Fellowship programs with VA

[HemeOncBound87]

Researching programs for the upcoming cycle and noticing a lot of programs with VA affliations.
How do you think this impacts your training as a fellow? Assuming you get a lot less breast cancer exposure?
Similar to the standard pros/cons of training at a VA?

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[gutonc]

Researching programs for the upcoming cycle and noticing a lot of programs with VA affliations.
How do you think this impacts your training as a fellow? Assuming you get a lot less breast cancer exposure?
Similar to the standard pros/cons of training at a VA?

I loved having a VA. Day 1 of continuity clinic as a fellow (which was Day 2 of fellowship) and I'm on my own with 3 new and 6 follow up patients. Sink or swim. Sure...there's an attending. But there's 1 for all the (in our case 9) fellows and by the time he rolled in, I'd already sent 3 up to the chemo unit and 2 more home.

Sure, there's a dearth of breast and GYN cancers, but breast is actually not that hard and if you're lucky, you'll get to work in a place with Gyn Onc and never have to deal with that outside of your boards. And even then...how hard is carbo/taxol --> olaparib --> Doxil --> hospice?

 

[beyondbethany]

My experience is similar to gutonc. My VA clinic was my only true continuity experience and I "owned" my patients. All of the orders, questions, issues in infusion clinic etc were always sent to me first and this was invaluable.

Of course your breast cancer experience there is reduced but if your main training site can't make up for that then that program isn't worth it. I saw everything from very common to very rare in my VA clinic. Lots of good benign and malignant heme.

Only downside, VA CPRS alerts...

Overall, I think VA experience is added value, but it is just one factor to consider.

 

[CatFactorial]

To add to the above, VA clinic is great. I have a good mix of benign and malignant heme (my VA is a transplant center so we perhaps get more of this than other centers), solid tumors of a variety of types. Lots of patients on active therapy, some real sickos but most of them are doing okay. Lots of surveillance. I am still delusional enough to try for academics so personally I wish I had a more focused subspecialty clinic but the converse of that is I feel that I've gotten good exposure to bread/butter heme and onc if private practice is where I end up.

Another converse/downside is that with the autonomy comes a lot more responsibility; with covid spooking patients from coming to their appointments, I do feel like I'm falling behind on getting people set up for biopsies and the like.

Also for the record I'm seeing two breast cancer patients tomorrow in my continuity clinic.