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Any aspiring Hematologist/Oncologists out there? Is the only track available to do an IM residency followed by a Heme/Onc fellowship?
Heme/Onc
- Thread starter Idiopathic
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If you want to see adult cancer pts, then yes, that is the only track. If you want to see peds cancer pt's, then you must do pediatrics then a heme onc fellowship. Heme onc is one of those specialties where the stuff you see in peds is oftentimes very different then the stuff you see in adults (except with ALL I guess, a very, very awful disease).
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I thought ALL was highly treatable? I have notes of something like an 85% 5-year survival (i know 100% would be ideal, but...)
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ALL is very treatable in kids. About 80% long term survival, but once you relapse, survival is down to about 30%. Still can be an awful disease with long term brain damage post rads therapy, hypogonadism and such. I don't know what the rates are like in adults.
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I see, yes...the treatment could be worse than the disease.
I am also interested in heme onc. However, I have several concerns:
1) What is the average salary right now? and how low can it drop if insurance companies change chemo reimbursement?
2) How depressing is it? Are most heme/onc doctors always depressed and does it affect their lifestyle? Do most patients die?
3) How many hours per week do most docs work and how much call do they take?
4) Besides anemia, sickle cell, and hemophelia, what other major heme problems do these docs see?
5) Even though each practice is different, how many patients per day do heme/onc see on average?
6) How competitive is a hem onc fellowship in terms of board scores?
I know there will be many new advancements in terms of cancer treatment in the future, and I think it will be very rewarding and interesting to help cancer patients, who are most in need especially when facing the terminal diagnosis of metastatic disease.
Sorry for so many questions.
Thanks guys!!
1) What is the average salary right now? and how low can it drop if insurance companies change chemo reimbursement?
2) How depressing is it? Are most heme/onc doctors always depressed and does it affect their lifestyle? Do most patients die?
3) How many hours per week do most docs work and how much call do they take?
4) Besides anemia, sickle cell, and hemophelia, what other major heme problems do these docs see?
5) Even though each practice is different, how many patients per day do heme/onc see on average?
6) How competitive is a hem onc fellowship in terms of board scores?
I know there will be many new advancements in terms of cancer treatment in the future, and I think it will be very rewarding and interesting to help cancer patients, who are most in need especially when facing the terminal diagnosis of metastatic disease.
Sorry for so many questions.
Thanks guys!!
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What about all the big malignant heme stuff like acute/chronic leukemias, all the lymphomas, myeloma, aplastic anemia... and a huge part of heme being coagulopathies - lupus anticoagulant/antiphospholipid/FVL, preop/postop management for those with higher risk of clotting, use of EPO v. transfusions for those with any of the thalessemias including Hgb H, B-thal minor..., Cold Agglutinin Dz... the list goes on and on.. this is some of the stuff I've seen during my 1st month on heme as a R1.
JT
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One of our clinical Heme/Onc guys says he sees more Heme than Onc...
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My understanding is that Hem/Onc docs are in greater demand than there is supply. Thus it is not unusual to hear of people making 300 out of fellowship. There is talk that reimbursments on chemotherapy could affect this salary, but its unclear to me how reimbursment issues would alter the supply of doctors in Hem/Onc, except in a negative way.
Moreover, while it is nice that Hem/Onc garners nice wages at the moment, in my opinion, it is the last field where you would want to take money as a major motivating factor. Such thinking seems fraught with problems at the outset. Having said that, as a specialist, you will earn specialist wages regardless of changes in chemo reimbursment. Before the recognized shortage, Hem/Onc specialists were making around 200.
As for competitiveness, Hem/Onc is one of the less competitive subspecialties in medicine. This may be because people have difficulty working with the terminally ill. While you may actually cure patients as a pediatric or gyn oncologist, much of the work in medical oncology is palliative. Nonetheless, currently about half of the fellowships in medical oncology are taken by FMGs. It is not hard to match into a fellowship. If you are talking about training at Sloan Kettering, Dana Farber or MD Anderson, however, that's another story.
As for whether the field is depressing, you obviously have to find this out for yourself. You may be surprised to discover that some cancer patients can be truly inspirational in the way they deal with illness. Whether this can outweigh the challenge of countless difficult conversations is obviously a very personal matter. During my limited exposure, I have personally found it more difficult to talk to families than patients themselves about cancer.
If you are interested in oncology, look into pediatric and gyn oncology as well. These are more competitive, especially gyn oncology, but they offer better outcomes, different patient populations, and gyn onc- the opportunity to do some wonderful pelvic/bowel surgery.
As for Hem/Onc proper, if you are in private practice, I believe you tend to do mostly oncology. If you're in academia, you are more likely to do hematology and may even focus on it. There are 2 year medical oncology fellowships. I'm not aware if there are hematology fellowships alone.
Good luck.
Moreover, while it is nice that Hem/Onc garners nice wages at the moment, in my opinion, it is the last field where you would want to take money as a major motivating factor. Such thinking seems fraught with problems at the outset. Having said that, as a specialist, you will earn specialist wages regardless of changes in chemo reimbursment. Before the recognized shortage, Hem/Onc specialists were making around 200.
As for competitiveness, Hem/Onc is one of the less competitive subspecialties in medicine. This may be because people have difficulty working with the terminally ill. While you may actually cure patients as a pediatric or gyn oncologist, much of the work in medical oncology is palliative. Nonetheless, currently about half of the fellowships in medical oncology are taken by FMGs. It is not hard to match into a fellowship. If you are talking about training at Sloan Kettering, Dana Farber or MD Anderson, however, that's another story.
As for whether the field is depressing, you obviously have to find this out for yourself. You may be surprised to discover that some cancer patients can be truly inspirational in the way they deal with illness. Whether this can outweigh the challenge of countless difficult conversations is obviously a very personal matter. During my limited exposure, I have personally found it more difficult to talk to families than patients themselves about cancer.
If you are interested in oncology, look into pediatric and gyn oncology as well. These are more competitive, especially gyn oncology, but they offer better outcomes, different patient populations, and gyn onc- the opportunity to do some wonderful pelvic/bowel surgery.
As for Hem/Onc proper, if you are in private practice, I believe you tend to do mostly oncology. If you're in academia, you are more likely to do hematology and may even focus on it. There are 2 year medical oncology fellowships. I'm not aware if there are hematology fellowships alone.
Good luck.
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Points I failed to address...
Hem/Onc docs see lots of patients during the week. It is a high volume specialty. The hours however are not bad and there are only a few oncologic emergencies.
As mentioned elsewhere, obtaining fellowships is about who you know, what sort of affiliations your institution has, and/or whether your institution has its own fellowship in the field of interest. I don't believe board scores has much bearing at all. Research, however, seems quite important.
Hem/Onc docs see lots of patients during the week. It is a high volume specialty. The hours however are not bad and there are only a few oncologic emergencies.
As mentioned elsewhere, obtaining fellowships is about who you know, what sort of affiliations your institution has, and/or whether your institution has its own fellowship in the field of interest. I don't believe board scores has much bearing at all. Research, however, seems quite important.
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Is there a "match" for Heme/Onc fellowships, or do you have to contact each program that you are interested in individually and apply separately?
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to answer some of the leftover questions...
no there is not a match in heme-onc...
next, while people may do med onc alone for 2 years...
heme alone is also 2 year...both combined are 3 years at most places...
in private practice, heme only makes up 30% of your practice...
i dont know if there really are board cutoffs when it comes to fellowships...
i think most of the rest was answered...
my suggestion: rotate in heme-onc, inpt and outpt to see if you like it...otherwise, its hard to know if you are really built for it...since it does require people who are able to deal with death and all the associated issues....
good luck.
no there is not a match in heme-onc...
next, while people may do med onc alone for 2 years...
heme alone is also 2 year...both combined are 3 years at most places...
in private practice, heme only makes up 30% of your practice...
i dont know if there really are board cutoffs when it comes to fellowships...
i think most of the rest was answered...
my suggestion: rotate in heme-onc, inpt and outpt to see if you like it...otherwise, its hard to know if you are really built for it...since it does require people who are able to deal with death and all the associated issues....
good luck.
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A few points that you should really think about if you are interested in oncology.
First, take a look at all the possible avenues to cancer care. Heme/Onc, Radiation Oncology and Surgical Oncology. If you are not surgically inclined I would strongly recommend you take a very hard look at the little known field called radiation oncology.
Second, contrary to what people have said about there being few heme/onc emergencies. That is simply NOT TRUE. Patients with cancer can develop all sorts of life threatening illnesses all the time and emergent/urgent treatment is required by the medical hematology oncologist. The inpatient heme-onc service can have very sick patients many of whom wind up going to the UNIT (ICU). And that is if the ICU will take the patient. On the other hand, Radation oncology has very few emergencies, ie cord compression.
Lastly, oncology as a field can be very mentally difficult as compared other fields. It just has that stigma. Talking to patients and their families constant ly about death and dying is not for everyone. You need to be absolutely sure you can do this for the rest of you career.
First, take a look at all the possible avenues to cancer care. Heme/Onc, Radiation Oncology and Surgical Oncology. If you are not surgically inclined I would strongly recommend you take a very hard look at the little known field called radiation oncology.
Second, contrary to what people have said about there being few heme/onc emergencies. That is simply NOT TRUE. Patients with cancer can develop all sorts of life threatening illnesses all the time and emergent/urgent treatment is required by the medical hematology oncologist. The inpatient heme-onc service can have very sick patients many of whom wind up going to the UNIT (ICU). And that is if the ICU will take the patient. On the other hand, Radation oncology has very few emergencies, ie cord compression.
Lastly, oncology as a field can be very mentally difficult as compared other fields. It just has that stigma. Talking to patients and their families constant ly about death and dying is not for everyone. You need to be absolutely sure you can do this for the rest of you career.
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There are indeed many avenues into a career dealing with cancer patients. The amount you actually interact and care for these patients differs immensely between the disciplines. E.g. general surgeons commonly treat cancer patients by resecting tumors, but unless they specialize in doing this, they would hardly call themselves oncologists.
Furthermore, it is true that cancer patients are often very sick and require emergent therapy. However, in terms of problems that are actually oncologic in nature, there are few. Ever hear anyone needing emergent chemotherapy?
The care of cancer patients is complex. When I think of an "oncologist," I think of a doctor who is there with the patient throughout the various treatments and emotional challenges they experience. I am admittedly biased towards medical oncology for that reason.
As for radiation oncology, I must honestly say I have not met a single person going into that field being motivated primarily by a desire to be around cancer patients. They do important work, but from my admittedly limited exposure, I haven't been terribly impressed by their commitment to this patient population.
Does it matter? Perhaps not...
Although I am not pursuing it, I think gyn-oncologists are the most complete "oncologists." They get to resect tumors, provide chemotherapy, and often treat their patients for years on end and develop a relationship with their patients not unlike that seen in primary care practices. The only catch is that you have to train in OB to get there...although I hear there are apparently some ob-gyn residencies that are very light on the OB side of things....
Furthermore, it is true that cancer patients are often very sick and require emergent therapy. However, in terms of problems that are actually oncologic in nature, there are few. Ever hear anyone needing emergent chemotherapy?
The care of cancer patients is complex. When I think of an "oncologist," I think of a doctor who is there with the patient throughout the various treatments and emotional challenges they experience. I am admittedly biased towards medical oncology for that reason.
As for radiation oncology, I must honestly say I have not met a single person going into that field being motivated primarily by a desire to be around cancer patients. They do important work, but from my admittedly limited exposure, I haven't been terribly impressed by their commitment to this patient population.
Does it matter? Perhaps not...
Although I am not pursuing it, I think gyn-oncologists are the most complete "oncologists." They get to resect tumors, provide chemotherapy, and often treat their patients for years on end and develop a relationship with their patients not unlike that seen in primary care practices. The only catch is that you have to train in OB to get there...although I hear there are apparently some ob-gyn residencies that are very light on the OB side of things....
