Having a hard time deciding on fellowship

[Warderino92]

So i'm about to finish my intern year and having a bit of trouble deciding on my next step after residency. I originally came into Internal Medicine wanting to do Hematology/Oncology but recently found Allergy/Immunology to be appealing as well. I enjoy the basic science aspects of both fields as well as the mostly outpatient focused lifestyle each afford. After this year I know that I don't want to do anything that focuses mostly on inpatient medicine as I am happiest when I am in the clinic and away from the hospital. I know both fields can afford a good lifestyle as well, although I know onc will most likely work more hours than allergy due to the nature of the field with call and inpatient consults to see when on said call.

I was wondering if anyone had a similar dilemma and if there was anything that helped to sway their decision one way or the other. I'll have to start getting serious early this upcoming year to start getting as many research projects in as I can and rotating through both services didn't really help to settle the difference between the two as I enjoyed working in both fields when I rotated through them.

Thanks.

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[chessknt]

The content areas are pretty different. Allergy tends to have weird/esoteric diseases and does skin testing/laryngoscopy/rhinoscopy procedures. Their patients range from people ravaged by a rare disease to severe allergies looking for desensitization to crazy people who think they are allergic to everything. You'll essentially never have to go in to a hospital again.

Heme/onc is almost all cancer and as far as I know only does BM biopsies for procedures. Their patients also range the entire gambit but probably less crazy people and a lot more tough/sad cases. You'll need to have more tough conversations in heme/onc than allergy and you will probably have some light hospital call but I imagine it is infrequent and manageable.

 

[Redpancreas]

So i'm about to finish my intern year and having a bit of trouble deciding on my next step after residency. I originally came into Internal Medicine wanting to do Hematology/Oncology but recently found Allergy/Immunology to be appealing as well. I enjoy the basic science aspects of both fields as well as the mostly outpatient focused lifestyle each afford. After this year I know that I don't want to do anything that focuses mostly on inpatient medicine as I am happiest when I am in the clinic and away from the hospital. I know both fields can afford a good lifestyle as well, although I know onc will most likely work more hours than allergy due to the nature of the field with call and inpatient consults to see when on said call.

I was wondering if anyone had a similar dilemma and if there was anything that helped to sway their decision one way or the other. I'll have to start getting serious early this upcoming year to start getting as many research projects in as I can and rotating through both services didn't really help to settle the difference between the two as I enjoyed working in both fields when I rotated through them.

Thanks.

Cool question. We often tell medical students to decide first on medicine or surgery first. I think there's no rough equivalent to that butyou've already given us clinic >>> hospital. I think these three factors (not in order of importance) should be considered.

1. Setting (Hospital, Clinic, Hybrid)/Nature of your work
2. Procedural Involvement: GI, Cards, Pulm/IP/ICU.
3. Lifestyle vs. Compensation

I think Heme/Onc is awesome because patients have been given a lifechanging diagnosis and I feel they truly respect you and rely on your as you're linked by a terrible diagnosis. You have to be someone who thrives off of and enjoys the continuity of care aspect. Additionally, if you like basic science and research, Heme/Onc allows you to do this while being specialized in your own area of cancer. While general heme/onc pulls highly on IM training, once you enter a subspecialty of heme-onc you're really entering your own world. The setting can be anything from pure bread-butter clinic to hospital leukemia/solid tumor services. It truly allows for the hybrid. Compensation I have heard can be high even with low procedural involvement although I think fellows do BM biopsies but that's really a drop in the water.

I don't know as much about Allergy/Immunology so I guess if clinic is your jam that's most of allergy. Allergy is often mistakenly consulted in the hospital for suspected anaphylaxis when the management really entails getting a good history and a POC tryptase with follow up so in my mind, the service doesn't really have to be there in the hospital. I;m interested in what your experience in allergy has been and why you have liked it. The field's full of zebras and what worries me is how you would build a patient base off of this. Sure, you have your bread/butter severe allergy patients, but nowadays I see that even being managed via EConsult. Have you done a lot of clinical rotations in allergy? What was your experience? If you can't get an elective in a timely manner, ask your PD if something can be arranged during Y week.

 

[whoknows2012]

Cool question. We often tell medical students to decide first on medicine or surgery first. I think there's no rough equivalent to that but in clinic you've already given us clinic >>> hospital. I think these three factors (not in order of importance) should be considered.

1. Setting (Hospital, Clinic, Hybrid)
2. Procedural Involvement: GI, Cards, Pulm/IP/ICU.
3. Lifestyle vs. Compensation

I think Heme/Onc is awesome because patients have been given a lifechanging diagnosis and I feel they truly respect you. You have to be someone who thrives off of and enjoys the continuity of care aspect. Additionally, if you like basic science and research, Heme/Onc allows you to do this while being specialized in your own area of cancer. While general heme/onc pulls highly on IM training, once you enter a subspecialty of heme-onc you're really entering your own world. The setting can be anything from pure bread-butter clinic to hospital leukemia/solid tumor services. It truly allows for the hybrid. Compensation I have heard can be high even with low procedural involvement although I think fellows do BM biopsies but that's really a drop in the water.

I don't know as much about Allergy/Immunology so I guess if clinic is your jam that's your thing. Allergy is often mistakenly consulted in the hospital for suspected anaphylaxis when the management really entails getting a good history and a POC tryptase with follow up so in my mind, the service doesn't really have to be there in the hospital. I;m interested in what your experience in allergy has been and why you have liked it. The field's full of zebras and what worries me is how you would build a patient base off of this. Sure, you have your bread/butter severe allergy patients, but nowadays I see that even being managed via EConsult. Have you done a lot of clinical rotations in allergy? What was your experience? If you can't get an elective in a timely manner, ask your PD if something can be arranged during Y week.

Definitely agree with the hem/onc part above. I subspecialize in leukemia, it’s about 25-50% inpatient (at times more especially for junior faculty). It super specialized and definitely would be described as “entering your own world.” Such complex disease processes decision making, complications and research.

Re; the OP I think the best way to get a sense of which speciality is best suited for you would be to do some clinic related electives + research.

Lifestyle is definitely better with A/I but compensation is lower and you MAY find h/o to be more rewarding.

 

[90sportsfan]

Cool question. We often tell medical students to decide first on medicine or surgery first. I think there's no rough equivalent to that butyou've already given us clinic >>> hospital. I think these three factors (not in order of importance) should be considered.

1. Setting (Hospital, Clinic, Hybrid)/Nature of your work
2. Procedural Involvement: GI, Cards, Pulm/IP/ICU.
3. Lifestyle vs. Compensation

I think Heme/Onc is awesome because patients have been given a lifechanging diagnosis and I feel they truly respect you and rely on your as you're linked by a terrible diagnosis. You have to be someone who thrives off of and enjoys the continuity of care aspect. Additionally, if you like basic science and research, Heme/Onc allows you to do this while being specialized in your own area of cancer. While general heme/onc pulls highly on IM training, once you enter a subspecialty of heme-onc you're really entering your own world. The setting can be anything from pure bread-butter clinic to hospital leukemia/solid tumor services. It truly allows for the hybrid. Compensation I have heard can be high even with low procedural involvement although I think fellows do BM biopsies but that's really a drop in the water.

I don't know as much about Allergy/Immunology so I guess if clinic is your jam that's most of allergy. Allergy is often mistakenly consulted in the hospital for suspected anaphylaxis when the management really entails getting a good history and a POC tryptase with follow up so in my mind, the service doesn't really have to be there in the hospital. I;m interested in what your experience in allergy has been and why you have liked it. The field's full of zebras and what worries me is how you would build a patient base off of this. Sure, you have your bread/butter severe allergy patients, but nowadays I see that even being managed via EConsult. Have you done a lot of clinical rotations in allergy? What was your experience? If you can't get an elective in a timely manner, ask your PD if something can be arranged during Y week.

I'm just a medical student, but I was under the impression that Allergy was one of the IM subspecialties where many physicians in this field pair A/I with general IM practice? If that's the case, you may not have as much pressure to build a patient-base of strictly A/I patients since you would have a steady patient base of general IM patients. I went to a physician a few years back to test for a suspected allergy, and she was A/I fellowship trained and saw A/I patients, but she also saw general IM patients. That is why I had in my mind that this was common, but since it's such a small field, I really don't know. I guess academics vs private practice, and even where in the country you are (patient base) could impact the mode of practice.

 

[wamcp]

So i'm about to finish my intern year and having a bit of trouble deciding on my next step after residency. I originally came into Internal Medicine wanting to do Hematology/Oncology but recently found Allergy/Immunology to be appealing as well. I enjoy the basic science aspects of both fields as well as the mostly outpatient focused lifestyle each afford. After this year I know that I don't want to do anything that focuses mostly on inpatient medicine as I am happiest when I am in the clinic and away from the hospital. I know both fields can afford a good lifestyle as well, although I know onc will most likely work more hours than allergy due to the nature of the field with call and inpatient consults to see when on said call.

I was wondering if anyone had a similar dilemma and if there was anything that helped to sway their decision one way or the other. I'll have to start getting serious early this upcoming year to start getting as many research projects in as I can and rotating through both services didn't really help to settle the difference between the two as I enjoyed working in both fields when I rotated through them.

Thanks.

Not an allergist but have close friends who are now in private practice as allergists.

They have hands down far better lifestyle than hemeonc and probably less mental stress - no end of life treatment/discussions to be had vs heme onc. No true emergencies like TTP or whatever in heme. Pay is fine and they make just as much or more as heme onc if they hustle the same, but most people who do allergy choose not to hustle; they clear 300K with just 4 days of clinic (32-34 hours) a week.

That being said job market became very tight for one of them from covid but they did get a job where they desired, eventually.

So comes down to: what subject interests you the most vs lifestyle importance.

They don’t do any PCP work, plenty of referrals; bread and butter patients are seasonal allergy/rhinitis/asthma type stuff and the crazies who think they’re allergic to everything.

 

[Redpancreas]

I'm just a medical student, but I was under the impression that Allergy was one of the IM subspecialties where many physicians in this field pair A/I with general IM practice? If that's the case, you may not have as much pressure to build a patient-base of strictly A/I patients since you would have a steady patient base of general IM patients. I went to a physician a few years back to test for a suspected allergy, and she was A/I fellowship trained and saw A/I patients, but she also saw general IM patients. That is why I had in my mind that this was common, but since it's such a small field, I really don't know. I guess academics vs private practice, and even where in the country you are (patient base) could impact the mode of practice.

This is an interesting point. I don’t see this often and think this is probably not a good sign unless that physician is doing this voluntarily.