Hematology cases in community practice

[icecoo]

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Thinking about doing community oncology but only oncology trained so am trying to figure out what hematology case I should expect and whether I should do additional training.

What are bread and butter hematology cases?
What are your approach with complicated hematology patients (acute leukemia, stem cell transplant, PLEX, etc.)

Thank you very much for your insight.

 

[gutonc]

Thinking about doing community oncology but only oncology trained so am trying to figure out what hematology case I should expect and whether I should do additional training.

What are bread and butter hematology cases?

Iron deficiency anemia. 98% of my heme referrals. A reasonably competent MS3 could handle them. I used to try to be thoughtful about them. But then decided if their PCP couldn't bother to draw a ferritin before referring them, I was going to just go whole hog once they crossed the threshold into my office. I don't always do a PNH screen, but otherwise, I'm getting all the anemia labs. And sending them for a scope. And setting them up for a marrow.

What are your approach with complicated hematology patients (acute leukemia, stem cell transplant, PLEX, etc.)

Ship 'em. I ain't got time for that nonsense, and my nurses can't deal with it either.

Also, ROFL a bit at a PLEX case being complicated. You pherese them, you send them home.

 

[checkpointinhibitor]

Most are primary care physicians who are either incompetent or too lazy to do even basic workup.
Bread and butter is iron deficiency, mild cyeopenias or mild cytosis, easy bruising (mostly patients on ASA and or solar keratosis). Real heme cases that get me excited are about 1 in 50.
Any obscure bleeding issues send them to university hospital as most community centers don’t have advanced coag/bleeding lab.
And don’t get me started about fatigue consults. I ain’t seeing that nonsense:

 

[HemeOncHopeful19]

Heme can get a little more hairy inpatient IMO. I hate bleeding/clotting/PLEX consults but they’re part of the job. It’s not that you can’t handle it, but if you don’t have the board cert / training I could see a lawyer having a field day whether it’s your fault or not something bad happens. Not that the cert would really protect me much either I guess.

If you have a local mothership you can send the complex stuff to that would work better but my group helps cover the local mothership.

 

[HemeOncHopeful19]

And don’t get me started about fatigue consults.

90% of people when asked won’t have fevers, chills, night sweats, massive weight loss.

I can’t remember the last time someone with some random cytosis or cytopenia told me they didn’t have fatigue lol.

 

[MifflinDunder]

And don’t get me started about fatigue consults. I ain’t seeing that nonsense:

The threshold to consult hematology/oncology is extremely low.

 

[gutonc]

The threshold to consult hematology/oncology is extremely low.

Do they have blood? Heme consult!

 

[Plutarch02]

I've never had an easy bruising consult that turned out to be anything significant. I sigh when I see them on my schedule.

 

[MifflinDunder]

I've never had an easy bruising consult that turned out to be anything significant. I sigh when I see them on my schedule.

How much of your schedule is benign heme vs solid tumor/malignant heme?

 

[HemeOncHopeful19]

I've never had an easy bruising consult that turned out to be anything significant. I sigh when I see them on my schedule.

At least those are easy to order basic labs and handwave away.

 

[gutonc]

How much of your schedule is benign heme vs solid tumor/malignant heme?

You didn't ask me, but half. My last job it was maybe 15-20%.

 

[MifflinDunder]

You didn't ask me, but half.

Is that typical? I don't know why people just don't do community in that case. These are quick, no GOC, no running onc history. 100% solid onc in academia or hybrid feels significantly more burnout-inducing to me.

 

[bobsmith]

Is that typical? I don't know why people just don't do community in that case. These are quick, no GOC, no running onc history. 100% solid onc in academia or hybrid feels significantly more burnout-inducing to me.

I also have about half non-malignant heme

And yes, there are many examples on this forum of people just doing community practice, and many of us seem happy

 

[checkpointinhibitor]

I have 40-50% non-malignant heme. Don't mind that to ease up the pace of the clinic. Enjoy treating hemochromatosis, IDA etc. Fulfilling at best and speed breakers.

 

[Plutarch02]

How much of your schedule is benign heme vs solid tumor/malignant heme?

50% benign heme 10% malignant heme 40% solid tumor

 

[gutonc]

Is that typical? I don't know why people just don't do community in that case. These are quick, no GOC, no running onc history. 100% solid onc in academia or hybrid feels significantly more burnout-inducing to me.

Horses for courses. I hate benign heme cases for the most part and find them annoying. But once I started thinking about each one of them as a boat payment, it became much easier to put up with them