Heme/onc hospitalists

[hopefuloncologist]

I’m currently in my first year of heme/onc fellowship and I’m finding that my interests now are a bit different than when I started.

Coming in, I thought I preferred oncology significantly, but I’m now finding I like heme maybe equally as well. I am also one of those (perhaps unusual?) people who has a significant preference for inpatient work.

I think I’d like to be an oncology hospitalist when I graduate, but I am noticing that a good number of those jobs are primarily for internal medicine trained physicians and don’t require fellowship. Not to mention there aren’t SO many oncology hospitalist positions available regardless of training.

Are there any heme/onc hospitalists here that could tell me where they work and how they found their job? Could doing fellowship actually worsen my prospects of finding a hospitalist position? How can I best prepare myself for what I want to do?

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[TheBigCat]

There is a oncology hospitalist program at my hospital. In my experience, heme/onc fellowship will not hurt you, although it is unclear to what extent, if any, it will help. In terms of preparation, you're already there since you're board-certified in IM.

 

[hopefuloncologist]

There is a oncology hospitalist program at my hospital. In my experience, heme/onc fellowship will not hurt you, although it is unclear to what extent, if any, it will help. In terms of preparation, you're already there since you're board-certified in IM.

Thanks for your answer!

What part of the country are you in, generally? How many hospitalists are employed?

 

[gutonc]

There is a oncology hospitalist program at my hospital. In my experience, heme/onc fellowship will not hurt you, although it is unclear to what extent, if any, it will help. In terms of preparation, you're already there since you're board-certified in IM.

Agree with this. Most of the hem/onc hospitalists I know (or have known) are not fellowship trained, OR they are fellowship trained and are looking to join a particular institution and are using it as a foot in the door, hoping for a real faculty position in the future. One of my current partners did it at Pitt for a couple of years while his wife finished residency there before they both moved for fellowship. The program I trained in has 3 hospitalists now covering their malignant heme service (in addition to a half dozen mid-levels and 2-3 heme attendings). The 2 who do days are fellowship trained, one wants to keep doing the inpatient thing, the other is trying to make a go of a bench research career. The other one is a nocturnist and is IM trained but has not done fellowship.

Bottom line is that there are lots of places (almost universally academic) who are probably willing to hire you to do this, and many will be super psyched that you're fellowship trained.

The Heme Mal chief at my program tried to hire me to be a FT inpatient doc as I was graduating. I've never said "no" so fast in my life.

 

[hemonc12345]

Would there be any salary bump if you were fellowship trained and boarded?

 

[gutonc]

Would there be any salary bump if you were fellowship trained and boarded?

Unlikely. And if so, not enough to make up for 3 extra years of training.

 

[hopefuloncologist]

Unlikely. And if so, not enough to make up for 3 extra years of training.

This is part of what troubles me currently.

But I sleep so much better at night knowing I handed off my patient to someone else and that they are 100% not my problem any more.

How much salary, exactly, AM I giving up?

 

[gutonc]

This is part of what troubles me currently.

But I sleep so much better at night knowing I handed off my patient to someone else and that they are 100% not my problem any more.

This is easy...make the hospitalists admit your patient and act as a consultant. Done and done.

How much salary, exactly, AM I giving up?

You're basically going to get paid like any other hospitalist. So, depending on the salary structure, you're giving up somewhere between 50% and 250% of what you could be making as an outpatient hem/onc.

 

[hopefuloncologist]

This is easy...make the hospitalists admit your patient and act as a consultant. Done and done.



You're basically going to get paid like any other hospitalist. So, depending on the salary structure, you're giving up somewhere between 50% and 250% of what you could be making as an outpatient hem/onc.

Oooof. Ok maybe I don’t want to be a hospitalist THAT much. Yikes.

My gut is that I’ve put my family through too much to sacrifice that kind of possible income.

But I hate lying awake at night thinking about my outpatients, and did I miss something?

For some reason I never feel that way about inpatients because you have to make your decisions in real time, and once patients are out of the hospital, they just aren’t your problem any more. Also as an inpatient physician you 100% did not cause any of the circumstances that led to the patient getting admitted (whether through negligence or chemo).

Well. I guess I have a little time.

For a commitment-phobe like me, is locums also a big pay cut?

 

[hopefuloncologist]

This is easy...make the hospitalists admit your patient and act as a consultant. Done and done.



You're basically going to get paid like any other hospitalist. So, depending on the salary structure, you're giving up somewhere between 50% and 250% of what you could be making as an outpatient hem/onc.

I keep hearing that heme onc trained hospitalist positions are the way of the future.

Two of the hospitals I rotate at have collectively employed 4 of them in the last 2-3 years. Admittedly 3 are here for visa issues and one has personal issues that require a flexible schedule, so I doubt any of them are making tons of money. Or, given the reimbursements for our hospitalists, like ANY money (this is a terrible state to practice in, financially speaking).

I love being inpatient though. I love the pace, I still love internal medicine, and I enjoy interesting consult questions.

Anyway, thanks for your answer.

 

[HoldTheCoffee]

I keep hearing that heme onc trained hospitalist positions are the way of the future.

Where did you hear that? I really don't see why that would be the case. Unless you're talking about an inpatient malignant heme service, there really aren't any instances where the extra years of one training would confer much of a benefit. You're not going to be starting inpatient FOLFOX...

 

[arcus]

This might be helpful

The State of Cancer Care in America, 2017: A Report by the American Society of Clinical Oncology
http://ascopubs.org/doi/full/10.1200/JOP.2016.020743

 

[docsy]

I am on a j1 visa and I am looking for heme onc hospitalist positions preferably in university programs or places with fellowship. Is anyone aware of such positions?