Hematology Population and Routine in small community

[Kahreek]

My situation is the following: later this year i have a big chance of getting into a heme only fellowship, both benign and malign heme (with transplant training).

The caveat is I am not interested in academic career and i like small community hospitals.
I know there are some community hospitals hiring heme only docs to do 50% ward/consultation and 50% clinic.
In this small community scenario what are the main pathologies one has the deal with in the wards, with consults from other specialties and in clinic.
I am aware that agressive malign heme is not treated outside big academic centers. So that would be something i would forfeit once i am attending.

What would a heme only doc offer beyond a hospitalist to a small community hospital population.

I know some people will advise me to do heme/onc to widen my scope, but this is not a possibility, and really cannot postpone a year or two.

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[visari]

Your work will be mainly consulting on ridiculous inpatient and outpatient work up for anemia, thrombocytopenia and coagulation issues. Stuff that a competent PCP or hospitalist should be doing anyway. And then a little pinch of malignant heme. I find this to be the most dreadful part of the specialty. If you are passionate about doing it, sure go ahead and waste a couple of years on a fellow salary. you gotta keep in mind that there's no "hot market" for this in the community. If they're gonna hire a new person, they will prefer the one with dual training so they can see more patients.

IMHO, doing a hem only fellowship is not a good idea except for a very small number of people with true passion for one specific area of academic hem (MM, coaguation, Hodgkin's..etc) and realisitc plans to be a heavy duty trialist or physician-scientist after fellowship. It's not for people who think hematology "is cool" and definitely not for people who want to be (or likely to end up) in the community.

 

[hemonc12345]

No. This is definitely a very bad idea. Our faculty specifically tell us not to do hem only unless you are absolutely 100% sure you want to do academics, and even then that it's a terrible idea. Hem only is just not marketable at all.

 

[Kahreek]

Your work will be mainly consulting on ridiculous inpatient and outpatient work up for anemia, thrombocytopenia and coagulation issues. Stuff that a competent PCP or hospitalist should be doing anyway. And then a little pinch of malignant heme. I find this to be the most dreadful part of the specialty. If you are passionate about doing it, sure go ahead and waste a couple of years on a fellow salary. you gotta keep in mind that there's no "hot market" for this in the community. If they're gonna hire a new person, they will prefer the one with dual training so they can see more patients.

IMHO, doing a hem only fellowship is not a good idea except for a very small number of people with true passion for one specific area of academic hem (MM, coaguation, Hodgkin's..etc) and realisitc plans to be a heavy duty trialist or physician-scientist after fellowship. It's not for people who think hematology "is cool" and definitely not for people who want to be (or likely to end up) in the community.

What about those places where Heme and Onc are two different specialties (like australia or U.K)

 

[visari]

What about those places where Heme and Onc are two different specialties (like australia or U.K)

What about them?
I'm definitely not your best resource for practicing hem or onc in Australia

 

[gutonc]

What about those places where Heme and Onc are two different specialties (like australia or U.K)

If that's what you want to do, you should go there and train. Hem only fellowship for someone not planning an academic career is a terrible idea. Full stop.

 

[Kahreek]

If that's what you want to do, you should go there and train. Hem only fellowship for someone not planning an academic career is a terrible idea. Full stop.

I know it is not the most bulletproof career path, but sometimes life gives you lemons and all you can do is some bitter lemonade.

going back: what are the consults like in heme community, is it all trombocytopenia and anemia workup that should have been done by pcp's ?

 

[gutonc]

going back: what are the consults like in heme community, is it all trombocytopenia and anemia workup that should have been done by pcp's ?

I would say that's about 98% of my benign heme practice. Some of those turn out to be low grade MDS in a 93yo with COPD, ESLD and heart failure though.

And I would say that in my office of 4 docs and a PA (part of a larger group of 13 docs and 6 mid-levels with multiple offices), you could almost fill 1 clinic day a week with the kind of patients that you'd be trained to see. So I'm not sure what you'd do with the rest of your time.

But I need to reiterate, a heme only fellowship is a recipe for disaster if that's not what you want to actually do with your life. You say:

I know some people will advise me to do heme/onc to widen my scope, but this is not a possibility, and really cannot postpone a year or two.

But doing 2 years of a heme only fellowship is essentially going to be "postponing" for 2 years, until you can then get an Onc only fellowship (another 2 years). So either go all in on an academic benign heme career plan (there are plenty of these out there, nobody wants them) or take a year or 2 as a hospitalist to improve your CV so you can get the training you need for the career you actually want.

Don't half ass it like you're planning to do, it will end in misery.

 

[visari]

I know it is not the most bulletproof career path, but sometimes life gives you lemons and all you can do is some bitter lemonade.

It's a path that simply you don't have to take. Anyone who's telling you this's a good idea is not your friend or they truly have no freaking clue what they're talking about and you should stop asking them for career advice.

Why don't you do a quick search online for hematology only jobs in the community and let us know what you find? If that doesn't seal the deal for you, then nothing will.

 

[Kahreek]

I would say that's about 98% of my benign heme practice. Some of those turn out to be low grade MDS in a 93yo with COPD, ESLD and heart failure though.

And I would say that in my office of 4 docs and a PA (part of a larger group of 13 docs and 6 mid-levels with multiple offices), you could almost fill 1 clinic day a week with the kind of patients that you'd be trained to see. So I'm not sure what you'd do with the rest of your time.

But I need to reiterate, a heme only fellowship is a recipe for disaster if that's not what you want to actually do with your life. You say:

But doing 2 years of a heme only fellowship is essentially going to be "postponing" for 2 years, until you can then get an Onc only fellowship (another 2 years). So either go all in on an academic benign heme career plan (there are plenty of these out there, nobody wants them) or take a year or 2 as a hospitalist to improve your CV so you can get the training you need for the career you actually want.

Don't half ass it like you're planning to do, it will end in misery.

It's a path that simply you don't have to take. Anyone who's telling you this's a good idea is not your friend or they truly have no freaking clue what they're talking about and you should stop asking them for career advice.

Why don't you do a quick search online for hematology only jobs in the community and let us know what you find? If that doesn't seal the deal for you, then nothing will.

is Onc only fellowship less competitive than Heme/Onc, or there is no real difference.

 

[gutonc]

is Onc only fellowship less competitive than Heme/Onc, or there is no real difference.

No real difference. And less common.

Seriously...just do Hem/Onc