Heme/Onc private practice lifestyle and salary? M3 needing to make career decision soon

[Cremaster reflex]

Hi,

I am a M3 soon to be M4 needing to make a career decision very soon and am quite lost. Was 95% set on Rad Onc for most of med school and made myself competitive for it (260+ step 1, ~10 publications by the time I submit ERAS) but considering the dismal/worsening job market I am very unsure of the field.

I have always really, really liked both hematology and onc (hence why I was interested in Rad Onc) but to be honest, I know very little about what the lifestyle and salary are like for this field. I did an Oncology consult elective month and enjoyed it but I understand this is not representative of outpatient private practice. Can anyone comment on their experience/observations with these aspects of the heme/onc? By no means am I saying this is all I care about, I think I would really enjoy the field and be good at it but lifestyle (i.e. call, overall hours) is also very important to me from a mental health standpoint as well.

Additionally, can anyone comment what the lifestyle is like in fellowship? Thank you so much.

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[whoknows2012]

Hi,

I am a M3 soon to be M4 needing to make a career decision very soon and am quite lost. Was 95% set on Rad Onc for most of med school and made myself competitive for it (260+ step 1, ~10 publications by the time I submit ERAS) but considering the dismal/worsening job market I am very unsure of the field.

I have always really, really liked both hematology and onc (hence why I was interested in Rad Onc) but to be honest, I know very little about what the lifestyle and salary are like for this field. I did an Oncology consult elective month and enjoyed it but I understand this is not representative of outpatient private practice. Can anyone comment on their experience/observations with these aspects of the heme/onc? By no means am I saying this is all I care about, I think I would really enjoy the field and be good at it but lifestyle (i.e. call, overall hours) is also very important to me from a mental health standpoint as well.

Additionally, can anyone comment what the lifestyle is like in fellowship? Thank you so much.

Before I go in depth about all your questions may I inquire (without judgement) why you’re asking about private practice alone? No negative feelings towards that but students at your stage are usually interested in the academic side at first. Your response will also help me tailor my answers to your questions towards your interests

 

[Cremaster reflex]

Before I go in depth about all your questions may I inquire (without judgement) why you’re asking about private practice alone? No negative feelings towards that but students at your stage are usually interested in the academic side at first. Your response will also help me tailor my answers to your questions towards your interests

I appreciate the response. I may be misguided/uninformed in this manner (i.e. what it means to be PP vs. academic in heme/onc) but throughout my rotations I have found myself enjoying the office visit setting much more than actually being in the hospital. With that being said I have 0 interest in primary care as that would bore me to tears. Further I like the idea of being able to form a long-term relationship with patients and would look forward to continually seeing them q6months or whatever and hopefully telling them they continue to have NED

I hope this makes sense. Thank you.

 

[whoknows2012]

I appreciate the response. I may be misguided/uninformed in this manner (i.e. what it means to be PP vs. academic in heme/onc) but throughout my rotations I have found myself enjoying the office visit setting much more than actually being in the hospital. With that being said I have 0 interest in primary care as that would bore me to tears. I hope this makes sense

Ah ok this definitely helps. The academic vs pp distinction isn’t really predicated on outpt vs in hospital or inpatient. All academic oncology jobs are mostly outpatient (unless of course you’re an oncology Hospitalist which is rare). The main difference as far as pp vs academic is whether you’re employed by the hospital or by yourself or a group. Sometimes hospitals also own a group so it’s sort of an “affiliated” practice @gutonc can comment more about the pp side. The other major difference is pay, which is of course higher on the pp side. You often do not have the ability to specialize as much as you would with an academic position. Academic positions often are associated with more research or scholarly activity. Availability of clinical trials are also more prevalent within academic institutions. There are many other differences but these are just a few. As far as salary you can probably expect to make anywhere between 75-80% of what you could make in private practice in academics. Where you practice is also very important as that determines your compensation. Ie nyc pp and academic salaries are fairly low (250-300pp 180-250 academic) vs areas in south or Midwest where pp and academic salaries are high.

Overall hours worked can be higher in pp especially in the beginning but that all depends on your practice and call responsibilities. Stresses on the academic side usually come in the form of bureaucracy (ie billing, compliance) and research requirements (if any). Another difference with academic vs pp is that as an academic oncologist you will have some inpatient duties that vary from minimal (solid tumor) in the form of wknd and occasional inpatient consult coverage, to more significant if you do heme malignancies like leukemia or are BMT.

Lifestyle in fellowship depends highly on the type of program you train in. At cancer centers (ie mskcc, mdacc, farber) 18-24 months of your time is spent doing research. Versus community programs (which based on your stats I’m sure you won’t even be applying to when it comes time) where nearly all 3 yrs are spent doing clinical work. At high ranked academic institutions your schedule and call duties are heavily weighted towards 1st yr as thereafter you’ll be mostly focused on research. As an example from my academic oncology program 1st yr I averaged 50h/wk plus one night on call each wk (home call, answering clinic phone calls, rarely needed to come one for an acute leukemia or ttp) and 12 wknds per year on call (6 inpatient covering consults 6 outpatient covering outpatient clinic phone calls). As a 2nd yr the schedule is vastly improved no weeknight call, working 7 wknds (half inpatient/outpatient). I’m on research now and so in that regard I essentially make my own hours but have deadlines and so occasionally I have to work more some days/weeks than others.

I know I probably didn’t answer all your questions but happy to address anything more specifically either here or via pm.

 

[Cremaster reflex]

Ah ok this definitely helps. The academic vs pp distinction isn’t really predicated on outpt vs in hospital or inpatient. All academic oncology jobs are mostly outpatient (unless of course you’re an oncology Hospitalist which is rare). The main difference as far as pp vs academic is whether you’re employed by the hospital or by yourself or a group. Sometimes hospitals also own a group so it’s sort of an “affiliated” practice @gutonc can comment more about the pp side. The other major difference is pay, which is of course higher on the pp side. You often do not have the ability to specialize as much as you would with an academic position. Academic positions often are associated with more research or scholarly activity. Availability of clinical trials are also more prevalent within academic institutions. There are many other differences but these are just a few. As far as salary you can probably expect to make anywhere between 75-80% of what you could make in private practice in academics. Where you practice is also very important as that determines your compensation. Ie nyc pp and academic salaries are fairly low (250-300pp 180-250 academic) vs areas in south or Midwest where pp and academic salaries are high.

Overall hours worked can be higher in pp especially in the beginning but that all depends on your practice and call responsibilities. Stresses on the academic side usually come in the form of bureaucracy (ie billing, compliance) and research requirements (if any). Another difference with academic vs pp is that as an academic oncologist you will have some inpatient duties that vary from minimal (solid tumor) in the form of wknd and occasional inpatient consult coverage, to more significant if you do heme malignancies like leukemia or are BMT.

Lifestyle in fellowship depends highly on the type of program you train in. At cancer centers (ie mskcc, mdacc, farber) 18-24 months of your time is spent doing research. Versus community programs (which based on your stats I’m sure you won’t even be applying to when it comes time) where nearly all 3 yrs are spent doing clinical work. At high ranked academic institutions your schedule and call duties are heavily weighted towards 1st yr as thereafter you’ll be mostly focused on research. As an example from my academic oncology program 1st yr I averaged 50h/wk plus one night on call each wk (home call, answering clinic phone calls, rarely needed to come one for an acute leukemia or ttp) and 12 wknds per year on call (6 inpatient covering consults 6 outpatient covering outpatient clinic phone calls). As a 2nd yr the schedule is vastly improved no weeknight call, working 7 wknds (half inpatient/outpatient). I’m on research now and so in that regard I essentially make my own hours but have deadlines and so occasionally I have to work more some days/weeks than others.

I know I probably didn’t answer all your questions but happy to address anything more specifically either here or via pm.

First of all thank you so much for your helpful input, I can't tell you how much I appreciate it. The distinction between PP vs. academic and inpatient vs. outpatient is much more clear to me now. I understand that with high grade malignancies like certain leukemias and lymphomas there is greater risk for tumor lysis syndrome with rapid cell turnover but other than that, I don't really understand what else you would be getting called about in the middle of the night? Also, when on call what is a reasonable amount of times to be getting called as both a fellow and attending? Just trying to get an idea of how "call" works for the field and what I could expect.

Furthermore, I know it is probably highly variable but in general how many days a week, average weekly hours worked, and call frequency do you see PP and academic Heme/Onc doc with?

I have no interest in living in large cities like NYC, LA, Boston and would prefer to live around medium size cities in the SE so I guess it won't be an issue paying off ~$300k in med school loans then.

Again, thank you so much for answering my questions. I know they are mostly based on lifestyle/salary and these are far from the only things I care about but I tend to be someone who is pretty good at what I do but get kind of tired quickly if I am not engaged so this is really important to me. I am starting to panic as I need to schedule for M4 year in a couple of weeks and I am still deciding on Rad Onc vs. Heme/Onc. Anesthesia vs. a few other fields.

 

[whoknows2012]

First of all thank you so much for your helpful input, I can't tell you how much I appreciate it. The distinction between PP vs. academic and inpatient vs. outpatient is much more clear to me now. I understand that with high grade malignancies like certain leukemias and lymphomas there is greater risk for tumor lysis syndrome with rapid cell turnover but other than that, I don't really understand what else you would be getting called about in the middle of the night? Also, when on call what is a reasonable amount of times to be getting called as both a fellow and attending? Just trying to get an idea of how "call" works for the field and what I could expect.

Furthermore, I know it is probably highly variable but in general how many days a week, average weekly hours worked, and call frequency do you see PP and academic Heme/Onc doc with?

I have no interest in living in large cities like NYC, LA, Boston and would prefer to live around medium size cities in the SE so I guess it won't be an issue paying off ~$300k in med school loans then.

Again, thank you so much for answering my questions. I know they are mostly based on lifestyle/salary and these are far from the only things I care about but I tend to be someone who is pretty good at what I do but get kind of tired quickly if I am not engaged so this is really important to me. I am starting to panic as I need to schedule for M4 year in a couple of weeks and I am still deciding on Rad Onc vs. Heme/Onc. Anesthesia vs. a few other fields.

1) What types of calls while “on call”
As a fellow, the types of calls we get vary heavily as we cover both fellow and attending patients as well as inpatient consults on all hem/onc services. Which means we could get a patient phone call complaining of nausea or constipation to a 90 day post BMT patient complaining of a fever of 103 to an IM intern calling a consult for platelet count of 110 (can’t that wait until
Morning???) to an ED pa calling about mild anemia with a wbc count of 20 with 90% blasts (how could you miss that!!??). On average I received ~10 calls per night (highly variable of course) and only went in for a consult after hours 8 times throughout the whole year. My co fellows varied from 5-10 times (maybe as much as 12 for one fellow). Other calls? Solid tumor onc emergencies including cord compression and SVC syndrome. ITP with plt count less than 20 with or without bleeding. R/o TTP (which requires a smear review in the appropriate setting). And any type of phone call you could imagine from the patients.

As an attending this is vastly different. In an academic job the fellow usually fields most of the calls and only reaches out in the setting of an emergency or if there is a urgent clinical question. As a pp oncologist there is no fellow for you so you’d be covering your patients via an answering service in some way shape or form. In academics, when on inpatient for 2 wks let’s say for consults (solid tumor) or on service as a specialist in one of the heme malignancy areas (bmt, leukemia, lymphoma, myeloma) then you cover those patients at night (with or without fellow coverage) and so you can get calls in the middle of the night but never have to come in.

2) PP vs academic wkly
As you mentioned highly variable. PP mostly 9-5 seeing patients but likely some time spent before and after on admin stuff like phone calls note writing, sometime seeing patients inpatient if admitted etc. wknd coverage in pp is usually a rotation but someone with more experience @gutonc can comment. Academic hours depend if on or off service. When you’re doing purely outpatient it’s usually 2-4 days a week or clinic seeing 10-20 patients a day. Other days of week are spent on research duties(trials, clinical research) or admin (phone calls, tumor boards, meetings etc). When on service you usually do 1-2 wks straight AND see clinic patients and have admin/research duties so these are definitely more stressful weeks. Hours are probably 45-50 vs 60 outpatient vs when on service. Usually on service you work one or both wknds but those wknd days are not fully spent in house (can round early and be done by noon). Service duties per year vary heavily by specialty but on average ~2 months

As an aside, you strike me as someone who may be well suited for academics in a highly stimulating field. I’d strongly consider IM residency (for whatever my opinion is worth)

 

[Cremaster reflex]

1) What types of calls while “on call”
As a fellow, the types of calls we get vary heavily as we cover both fellow and attending patients as well as inpatient consults on all hem/onc services. Which means we could get a patient phone call complaining of nausea or constipation to a 90 day post BMT patient complaining of a fever of 103 to an IM intern calling a consult for platelet count of 110 (can’t that wait until
Morning???) to an ED pa calling about mild anemia with a wbc count of 20 with 90% blasts (how could you miss that!!??). On average I received ~10 calls per night (highly variable of course) and only went in for a consult after hours 8 times throughout the whole year. My co fellows varied from 5-10 times (maybe as much as 12 for one fellow). Other calls? Solid tumor onc emergencies including cord compression and SVC syndrome. ITP with plt count less than 20 with or without bleeding. R/o TTP (which requires a smear review in the appropriate setting). And any type of phone call you could imagine from the patients.

As an attending this is vastly different. In an academic job the fellow usually fields most of the calls and only reaches out in the setting of an emergency or if there is a urgent clinical question. As a pp oncologist there is no fellow for you so you’d be covering your patients via an answering service in some way shape or form. In academics, when on inpatient for 2 wks let’s say for consults (solid tumor) or on service as a specialist in one of the heme malignancy areas (bmt, leukemia, lymphoma, myeloma) then you cover those patients at night (with or without fellow coverage) and so you can get calls in the middle of the night but never have to come in.

2) PP vs academic wkly
As you mentioned highly variable. PP mostly 9-5 seeing patients but likely some time spent before and after on admin stuff like phone calls note writing, sometime seeing patients inpatient if admitted etc. wknd coverage in pp is usually a rotation but someone with more experience @gutonc can comment. Academic hours depend if on or off service. When you’re doing purely outpatient it’s usually 2-4 days a week or clinic seeing 10-20 patients a day. Other days of week are spent on research duties(trials, clinical research) or admin (phone calls, tumor boards, meetings etc). When on service you usually do 1-2 wks straight AND see clinic patients and have admin/research duties so these are definitely more stressful weeks. Hours are probably 45-50 vs 60 outpatient vs when on service. Usually on service you work one or both wknds but those wknd days are not fully spent in house (can round early and be done by noon). Service duties per year vary heavily by specialty but on average ~2 months

As an aside, you strike me as someone who may be well suited for academics in a highly stimulating field. I’d strongly consider IM residency (for whatever my opinion is worth)

Again really appreciate these posts. In high school when I first figured out I wanted to go to med school I always thought I would do Endocrinology because I love metabolism, biochemistry, and hormone pathways. I have always seen myself as a "medicine" type person but I was absolutely miserable on my 2 month IM rotation. Granted, it was the very first rotation I did but still, I was very unhappy and I had very good hours on this rotation versus. residents and other med students. At this point the IM residency is really the only thing keeping me from committing to Heme/Onc, any comments on whether working those hours get easier or more difficult as you go? Additionally, what is the lifestyle like for an IM resident at a top institution (i.e. MGH, Duke, Hopkins) versus a lower-tier program? I am not sure if it would be more difficult, slightly less work since they have more resources, or the same.

Thank you.

 

[Chibucks15]

Again really appreciate these posts. In high school when I first figured out I wanted to go to med school I always thought I would do Endocrinology because I love metabolism, biochemistry, and hormone pathways. I have always seen myself as a "medicine" type person but I was absolutely miserable on my 2 month IM rotation. Granted, it was the very first rotation I did but still, I was very unhappy and I had very good hours on this rotation versus. residents and other med students. At this point the IM residency is really the only thing keeping me from committing to Heme/Onc, any comments on whether working those hours get easier or more difficult as you go? Additionally, what is the lifestyle like for an IM resident at a top institution (i.e. MGH, Duke, Hopkins) versus a lower-tier program? I am not sure if it would be more difficult, slightly less work since they have more resources, or the same.

Thank you.

just my two cents but I've always been told to be wary of going into IM with the sole intention of being a specialist. Fellowships are nowhere near a given. But other than that I agree these posts have been awesome

 

[Cremaster reflex]

just my two cents but I've always been told to be wary of going into IM with the sole intention of being a specialist. Fellowships are nowhere near a given. But other than that I agree these posts have been awesome

Yeah that is a good point. Hypothetically speaking if I were able to get into say a top 5 IM program do you think I would have difficulty matching Heme/Onc? Some of my published med school research is oncology rather than Rad Onc specific

 

[Chibucks15]

Yeah that is a good point. Hypothetically speaking if I were able to get into say a top 5 IM program do you think I would have difficulty matching Heme/Onc? Some of my published med school research is oncology rather than Rad Onc specific

you're in a hell of a lot better position than me that's for sure haha

 

[lulu09]

Again really appreciate these posts. In high school when I first figured out I wanted to go to med school I always thought I would do Endocrinology because I love metabolism, biochemistry, and hormone pathways. I have always seen myself as a "medicine" type person but I was absolutely miserable on my 2 month IM rotation. Granted, it was the very first rotation I did but still, I was very unhappy and I had very good hours on this rotation versus. residents and other med students. At this point the IM residency is really the only thing keeping me from committing to Heme/Onc, any comments on whether working those hours get easier or more difficult as you go? Additionally, what is the lifestyle like for an IM resident at a top institution (i.e. MGH, Duke, Hopkins) versus a lower-tier program? I am not sure if it would be more difficult, slightly less work since they have more resources, or the same.

Thank you.

I went to a mid-tier academic IM program and matched at a pretty decent fellowship this year. Anyways, IM residency first year sucks, and then it gets easier and easier as you become a senior resident. As mentioned above, most competitive heme-onc fellowships usually protect their fellows 2nd and 3rd years to do research since it's the primary focus of fellowship training, so you're also similarly just looking at one year of a very busy schedule. At the top programs, they are aiming to train academic physicians, physician scientists, and others that are more likely to stay in a research/teaching environment, so if one is aiming to be community practice I think one might actually have to try harder at widening their clinical exposure at the very top programs (e.g. MSKCC fellows mainly working with patients on clinical trials rather than the general bread and butter community oncologist).

IM residency similar to fellowship is that the higher you go and the more competitive the program is, the more the program wants to generate academic physicians, researchers, or what they like to call "leaders" in the XYZ field in the future. Thus, the better the IM residency is, usually the less scut there is and the more protected time you have to do research in the latter years. You can pick this up very easily on the trail when different programs advertise themselves as having either really good access to mentors and research or that they are a "clinically strong" program (which is a codeword for there is a lot of service months and it's busy when you're on service). Technically good clinical training is certainly not a bad thing especially if you're looking at more clinical practice oriented for the future, but it's just my experience from working with peers who trained at the higher caliber IM programs now that a lot of their residency was more geared towards research and academic medicine (attending conference, writing up manuscripts) and as a result they are smart, but I don't think they are the best doctors at "getting stuff done" and honestly grinding through a list of patients to see.

With your scores and your research, you should easily match a Top 10 IM residency. It's irrelevant that your publications are in rad-onc as even medical oncologists sometimes publish in rad-onc journals and there's often significant overlap in the topics (e.g. cancer screening). It's honestly also easier to publish in rad-onc journals sometimes since I think there's actually more of them that publish more frequently. Anyways, pre-residency this doesn't really matter. Residency programs just want to see that you have a good track record of staying committed to your projects and that you have some academic inquiry. You should have also little difficulty matching a pretty good fellowship as long as you continue your performance in residency. You now have a great resume to start off your residency in IM, but it's simply whether you want to do IM then fellowship or go straight into rad-onc and commit to that instead. I can assure you that applicants who come from community IM residencies match fellowship, and mere mortals like me who went to mid-tier academics did too, so you honestly have nothing to worry about since I'm fairly certain you will have a more competitive application than me in 3 years should you choose to go the medical oncology route.

 

[whoknows2012]

I went to a mid-tier academic IM program and matched at a pretty decent fellowship this year. Anyways, IM residency first year sucks, and then it gets easier and easier as you become a senior resident. As mentioned above, most competitive heme-onc fellowships usually protect their fellows 2nd and 3rd years to do research since it's the primary focus of fellowship training, so you're also similarly just looking at one year of a very busy schedule. At the top programs, they are aiming to train academic physicians, physician scientists, and others that are more likely to stay in a research/teaching environment, so if one is aiming to be community practice I think one might actually have to try harder at widening their clinical exposure at the very top programs (e.g. MSKCC fellows mainly working with patients on clinical trials rather than the general bread and butter community oncologist).

IM residency similar to fellowship is that the higher you go and the more competitive the program is, the more the program wants to generate academic physicians, researchers, or what they like to call "leaders" in the XYZ field in the future. Thus, the better the IM residency is, usually the less scut there is and the more protected time you have to do research in the latter years. You can pick this up very easily on the trail when different programs advertise themselves as having either really good access to mentors and research or that they are a "clinically strong" program (which is a codeword for there is a lot of service months and it's busy when you're on service). Technically good clinical training is certainly not a bad thing especially if you're looking at more clinical practice oriented for the future, but it's just my experience from working with peers who trained at the higher caliber IM programs now that a lot of their residency was more geared towards research and academic medicine (attending conference, writing up manuscripts) and as a result they are smart, but I don't think they are the best doctors at "getting stuff done" and honestly grinding through a list of patients to see.

With your scores and your research, you should easily match a Top 10 IM residency. It's irrelevant that your publications are in rad-onc as even medical oncologists sometimes publish in rad-onc journals and there's often significant overlap in the topics (e.g. cancer screening). It's honestly also easier to publish in rad-onc journals sometimes since I think there's actually more of them that publish more frequently. Anyways, pre-residency this doesn't really matter. Residency programs just want to see that you have a good track record of staying committed to your projects and that you have some academic inquiry. You should have also little difficulty matching a pretty good fellowship as long as you continue your performance in residency. You now have a great resume to start off your residency in IM, but it's simply whether you want to do IM then fellowship or go straight into rad-onc and commit to that instead. I can assure you that applicants who come from community IM residencies match fellowship, and mere mortals like me who went to mid-tier academics did too, so you honestly have nothing to worry about since I'm fairly certain you will have a more competitive application than me in 3 years should you choose to go the medical oncology route.

Don’t have much more to add here. Great post. You have an excellent shot at top programs and even if you match to a not top 10 program you still will likely match well to hem/onc. IM residency lifestyle isn’t as good as Rad Onc but it’s still way better as a pgy2/3 vs pgy1. Ultimately your happiness is most important so you have to think long and hard about where you’ll be most happy.

 

[PolarPenguin]

Again really appreciate these posts. In high school when I first figured out I wanted to go to med school I always thought I would do Endocrinology because I love metabolism, biochemistry, and hormone pathways. I have always seen myself as a "medicine" type person but I was absolutely miserable on my 2 month IM rotation. Granted, it was the very first rotation I did but still, I was very unhappy and I had very good hours on this rotation versus. residents and other med students. At this point the IM residency is really the only thing keeping me from committing to Heme/Onc, any comments on whether working those hours get easier or more difficult as you go? Additionally, what is the lifestyle like for an IM resident at a top institution (i.e. MGH, Duke, Hopkins) versus a lower-tier program? I am not sure if it would be more difficult, slightly less work since they have more resources, or the same.

Thank you.

First of all, thank you all so much for the thorough answers! I'm not OP but I had similar questions and this is incredibly helpful.

I'm on the IM interview trail now and can speak to the lifestyle at some different programs. It seems to vary significantly by program, and not entirely along the lines of top vs mid-tier. There are some top programs that at least by reputation (Hopkins, UTSW) are also very clinically heavy. I've heard applicants talking about expecting more than average ward months at or just under duty hours each week/ month. Other programs have reputation for being much less intense (Mayo (though some argue this isn't a top program), NW). These programs are often X+Y scheduling and promise golden weekends on the Y weeks. Mayo for example is 4+4. Mid tier programs seem to follow this same general principle, some busier and some less busy. It seems like all these programs match just fine, and I don't think there is really too much concern that the "less rigorous" programs don't provide solid training though I've heard some rumblings of this opinion on the interview trail. I'm not convinced it's really true based on their fellowship matches and quality of discussion at morning/noon report.

On average, IM residency looks like 60-70% ward months intern year with an average of 50-80 hours over 6 days/ week, and the rest of the time is outpatient rotations (or a rare subspecialty consult service), 9-5 with golden weekends. Ward schedules seem to vary from 6am-7pm daily (must stay til sign out every day but admissions stop earlier than that) to rotating schedules with late and early days (ex: always in at 7, sometimes stay til signout at 7, sometimes leave when done at about 3-6pm.) None of the programs I interviewed at had 28's for wards as an intern, but some did for seniors. Most have night-float. ICU varied a lot more. Most still had night float for interns, many did have 28's for seniors usually Q4 with an occasional Q3. It gets progressively better each year with increasing elective time for elective outpatient rotations and consult months. I've been pleasantly surprised by the amount of time that interns seem to have even on ward and ICU months at many programs.

Regarding the resources, all the mid-tier and top tier programs I interviewed at had ample resources (or at least claimed to on interview day and the dinner beforehand). No program was having interns or residents schedule follow ups, draw blood samples, or transport patients other than in very rare circumstances. They all talked about great ancillary support staff like case managers and social work to set up dispo planning. That said, there are some programs that do have reputations for not having good ancillary support (Columbia). As with reputations for "intensity," you'll get a good sense of this during the application an interview season. Reputations may or may not align with reality.

Regardless of what you decide, I would highly recommend an early IM sub-I if you're considering IM. If at all possible, see if you can swing a sub-I in inpatient heme or onc. I agree that it's not usually advisable to go into IM aiming for fellowship, but it's also not unheard of and I have absolutely no reason to think you'd have any trouble landing a heme/onc fellowship if you keep doing what you've been doing. A subspecialty sub-I will give you a much better sense of what things would be like for your career rather than just residency.

 

[CatFactorial]

First of all thank you so much for your helpful input, I can't tell you how much I appreciate it. The distinction between PP vs. academic and inpatient vs. outpatient is much more clear to me now. I understand that with high grade malignancies like certain leukemias and lymphomas there is greater risk for tumor lysis syndrome with rapid cell turnover but other than that, I don't really understand what else you would be getting called about in the middle of the night? Also, when on call what is a reasonable amount of times to be getting called as both a fellow and attending? Just trying to get an idea of how "call" works for the field and what I could expect.

Furthermore, I know it is probably highly variable but in general how many days a week, average weekly hours worked, and call frequency do you see PP and academic Heme/Onc doc with?

I have no interest in living in large cities like NYC, LA, Boston and would prefer to live around medium size cities in the SE so I guess it won't be an issue paying off ~$300k in med school loans then.

Again, thank you so much for answering my questions. I know they are mostly based on lifestyle/salary and these are far from the only things I care about but I tend to be someone who is pretty good at what I do but get kind of tired quickly if I am not engaged so this is really important to me. I am starting to panic as I need to schedule for M4 year in a couple of weeks and I am still deciding on Rad Onc vs. Heme/Onc. Anesthesia vs. a few other fields.

As a first year fellow at an academic institution in a medium-sized SE city and a loan burden that would make you gnash your teeth, home call usually involves anywhere from 10 to 20 pages, comprising calls from patients about standard medicine issues like VTE/ACS, immunotherapy adverse events, study drug reactions, calls from outside providers (it’s always fun when you suggest someone go to their podunk ED to get checked out for neutropenic fever and later find that the gung ho ED physician airlifted them to the main hospital for a T of 99.2) RNs/PharmDs on the heme and onc floors calling about chemo approvals, calls from surgical services about approving KCentra for bleeding folks (the answer is usually to get a factor X level and to STFU), etc.

It was harrowing at the beginning of the year but now it is entirely annoying. Even acute leuks and such are protocol driven and you are just telling other people what to do over the phone. Heme path will email me representative slide photos. When asked to physically come in for an acute leuk I’ll say to get a factor X level, go join the neurosurgery folks and STFU.

Great field to be an on-call-ogist

 

[HOIV]

As a first year fellow at an academic institution in a medium-sized SE city and a loan burden that would make you gnash your teeth, home call usually involves anywhere from 10 to 20 pages, comprising calls from patients about standard medicine issues like VTE/ACS, immunotherapy adverse events, study drug reactions, calls from outside providers (it’s always fun when you suggest someone go to their podunk ED to get checked out for neutropenic fever and later find that the gung ho ED physician airlifted them to the main hospital for a T of 99.2) RNs/PharmDs on the heme and onc floors calling about chemo approvals, calls from surgical services about approving KCentra for bleeding folks (the answer is usually to get a factor X level and to STFU), etc.

It was harrowing at the beginning of the year but now it is entirely annoying. Even acute leuks and such are protocol driven and you are just telling other people what to do over the phone. Heme path will email me representative slide photos. When asked to physically come in for an acute leuk I’ll say to get a factor X level, go join the neurosurgery folks and STFU.

Great field to be an on-call-ogist

We’d have gotten killed for not going to see an acute leuk. Maybe you are blessed having not seen one go really bad yet or maybe the people admitting for you are good enough to do it alone but the fellows where I trained never did an acute leuk over the phone.