Help with HemeOnc fellowship and beyond?

[Calicliffs]

I'm currently caught between going directly to primary care or pursue a HemeOnc fellowship after residency. I am not opposed to either but leaning toward fellowship because I find myself a bit interested in academics. However, another three years of training sounds a bit daunting to me, for I will be well into my thirties when I'm finished. So I wanted to find out more information to help me decide. Can anyone tell me what the typical day of a HemeOnc fellowship is like? Do you have better hours compared with residency? If so, to what extent? Do you get to have your weekends off often? What about moonlighting opportunities? Also, how hard is it to find a tenure-track job in a mid-tier university after training's complete?
Any response is appreciated. Thank you all in advance. 🙂

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[CatFactorial]

2nd year fellow, In my early 30s, have a kid, my life as I knew it is gone.

More seriously:
1st year: hellish, about 50 overnight calls, 12 weekends worked, got bent over routinely by consult services
2nd year: significantly better, more time for research. Less structure though, so still working as much as 1st year but in more flexible ways. for instance covid 19 has shut down lots of clinical operations at my medical center but currently my research workload (manuscript submissions, grant applications, experimental planning if not actual bench work at this time, etc.) has not changed considerably.

 

[HemeOncBound87]

2nd year fellow, In my early 30s, have a kid, my life as I knew it is gone.

More seriously:
1st year: hellish, about 50 overnight calls, 12 weekends worked, got bent over routinely by consult services
2nd year: significantly better, more time for research. Less structure though, so still working as much as 1st year but in more flexible ways. for instance covid 19 has shut down lots of clinical operations at my medical center but currently my research workload (manuscript submissions, grant applications, experimental planning if not actual bench work at this time, etc.) has not changed considerably.

Is this the norm for most fellowships? Or would you say you are at a busier than average fellowship? How many fellows per year if you don't mind me asking?

Are the hours of first year fellowship worse than intern year?

 

[gutonc]

Is this the norm for most fellowships? Or would you say you are at a busier than average fellowship? How many fellows per year if you don't mind me asking?

Are the hours of first year fellowship worse than intern year?

This will (of course) depend on your residency and fellowship. But mine was as bad or worse from an hours/workload perspective, with one marvelous exception...nights and weekends. We took call obviously, but we had moonlighters in-house to cover all the hem/onc and BMT inpatients which was easily of 75-95% of the calls you'd get overnight.

The "hard" part IMO is that, as an intern, nobody expects anything from you other than that you show up and at least try. On your first day of fellowship, you're taking all the calls and expected to be the expert on them, despite the fact that, in my case, I was the senior resident on the Cardiac ICU team on Tuesday and the "Hem/Onc expert" on Wednesday morning. Nothing about me or my knowledge base changed in those 10 hours, but the expectations were dramatically different.

 

[whoknows2012]

Is this the norm for most fellowships? Or would you say you are at a busier than average fellowship? How many fellows per year if you don't mind me asking?

Are the hours of first year fellowship worse than intern year?

I can’t speak for @CatFactorial but my schedule sounded pretty similar. Large academic center in NYC. 1st year very clinically heavy with a lot of call (~50 weekdays) and 12 weekends. Average hours worked about 50-55 per week on inpatient services (Onc or heme consults, bmt, etc) and 40-45 on outpatient weeks. The main rub is one night a week on call which could be anything from dead quiet to barely getting any sleep and the one wknd a month which means once a month you work 12 days straight (4 of those days youd be on overnight call). At first it’s very manageable and wasn’t that disruptive but it gets tiring by the end of the year. Weekday calls are only taken by 1st years. We have 15-16 fellows (some years we take 6, like this incoming class). For me one major difference between being an intern and a first year fellow is the level of responsibility. You’re making decisions overnight sometimes without attending input. Additionally ordering chemotherapy, looking for adverse events, dealing with difficult outcomes etc also carries with it WAY more responsibility than intern year. Oh and I also had a daughter born January of 1st year so that had an impact of course as well.

2nd year for me was all research and 7 weekend calls so fairly light. Hours worked depended on the lab you were in, grant/manuscript/experiment deadlines etc. I worked some 13-14 hour days running experiments which were way longer than any of my clinical days, though overall my research months were mostly 40-45hr/wk.

3rd year 1st half is research same as above, if not better. One wknd call. Last 6 months are clinical electives of your choice for 2 months (leukemia for me) and 3 months benign heme and 1 month solids. Hours are more along the lines of 40-45hr/week. In July I’m staying on for a faculty leukemia position.

 

[HemeOncBound87]

This will (of course) depend on your residency and fellowship. But mine was as bad or worse from an hours/workload perspective, with one marvelous exception...nights and weekends. We took call obviously, but we had moonlighters in-house to cover all the hem/onc and BMT inpatients which was easily of 75-95% of the calls you'd get overnight.

The "hard" part IMO is that, as an intern, nobody expects anything from you other than that you show up and at least try. On your first day of fellowship, you're taking all the calls and expected to be the expert on them, despite the fact that, in my case, I was the senior resident on the Cardiac ICU team on Tuesday and the "Hem/Onc expert" on Wednesday morning. Nothing about me or my knowledge base changed in those 10 hours, but the expectations were dramatically different.

I can’t speak for @CatFactorial but my schedule sounded pretty similar. Large academic center in NYC. 1st year very clinically heavy with a lot of call (~50 weekdays) and 12 weekends. Average hours worked about 50-55 per week on inpatient services (Onc or heme consults, bmt, etc) and 40-45 on outpatient weeks. The main rub is one night a week on call which could be anything from dead quiet to barely getting any sleep and the one wknd a month which means once a month you work 12 days straight (4 of those days youd be on overnight call). At first it’s very manageable and wasn’t that disruptive but it gets tiring by the end of the year. Weekday calls are only taken by 1st years. We have 15-16 fellows (some years we take 6, like this incoming class). For me one major difference between being an intern and a first year fellow is the level of responsibility. You’re making decisions overnight sometimes without attending input. Additionally ordering chemotherapy, looking for adverse events, dealing with difficult outcomes etc also carries with it WAY more responsibility than intern year. Oh and I also had a daughter born January of 1st year so that had an impact of course as well.

2nd year for me was all research and 7 weekend calls so fairly light. Hours worked depended on the lab you were in, grant/manuscript/experiment deadlines etc. I worked some 13-14 hour days running experiments which were way longer than any of my clinical days, though overall my research months were mostly 40-45hr/wk.

3rd year 1st half is research same as above, if not better. One wknd call. Last 6 months are clinical electives of your choice for 2 months (leukemia for me) and 3 months benign heme and 1 month solids. Hours are more along the lines of 40-45hr/week. In July I’m staying on for a faculty leukemia position.

Man how do you guys survive overnight call? My hours for intern year were definitely worse probably 60-70 hrs/week on a 4 + 2 schedule but at least I would get to sleep overnight! And if you are on call that night I am assuming you still have to work the next day.... This makes it seem more challenging in a way then 30 hr ICU call because at least I get to go home after the 30 hours. Any general tips for surviving overnight call as a fellow? Kind of scared to be honest.

 

[whoknows2012]

Man how do you guys survive overnight call? My hours for intern year were definitely worse probably 60-70 hrs/week on a 4 + 2 schedule but at least I would get to sleep overnight! And if you are on call that night I am assuming you still have to work the next day.... This makes it seem more challenging in a way then 30 hr ICU call because at least I get to go home after the 30 hours. Any general tips for surviving overnight call as a fellow? Kind of scared to be honest.

All my cofellows and myself were all a little scared/apprehensive before starting but you quickly adjust. A normal night for me on call was 10-12 calls before midnight anything from urgent consults to critical results from the lab or patients with a medical complaint or question. After midnight until about 6am I would usually get anywhere from 0 to 2-3 calls, average was probably 2. I would estimate about 15-20 of these calls I got no pages between 12-6am so not sleeping wasn’t that but it an issue. There were some nights that were worse and obviously the acute leuk or ttp where you’d have to come in to look at the smear. It was also worse at the beginning of the year where all the new interns and inexperienced interns/residents in the ER bothered us for unnecessary stuff. That improved throughout the year though.

 

[gutonc]

Man how do you guys survive overnight call? My hours for intern year were definitely worse probably 60-70 hrs/week on a 4 + 2 schedule but at least I would get to sleep overnight! And if you are on call that night I am assuming you still have to work the next day.... This makes it seem more challenging in a way then 30 hr ICU call because at least I get to go home after the 30 hours. Any general tips for surviving overnight call as a fellow? Kind of scared to be honest.

Unless you get a job in academics with a fellowship program (which, statistically at least, you will not), you're going to be doing overnight calls for the rest of your life.

It's a LOT easier in the real world than it is in training. Sure...there are some crappy nights, but most of the time it's a handful of calls from 5-10p and then 0-3 the rest of the night.

 

[CatFactorial]

Is this the norm for most fellowships? Or would you say you are at a busier than average fellowship? How many fellows per year if you don't mind me asking?

Are the hours of first year fellowship worse than intern year?

I think everyone likes to think they're doing a more busy fellowship than others, so I don't know. But from the above my experience is not uncommon. And yes I would say the hours are worse than intern year in that as an intern, I didn't feel too much compunction at putting down MKSAP and turning on netflix or its ilk. As gutonc mentioned, consulting teams seem to ask us questions and expect us to know the answer, so the pressure to keep reading and such when done for the day is higher (at least for me).

 

[CatFactorial]

Man how do you guys survive overnight call? My hours for intern year were definitely worse probably 60-70 hrs/week on a 4 + 2 schedule but at least I would get to sleep overnight! And if you are on call that night I am assuming you still have to work the next day.... This makes it seem more challenging in a way then 30 hr ICU call because at least I get to go home after the 30 hours. Any general tips for surviving overnight call as a fellow? Kind of scared to be honest.

When post-home call, I am kind of like a zombie the next day. A log of patient and hospital pages is helpful, a good set of phone numbers and logistical info (hopefully your fellowship provides a good primer), that kind of stuff. but by halfway through first year even acute leuks stop being terrifying and become nuisances. some nights though you can't prepare, your pager will just keep going off as soon as you address the previous page. the eventual answer to that is usually the following year's first year fellow class.

 

[lulu09]

I'm currently caught between going directly to primary care or pursue a HemeOnc fellowship after residency. I am not opposed to either but leaning toward fellowship because I find myself a bit interested in academics. However, another three years of training sounds a bit daunting to me, for I will be well into my thirties when I'm finished. So I wanted to find out more information to help me decide. Can anyone tell me what the typical day of a HemeOnc fellowship is like? Do you have better hours compared with residency? If so, to what extent? Do you get to have your weekends off often? What about moonlighting opportunities? Also, how hard is it to find a tenure-track job in a mid-tier university after training's complete?
Any response is appreciated. Thank you all in advance. 🙂

Just adding my 0.02. First year fellow here at a large academic program, almost done with first year!

I just want to preface this by saying that when I interviewed last year programs basically fell into two tiers - those that have you front-load and do 12 of the required 18 months of clinical work up-front and others that spread it out more evenly in the 3 years. Not subtle hint: the former is better because you get your annoying calls and consult weeks out of the way and you can focus solely on research (=better schedule) in the last two years.

I'm also in my early 30s with a young child.

I was a hospitalist last year (did a bunch of gen med consults for surgery/ob-gyn at a busy academic med center) so it was interesting coming back to fellowship because I felt I was super well supported throughout (first month or two felt weird when I had to staff again rather than just handle consults on my own). Overnight calls (same thing as everyone else above, we took on average 4-5 calls a month, 1 being a weekend) were not very daunting to me because they were mostly gen med questions from patients (I can't believe how many calls I had this year about GI-related issues - nausea, vomiting, diarrhea, and constipation - I'm shocked how many people don't even know what Miralax is, or why their physicians never told them about laxatives). Acute leuks were scary in the beginning but once you know what you're looking for and decide if a patient needs pheresis or not it's very routine. We have the ability to look up blood smears online so I usually know whether it's a real acute leuk or not before heading in (still had to go in per program policy to assess the patient in person -- even though honestly our ER does a very good job).

Most of first year is rotating among the various outpatient clinics - all types of solid oncology clinics plus benign heme, malignant heme, and BMT clinics. Every clinic is somewhat different in what they expect of you but you'll figure out what you like after rotating through all of them. I was lucky and I finished nearly all of my outpatient rotations before COVID hit, so I figured out what I want to do. Clinic blocks are typically quite easy, a standard 8a-5p type of day (6p if you want to finish your notes in the hospital before going home, which I often did so I don't have to use remote).

Inpatient rotations consist of BMT, leukemia floors, and heme/onc inpatient consults. The most annoying of these is gen heme consult because I'm literally the hospital operator for any type of yellow flag on a CBC. You'll get questions ranging from routine IDA (because of GI blood loss!! they are always bleeding somewhere!!) to literally a patient transforming into acute leuk on the floor and the team was calling about why there are 25% blasts on the CBC that they decided to get with diff today....*facepalm. Anyways, if you do a heme consult rotation in residency you'll know what it's like, it's the same everywhere (although as the fellow now I have to hold the consult pager, when I didn't as a resident! -- the triage part is what's time-consuming and annoying about heme consults). Our inpatient floors have either PAs or residents as first-call (again, this may vary by fellowship), so it's more pure learning during rounds and bone marrow biopsies for the fellows, which is great. Usually out by 3 pm for inpatient floors but obviously depending on the volume of the consults I have left the hospital as late as 11 pm while on heme consults (usually averages to 6-7 PM).

Compared to residency I would say that it feels much easier. I don't know if it's because I did my residency in a very scutty, inner-city place but I felt first year of fellowship was so much easier than intern year (when a lot of people say the opposite). It's nice that you are only focusing on two fields (that you actually care about!), rather than the 13 or so that is across general medicine (ugh rheum and ugh endocrine). It is quite daunting though when you start, especially when you're handling random ED curbside calls in the middle of the night that you're expected to be the expert of hematology when you're only a few months into fellowship. We do have a pretty great faculty support system and on the few times I've needed to call the attending in the middle of the night everyone was actually super nice and not at all upset or even annoyed (one actually offered to drive in to see an acute leuk with me but I told him I could handle it...lol). Obviously, YMMV depending on which program you go to. A busy heme consult week (we do 6 days in a row while on consults for 2 weeks straight) sometimes feels like ICU in residency, although we don't take home call while on heme consults so it helps tremendously that once you sign out the consult pager you won't be bothered again and can get a good night's sleep.

There is a lot more weekends off in fellowship. If I'm not on an inpatient rotation that requires a 6-day week, I have all weekends off aside from the scheduled roughly-once-monthly weekend call day.

We can moonlight here (plenty of moonlighting in gen med between the two hospitals we cover) but you can't do it as a first year. Second and third years moonlight plenty - I know a dude that tripled his fellow salary through tons of moonlighting...speaking of second and third year here, it's like what people have described above. If you go to a front-loaded program 2nd and 3rd years have plenty of free time when they're supposed to be doing "research" but obviously if you're not in a wet lab you can moonlight during the day and work on your research at night or during your off-time, or whatever.

As for jobs following fellowship, I only have the experience of the third years that are graduating this year (and obviously things will be interesting for the second year class primarily if the COVID economic situation forces a prolonged hiring freeze lasting through the next academic year at academic institutions) but it's generally been very easy if you want an academic job. It's hard to stay here geographically (I think given our location and family connections that people have a LOT of locals want to stay at the home hospital, and you essentially need to wait for someone to retire or to move away). However, if you're open to looking all over there wasn't a third year who wanted an academic job that couldn't. I would say if you go to a decently competitive program and have a good research CV coming out (maybe doesn't even need to be that good, if you're going to be mostly clinical) you should be fine. I still think heme-onc is a sellers market for now when it comes to jobs with rising lifespan, # of seniors, and # of cancer diagnoses.

As for deciding between primary care and fellowship, I think the two are totally different. If you want to focus more on patient care, enjoy the breadth of gen med, or need to earn money quickly, then go into primary care. Fellowship is really if you have true interest in the field and don't mind just seeing patients for those problems for the rest of your career (and often in a big academic center you super-specialize, like just gastric cancer or CLL, for example). I think there's no easy answer to this question and you'll have to decide for yourself. Personally, having been a hospitalist who saw everything inpatient and having that as a reference, I like to be the consultant and the "expert." It really feels a lot more satisfying to me than to keep and manage a laundry list of 10+ problems and especially the dreaded dispo...(although truly a good hematologist is a good internist - but for oncologist....I don't know 😉)

 

[dreamforever]

I'm currently caught between going directly to primary care or pursue a HemeOnc fellowship after residency. I am not opposed to either but leaning toward fellowship because I find myself a bit interested in academics. However, another three years of training sounds a bit daunting to me, for I will be well into my thirties when I'm finished. So I wanted to find out more information to help me decide. Can anyone tell me what the typical day of a HemeOnc fellowship is like? Do you have better hours compared with residency? If so, to what extent? Do you get to have your weekends off often? What about moonlighting opportunities? Also, how hard is it to find a tenure-track job in a mid-tier university after training's complete?
Any response is appreciated. Thank you all in advance. 🙂

Same!

 

[qv3755]

i'm currently a BMT clinician scholar track (academic but not physician scientist track) with assistant professor title at a Tier 1 BMT center. Salary is mid 200k (based of 50% clinical work) and there's a good opportunity that I'd be promoted in 2 years to associate (with a 50k increase in salary). However, I want to explore PP for BMT only jobs to see how much more I could potentially make. I'm getting tired of pressure of having to produce in academia. Also, I love seeing patients.

What's the salary I should expect to get in PP as a full-time BMT/cellular therapy physician? I know there're not a lot of PP BMT looking for full-time BMT physician but they're out there and the way the field is going - many PP would love to have a BMT center.

Should I wait until I get my Associate stripe to command a bigger salary or it doesn't matter??

 

[gutonc]

i'm currently a BMT clinician scholar track (academic but not physician scientist track) with assistant professor title at a Tier 1 BMT center. Salary is mid 200k (based of 50% clinical work) and there's a good opportunity that I'd be promoted in 2 years to associate (with a 50k increase in salary). However, I want to explore PP for BMT only jobs to see how much more I could potentially make. I'm getting tired of pressure of having to produce in academia. Also, I love seeing patients.

What's the salary I should expect to get in PP as a full-time BMT/cellular therapy physician? I know there're not a lot of PP BMT looking for full-time BMT physician but they're out there and the way the field is going - many PP would love to have a BMT center.

Should I wait until I get my Associate stripe to command a bigger salary or it doesn't matter??

Your salary would depend on where it is and how the group is structured. Unless you're bringing a fully operational cellular therapy program along with you, I wouldn't expect to get paid any more than anyone else in the group. And no, academic rank alone matters little or nothing in the PP world. So if you're going to bounce, do it now.