 mile radius? The first is doable, the 2nd not really.

I'm wondering if attendings in community can comment on the following:
- Are you generally happy with your work-life balance?

Very much so.

- How much time do you spend outside of work prepping for your clinics?
- How much time do you spend after clinic on notes?
- Is inbox mgmt really draining? How much personal time do you spend on this?

This is not going to be specific to the community job. This will be true in every job. When I first started in practice, I spent 1-2 hours a day prepping/recovering from clinic. Now, 10 years out, probably that much time a week outside of "clinic hours". Inbox management is much better when you have good support.
(ETA: My first patient in clinic today is at 8:30. I got here at 8. All 10 of my morning charts, including a complex new patient and 4 imaging reviews, are prepped, and I still have 5 minutes before I start clinic.)

- Does the "cover your patient if they're admitted" thing seem like it could get really busy, or are patients generally not admitted too much/you are able to give recs over the phone without seeing them?

This will depend on the hospitalists/surgeons managing them, but in general, most of the time when I'm seeing a patient of mine in the hospital it's a social visit, not something I'm actively needing to do. Phone recs and a quick chart note cover about 95% of the rest of it.

 

[bobsmith]

Hi all,

When I discuss the community job with attendings, they act like 4d/week is the end of the world and unsustainable. I know I'm in a biased pool of people who chose academia, but their comments make me nervous/second-guess.

I had a similar experience with my attendings in fellowship. Of course, everyone (myself included!) is going to respond in a way that also justifies their own decisions, right?

And so I don't blame my fellowship attendings for thinking a community general practice job was crazy. Some community jobs are unsustainable, but some academic jobs are also. The truth is that most of my academic attendings were mostly uninformed.

If you haven't actually shadowed or seen what a community general practice oncologist does, you should try to work with one if you can so that you can actually see what it's like.

So I'm curious about QOL in real life/not fellow clinic. QOL/my personal life is extremely important to me and I would take a pay cut for a job with good work-life balance. This job is close to my family, which is why I'm considering it more over the 3d/week academic job.

I would just add that there is more to each job than 3d/week vs 4d/week, though I feel like this seems to be the major thing that graduating fellows focus on.

There are some people in my extended practice group that work a reduced time schedule which effectively puts them in the office 3d/week - and yet, their job looks very different than an academic job in terms of type of pts that they see, academic requirements, pay structures, etc.

I'm expected to be available for my pts if/when they get admitted to local hospitals and see them as consults if needed, but otherwise no inpatient consults.

As gutonc said above, depending on how many hospitals you have to cover, this can be very challenging.

Inpatient consults are not so bad - part of the reason they were so painful in fellowship (for me, anyway) was because I felt like I always had to staff each patient twice - once with the consult attending, and then again with a new attending that specialized in the tumor that the consulting attending wanted me to "run it by"

I'm wondering if attendings in community can comment on the following:
- Are you generally happy with your work-life balance?

Yes.

As gutonc mentioned, being in a well run clinic is the key here. If my clinic had more issues, it could easily be miserable. Some of the things that would make my life worse:
- Fewer support staff
- Less well trained support staff
- Higher staff turnover
- Covering more than 1 hospital every day

- Is inbox mgmt really draining? How much personal time do you spend on this?

It's not so bad if you have support staff that help. It also helps to set clear expectations with patients - if they have symptoms that need addressing or anything that requires a longer discussion, they need to make an appointment.

In my opinion, it's much better to just add on a few patients to your schedule every week than to spend hours trying to diagnose and treat patients through secure messaging (especially since it's not compensated in our system)

I'm basically asking for reassurance that this is doable and I won't completely burn out haha - greatly appreciate any advice in advance!

Like I said above, if you're able to actually follow around a general community doctor for a day, it would probably give you a lot of insight.

 

[blackcadillacs]

Thank youuu so much for your insights! Already super helpful.

When you say "local hospitals", what does that mean? Like the one across the street from your clinic? Or every hospital in a 100 mile radius? The first is doable, the 2nd not really.

One hospital within 10 miles of the clinic!

This is not going to be specific to the community job. This will be true in every job. When I first started in practice, I spent 1-2 hours a day prepping/recovering from clinic. Now, 10 years out, probably that much time a week outside of "clinic hours". Inbox management is much better when you have good support.

True, I definitely expect taking forever to prep pts in the beginning regardless of practice setting. But I was thinking that in academia, you have an extra 2 days where you can knock out that 1-2 hours of prepwork and be relatively free the rest of the day, compared to community where I'd be doing that extra 1-2 hours at the end of a work day, which is why I worried about it being more exhausting.

 

[gutonc]

True, I definitely expect taking forever to prep pts in the beginning regardless of practice setting. But I was thinking that in academia, you have an extra 2 days where you can knock out that 1-2 hours of prepwork and be relatively free the rest of the day, compared to community where I'd be doing that extra 1-2 hours at the end of a work day, which is why I worried about it being more exhausting.

Is this really what you think your attendings are doing on the days they're not in clinic? Just faffing about? Because that is 110% NOT the case.

Sure, I see 2x the patients my academic colleagues see, but I probably only work about 75% as hard as they do overall. The fact that I make 75% more than they do is just icing on the cake.

 

[blackcadillacs]

Is this really what you think your attendings are doing on the days they're not in clinic? Just faffing about? Because that is 110% NOT the case.

Sure, I see 2x the patients my academic colleagues see, but I probably only work about 75% as hard as they do overall. The fact that I make 75% more than they do is just icing on the cake.

One of the attendings actually did make it seem like non-clinical days are laid back - I think my institution is less stringent about research requirements if you do other things like teaching (which I do enjoy). Maybe I'm being too naive about the workload on non-clinical days!

I think it's also about what tires you out? Talking to patients a lot and dealing with all the personalities that come with it emotionally tires me (at least currently as a fellow), more than sitting in an office doing a research paper. Did you feel this way at all during fellowship regarding patient care, and maybe it changes when you're an attending??

 

[guildsman]

It fundamentally depends on your practice model and location. I am in a "hybrid" academic model in clinic with 3.5 days a week of clinical practice in a subspecialty. The remaining 1.5 are comprised of about 8 hours of meetings (essentially a full working day just of tumor boards, QI reviews, trials, etc.), paperwork, fellowship administrative work, etc. Probably there are even more clinical hybrid positions where the administrative component is less busy, but most true academic hybrid programs just add additional clinic time (3-3.5 vs 2-2.5 days of clinic) on top of administrative work.

 

[gutonc]

One of the attendings actually did make it seem like non-clinical days are laid back - I think my institution is less stringent about research requirements if you do other things like teaching (which I do enjoy). Maybe I'm being too naive about the workload on non-clinical days!

I think it's also about what tires you out? Talking to patients a lot and dealing with all the personalities that come with it emotionally tires me (at least currently as a fellow), more than sitting in an office doing a research paper. Did you feel this way at all during fellowship regarding patient care, and maybe it changes when you're an attending??

If talking to people about their problems exhausts you, perhaps medicine wasn't the best choice. Having said that, yes, I much preferred the lab to the clinic when I was a fellow. After spending some time in my clinic as an attending, that feeling switched 180 degrees.

The difference between 3 and 4 days of clinic isn't as much as you might think it is. And 16 pt max a day (especially if all f/u) is almost like a vacation day for me at this point.

 

[blackcadillacs]

If talking to people about their problems exhausts you, perhaps medicine wasn't the best choice.

Haha I enjoy it and it's rewarding! Just tiring. I think a lot of people don't realize just how emotionally draining it can be until they're solidly into training.

At the same time - I've heard the second sentiment echoed a lot of times, about people being burnt out by patient care during fellowship but when you're an attending and it's your patients/clinic, it's much more enjoyable. So am glad to hear you say that as well.

The difference between 3 and 4 days of clinic isn't as much as you might think it is. And 16 pt max a day (especially if all f/u) is almost like a vacation day for me at this point.

Thanks for this! May be getting too fixated on a 1 day difference.

 

[A-med Onc]

- Are you generally happy with your work-life balance?
Absolutely. I live in a smaller rural community and work is 8-4.30 PM. Maybe need to be available for calls until 5PM. Couldnt ask for a better lifestyle. Unfortunately it is a rural area so nothing much to do.
- How much time do you spend outside of work prepping for your clinics?
I prep for a 2-3 hrs a week (during admin time)
- How much time do you spend after clinic on notes? Maybe 15-30 mins
- Is inbox mgmt really draining? How much personal time do you spend on this?
I get it done in between patients- I am quite efficient so get done as the day goes by.
- Does the "cover your patient if they're admitted" thing seem like it could get really busy, or are patients generally not admitted too much/you are able to give recs over the phone without seeing them?
Able to give reccs over the phone.

 

[bobow98]

I will give this a go too

- Are you generally happy with your work-life balance?
Yes. I get bored if I am not productive. But need time for family too. This is a good balance. Traveling and wanderlust is for those who are young and without children.
- How much time do you spend outside of work prepping for your clinics?
30 min a day. 1 hour on admin days. Adds to 3 - 4 hours a week.
- How much time do you spend after clinic on notes?
20-30 minutes. Get a scribe!
- Is inbox mgmt really draining? How much personal time do you spend on this?
Do it between patients
- Does the "cover your patient if they're admitted" thing seem like it could get really busy, or are patients generally not admitted too much/you are able to give recs over the phone without seeing them?
Join a place that has a rounding system and rounding weeks.

 

[Ubba]

20-30 minutes. Get a scribe!

Interested in learning more about this. I'm familiar with scribing basics, but which tasks in H/O (which has a different flow from general IM) are made substantially more efficient with scribes? Do you use an in-person scribe or a virtual scribe?

 

[MD46]

Interested in learning more about this. I'm familiar with scribing basics, but which tasks in H/O (which has a different flow from general IM) are made substantially more efficient with scribes? Do you use an in-person scribe or a virtual scribe?

I know of people seeing more than 30pts a day having scribes. If Averaging 20-25, dictation with dragon has been good.

If < 18 patients, typing if you are moderate fast is also good. But depends on which EMR you use. We use EPIC

 

[gutonc]

I know of people seeing more than 30pts a day having scribes. If Averaging 20-25, dictation with dragon has been good.

If < 18 patients, typing if you are moderate fast is also good. But depends on which EMR you use. We use EPIC

i could never get either a scribe (I admittedly only gave it a short trial) or Dragon (used it for 2 months) to be any more efficient than typing and using my own dotphrases in Epic. I can see 25 in a day and have most/all of the my notes done within 30 minutes of my last patient.

 

[guildsman]

i could never get either a scribe (I admittedly only gave it a short trial) or Dragon (used it for 2 months) to be any more efficient than typing and using my own dotphrases in Epic. I can see 25 in a day and have most/all of the my notes done within 30 minutes of my last patient.

An aspirational goal to accomplish this. Seeing patients in a subspecialty clinic for advanced malignancy, when most are on systemic therapy with complications and ongoing goals of care makes this very challenging unfortunately though.

 

[gutonc]

An aspirational goal to accomplish this. Seeing patients in a subspecialty clinic for advanced malignancy, when most are on systemic therapy with complications and ongoing goals of care makes this very challenging unfortunately though.

Straight out of fellowship maybe, but not after a few years in practice.

 

[osprey099]

An aspirational goal to accomplish this. Seeing patients in a subspecialty clinic for advanced malignancy, when most are on systemic therapy with complications and ongoing goals of care makes this very challenging unfortunately though.

I think this is doing especially if you can copy forward old notes and just update the new things.

 

[SpagoBMS]

Any idea how flexible schedule is in terms of weeks off? On average how many vacation weeks do community practices offer?

 

[solidonc2020]

Any idea how flexible schedule is in terms of weeks off? On average how many vacation weeks do community practices offer?

Offer I just received from a hospital employed community group was 6 weeks PTO (including for CME), although they're 100% productivity based after initial salary contract so I imagine that factors into people's vacation plans. My assumption is you take vacation whenever you want, just need to plan around call schedules.

 

[Ubba]

Offer I just received from a hospital employed community group was 6 weeks PTO (including for CME), although they're 100% productivity based after initial salary contract so I imagine that factors into people's vacation plans. My assumption is you take vacation whenever you want, just need to plan around call schedules.

It seems more complicated than this to my first-year-fellow eyes. H/O patients have pretty strict schedules for chemo clearances and the like. I guess physicians in this specialty are just stuck with having to care for partners' patients all the time when said partners are on vacation, but I'd guess that gets irritating quickly if someone is more lifestyle-oriented and wants to take 8-10 weeks of vacation.

 

[solidonc2020]

It seems more complicated than this to my first-year-fellow eyes. H/O patients have pretty strict schedules for chemo clearances and the like. I guess physicians in this specialty are just stuck with having to care for partners' patients all the time when said partners are on vacation, but I'd guess that gets irritating quickly if someone is more lifestyle-oriented and wants to take 8-10 weeks of vacation.

8-10 weeks would be a lot. I think more likely situation would be finding a part-time job that allows you to work 2-3 clinic days if possible. For most larger groups, my guess is vacation is largely covered by scheduling around your weeks off and using APPs as much as possible when you’re away.

 

[gutonc]

Any idea how flexible schedule is in terms of weeks off? On average how many vacation weeks do community practices offer?

My new contract has 6.5 weeks of PTO (can roll over unused days for up to 3 years) and 2 weeks of CME time a year (not bankable).

 

[gutonc]

It seems more complicated than this to my first-year-fellow eyes. H/O patients have pretty strict schedules for chemo clearances and the like. I guess physicians in this specialty are just stuck with having to care for partners' patients all the time when said partners are on vacation, but I'd guess that gets irritating quickly if someone is more lifestyle-oriented and wants to take 8-10 weeks of vacation.

Yes, that is your first year fellow eyes.

8-10 weeks of vacation is uncommon, but not out of the question. And chemo clearance is what APPs are for.

 

[bigboyonc]

My new contract has 6.5 weeks of PTO (can roll over unused days for up to 3 years) and 2 weeks of CME time a year (not bankable).

Does your PTO include sick days and holidays as well? Or do you have additional days on top of this?

 

[gutonc]

Does your PTO include sick days and holidays as well? Or do you have additional days on top of this?

PTO is PTO. Holidays are holidays.

 

[bigboyonc]

PTO is PTO. Holidays are holidays.

That’s nice. The place I signed with makes you take PTO for holidays

 

[bobsmith]

That’s nice. The place I signed with makes you take PTO for holidays

What? That's ridiculous

Hardly "personal" time off if you can't choose to work that day even if you wanted to

 

[bigboyonc]

Yup. It’s annoying. But at least I have 10 days of CME. So still have 40 days off total in a year.

 

[HemeOncHopeful19]

What? That's ridiculous

Hardly "personal" time off if you can't choose to work that day even if you wanted to

I’ve been in an Academic system where certain holidays were “mandatory PTO” unless you were assigned to cover that day. FWIW at least that system still gave way more vacation than a typical job.