Hospitalist or Heme/Onc fellowship?

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osprey099

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I am a current PGY2 internal medicine resident. My original plan was to apply heme onc and become an outpatient oncologist in a group practice setting seeing mostly solid tumor. However, due to various life circumstances, I just do not think I can endure 3 more years of training. I know fellowship training is not as tough as residency but you are still working a ton for very little compensation. In addition, you are still appeasing attendings, getting yelled at for things outside of your control, and sacrificing valuable time spent with family and friends.

Lately, I have been thinking of becoming just a Hospitalist, specifically a nocturnist. The gigs in my area offer good compensation (250k ish) for 7 on 7 off overnight shifts just admitting. This has become more and more attractive to me as I become more and more depressed throughout residency.

I don’t have any particular interest in oncology, nor do I have any particular interest in being a Hospitalist. I just want to have a well respected high paying job with minimal cerebral effort. Currently, nocturnist fits into what I want to do. What do you all think?
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osprey099 said:
I am a current PGY2 internal medicine resident. My original plan was to apply heme onc and become an outpatient oncologist in a group practice setting seeing mostly solid tumor. However, due to various life circumstances, I just do not think I can endure 3 more years of training. I know fellowship training is not as tough as residency but you are still working a ton for very little compensation. In addition, you are still appeasing attendings, getting yelled at for things outside of your control, and sacrificing valuable time spent with family and friends.

Lately, I have been thinking of becoming just a Hospitalist, specifically a nocturnist. The gigs in my area offer good compensation (250k ish) for 7 on 7 off overnight shifts just admitting. This has become more and more attractive to me as I become more and more depressed throughout residency.

I don’t have any particular interest in oncology, nor do I have any particular interest in being a Hospitalist. I just want to have a well respected high paying job with minimal cerebral effort. Currently, nocturnist fits into what I want to do. What do you all think?
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Don’t think nocturnist is sustainable in the long run...

Well respected...well that’s debatable...and I speak from having been hospitalist/nocturnist.
 
osprey099 said:
I am a current PGY2 internal medicine resident. My original plan was to apply heme onc and become an outpatient oncologist in a group practice setting seeing mostly solid tumor. However, due to various life circumstances, I just do not think I can endure 3 more years of training. I know fellowship training is not as tough as residency but you are still working a ton for very little compensation. In addition, you are still appeasing attendings, getting yelled at for things outside of your control, and sacrificing valuable time spent with family and friends.

Lately, I have been thinking of becoming just a Hospitalist, specifically a nocturnist. The gigs in my area offer good compensation (250k ish) for 7 on 7 off overnight shifts just admitting. This has become more and more attractive to me as I become more and more depressed throughout residency.

I don’t have any particular interest in oncology, nor do I have any particular interest in being a Hospitalist. I just want to have a well respected high paying job with minimal cerebral effort. Currently, nocturnist fits into what I want to do. What do you all think?
Click to expand...

You sound like you are quite burned out and possibly at a stressful program (based on the “you are still appeasing attendings, getting yelled at for things outside of your control“.)

I wouldn’t jump into a fellowship if you don’t already feel strongly about it. As you pointed out, fellowship in general can be quite grueling and if you don’t find the field interesting, it will only seem like another hoop to jump through.

Do you have elective rotations that you could explore other fields, with the hope you may stumble on something more stimulating? Geriatrics, palliative care, straight critical care fellowships (without pulm) are shorter fellowships you could consider.

Hopefully things get better as you finish out 2nd year and begin 3rd year with less call and developing a plan for patients is becoming easier.
 
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Things get better but I agree it does sound like your'e burned out. Not all programs are equally grueling and many heme/onc fellowships allot a significant amount of time to outpatient. It is also a lower "stress" specialty given there are not really emergencies.

You could always do a year or two as a hospitalist and see how you like it. That way you can be sure if you want to invest the years into an oncology fellowship.
 
I can relate to your dilemma, I knew I wanted to be an Oncologist from the get go but during my late 2nd yr and early 3rd year saw seniors graduate and go into various hospitalist jobs and starting making close to or more than 300k!, this kind of made me re-think about fellowship as well.

First year of fellowship in heme/onc may be like an intern year or close to it. As the learning curve is pretty steep. But 2nd and 3rd year at least at most programs is relaxed and you have quite a bit of down time.

This allowed me to moonlight, with PDs permission I moonlighted with our non-academic hospitalist group and actually for both 2nd and 3rd yr, almost tripled my fellowship salary. This gave me some extra to work with while not feeling bad about getting too behind in terms finances as compared to my peers.

Once you start a heme/onc job, you will easily make up the difference in a couple of years and then its all positive.

Try to do more rotations in 3rd year for Oncology, I did a total of 4 in-house rotations and 1 away during my 3 yr residency period

my 2 cents

Good luck
 
If you don't feel strongly about oncology, don't go into oncology.

Outside of a few specialties, fellowships aren't a good ROI. A three year fellowship is easily a million dollars lost in compensation. The median hospitalist pay is pretty close to $300k. Add benefit, 401ks, its higher. I know several that make $400k without killing themselves.

Again, you will work a long time. What do you want to do?
 
Same dilemma here:

Would like to do a fellowship, but after seeing hospitalist working (7 days on/off) from 7 am to 5pm making 250k+/year, I am reconsidering.
 
osprey099 said:
I am a current PGY2 internal medicine resident. My original plan was to apply heme onc and become an outpatient oncologist in a group practice setting seeing mostly solid tumor. However, due to various life circumstances, I just do not think I can endure 3 more years of training. I know fellowship training is not as tough as residency but you are still working a ton for very little compensation. In addition, you are still appeasing attendings, getting yelled at for things outside of your control, and sacrificing valuable time spent with family and friends.

Lately, I have been thinking of becoming just a Hospitalist, specifically a nocturnist. The gigs in my area offer good compensation (250k ish) for 7 on 7 off overnight shifts just admitting. This has become more and more attractive to me as I become more and more depressed throughout residency.

I don’t have any particular interest in oncology, nor do I have any particular interest in being a Hospitalist. I just want to have a well respected high paying job with minimal cerebral effort. Currently, nocturnist fits into what I want to do. What do you all think?
Click to expand...

I had a similar thought about GI - was very interested (and still am!), but don't want to commit to 3 years of extra training given the lifestyle and the fact that, importantly, I think I could be happy as a hospitalist/nocturnist.

Let me put one thing out there, though: $250,000/year for 7 on/ 7 off nocturnist is not great compensation. My job in a major metropolitan and highly desirable location will be $240,000 for 10 shifts per month. There may be other reasons this job is appealing, but make sure you consider multiple options.
 
tantacles said:
I had a similar thought about GI - was very interested (and still am!), but don't want to commit to 3 years of extra training given the lifestyle and the fact that, importantly, I think I could be happy as a hospitalist/nocturnist.

Let me put one thing out there, though: $250,000/year for 7 on/ 7 off nocturnist is not great compensation. My job in a major metropolitan and highly desirable location will be $240,000 for 10 shifts per month. There may be other reasons this job is appealing, but make sure you consider multiple options.
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Economically, GI and cards are generally worth the investment though right?


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Osteoth said:
Economically, GI and cards are generally worth the investment though right?


Sent from my iPhone using Tapatalk
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It's probably not the case for tentacles since he/she is going to make 240k/yr working only 10 shifts/month... Working an extra 6 shifts/month will probably add another 150k/yr to his/her salary... That is >400k/yr working ~46 hrs/wk average. Only derm/radiology make that kind of money for such # of hours.


If one is ok (not happy) being a hospitalist, doing a fellowship does not pay dividend financially... For instance, card fellows where I am probably work >60 hrs/hr on average. Imagine if you work that many hours for 3 yrs as hospitalist, you can make 500k/yr x(3).


I must say @tantacles has a unicorn job... I have seen a few good offers but none comes close to his/hers...
 
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Splenda88 said:
It's probably not the case for tentacles since he/she is going to make 240k/yr working only 10 shifts/month... Working an extra 6 shifts/month will probably add another 150k/yr to his/her salary... That is >400k/yr working ~46 hrs/wk average. Only derm/radiology make that kind of money for such # of hours.


If one is ok (not happy) being a hospitalist, doing a fellowship does not pay dividend financially... For instance, card fellows where I am probably work >60 hrs/hr on average. Imagine if you work that many hours for 3 yrs as hospitalist, you can make 500k/yr x(3).


I must say @tantacles has a unicorn job... I have seen a few good offers but none comes close to his/hers...
Click to expand...

That's actually my question as well-- Based on what I've heard from other people looking in the job market, I feel like making 240K as a hospitalist in a large and highly desirable city only working 10 shifts a month is the exception and not the norm. My program in a medium sized city offered 180K for hospitalist positions working 12-14 shifts per month last year, and other hospitals in the area paid around 210-220K. I've heard places larger cities like NYC and Boston were paying about the same if not a bit worse. Someone can correct me if I'm wrong about this.

That being said, I'm not sure what cards/GI/heme-onc salaries are like exactly compared to hospitalist salaries.
 
smarts1 said:
That's actually my question as well-- Based on what I've heard from other people looking in the job market, I feel like making 240K as a hospitalist in a large and highly desirable city only working 10 shifts a month is the exception and not the norm. My program in a medium sized city offered 180K for hospitalist positions working 12-14 shifts per month last year, and other hospitals in the area paid around 210-220K. I've heard places larger cities like NYC and Boston were paying about the same if not a bit worse. Someone can correct me if I'm wrong about this.

That being said, I'm not sure what cards/GI/heme-onc salaries are like exactly compared to hospitalist salaries.
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Median salaries are like $280k right now. Lots of Nocturnists are 1 on, 2 off (ours are), but it isn't hard to find Hospitalist who make $350k-$450k.
 
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smarts1 said:
That's actually my question as well-- Based on what I've heard from other people looking in the job market, I feel like making 240K as a hospitalist in a large and highly desirable city only working 10 shifts a month is the exception and not the norm. My program in a medium sized city offered 180K for hospitalist positions working 12-14 shifts per month last year, and other hospitals in the area paid around 210-220K. I've heard places larger cities like NYC and Boston were paying about the same if not a bit worse. Someone can correct me if I'm wrong about this.

That being said, I'm not sure what cards/GI/heme-onc salaries are like exactly compared to hospitalist salaries.
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I agree with the highlighted sentence. One probably would have to work 7 days on/off to make 240k-280k in a desirable city.

Salary tend to be lower in big cities... But many tend to go 1/2-to 1 hr away of big cities to maximize their earning potential. I saw contracts ~300k/yr + production bonus 1 hr away from where I am.
 
NITRAS said:
Median salaries are like $280k right now. Lots of Nocturnists are 1 on, 2 off (ours are), but it isn't hard to find Hospitalist who make $350k-$450k.
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Your gig is 1 wk on and 2 weeks off! Is your salary close to 200k?
 
Salaries for academic oncology seem to be 220-275 starting for NYC and immediate surrounding areas. Suspect it’s slightly higher elsewhere. If you want to do PP or hybrid it’s significantly higher (another 100k plus)
 
Splenda88 said:
It's probably not the case for tentacles since he/she is going to make 240k/yr working only 10 shifts/month... Working an extra 6 shifts/month will probably add another 150k/yr to his/her salary... That is >400k/yr working ~46 hrs/wk average. Only derm/radiology make that kind of money for such # of hours.


If one is ok (not happy) being a hospitalist, doing a fellowship does not pay dividend financially... For instance, card fellows where I am probably work >60 hrs/hr on average. Imagine if you work that many hours for 3 yrs as hospitalist, you can make 500k/yr x(3).


I must say @tantacles has a unicorn job... I have seen a few good offers but none comes close to his/hers...
Click to expand...

To be fair, my second and third jobs (per diem, also nights) pay even better.
 
Just to follow up on my original post:
Given the current covid situation, I do believe the healthcare landscape will change in the near future. I cannot predict how it will change but I feel like hospitalists will be more valued in the future since they are considered front-line doctors. What do you all think about this?
 
It depends.

I hope we will be able to do more tele-medicine in house. The IM ward doesn't make much money at the moment, but we are like the only thing running right now except the ED and emergency surgeries.
 
osprey099 said:
Just to follow up on my original post:
Given the current covid situation, I do believe the healthcare landscape will change in the near future. I cannot predict how it will change but I feel like hospitalists will be more valued in the future since they are considered front-line doctors. What do you all think about this?
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Why would they be valued after the fact when they are not being valued now?
 
rokshana said:
Why would they be valued after the fact when they are not being valued now?
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Because we are in dire need of hospitalists now. All elective procedures have been canceled and a lot of outpatient offices have completely shut down. Hospitalists are now in huge demand, more than ever before
 
osprey099 said:
Because we are in dire need of hospitalists now. All elective procedures have been canceled and a lot of outpatient offices have completely shut down. Hospitalists are now in huge demand, more than ever before
Click to expand...

Yeah...that’s why a hospitalist I know was told that due to covid, they were reducing her (and all the hospitalists in her group) pay by 30%....and a ED In Massachusetts has ended their contract with the EM group...
 
rokshana said:
Yeah...that’s why a hospitalist I know was told that due to covid, they were reducing her (and all the hospitalists in her group) pay by 30%....and a ED In Massachusetts has ended their contract with the EM group...
Click to expand...

See this trend in medicine. Pay goes down when there is an actual need. Pediatrics, PCPs, hospitalists etc all are needed the most now but their pay is the worst compared to fields that do elective procedures.
 
osprey099 said:
Just to follow up on my original post:
Given the current covid situation, I do believe the healthcare landscape will change in the near future. I cannot predict how it will change but I feel like hospitalists will be more valued in the future since they are considered front-line doctors. What do you all think about this?
Click to expand...

Don't think so unfortunately. I think the main limiting factor in the current situation is resources (vents, O2, beds, PPE, etc) rather than hospitalists. Medicine is just way too specialized now. I think hospitalists need more social support so the focus can be on treating patients medical problems rather than getting people hoyer lifts and power scooters.
 
Hospitalists have already been in demand prior to the covid situation so it won’t be that different from an individual job market standpoint. Easy to find a job pre covid and post covid. Having a need for more hospitalists won’t affect you at an individual level. If anything, it will make being a hospitalist work more stressful with high patient censuses and knowing that hospitals are hemorrhaging money hospitalist pay is unlikely to go up. If anything this is the time to avoid being a hospitalist unless you find it meaningful to be on the front lines.
 
OP here.

I just wanted to follow up on this thread as I decided to apply for heme-onc and eagerly awaiting the match in a few days. Here are some things that swayed me towards fellowship in case someone in the future with a similar predicament stumbles upon this thread:

1. Although I enjoy shift work, it would be a selfish decision to be a 7on 7off hospitalist for my entire life. I want to be available for my family and attend my kids' events without worrying about coverage.

2. The oncology patient population is very rewarding to care for. I train at a busy inner city program and have to deal with the most difficult and demanding patients (IVDA, placement nightmares, zero medical knowledge, difficult families, etc). From my limited experiences interacting with oncology patients and their families, I have almost always found those conversations to be a lot more fulfilling and pleasant.

3. COVID has exposed the healthcare system's overall apathy towards physicians. My personal belief is that hospitalists and ED docs have gotten the biggest middle finger from admin as there have been plenty of pay cuts across the board although they are expected to shoulder more responsibilities. From what I've read and head, there is less of this bureaucratic bs in outpatient specialty private practices.

Thanks to all who made insightful comments above!
 
osprey099 said:
OP here.

I just wanted to follow up on this thread as I decided to apply for heme-onc and eagerly awaiting the match in a few days. Here are some things that swayed me towards fellowship in case someone in the future with a similar predicament stumbles upon this thread:

1. Although I enjoy shift work, it would be a selfish decision to be a 7on 7off hospitalist for my entire life. I want to be available for my family and attend my kids' events without worrying about coverage.

2. The oncology patient population is very rewarding to care for. I train at a busy inner city program and have to deal with the most difficult and demanding patients (IVDA, placement nightmares, zero medical knowledge, difficult families, etc). From my limited experiences interacting with oncology patients and their families, I have almost always found those conversations to be a lot more fulfilling and pleasant.

3. COVID has exposed the healthcare system's overall apathy towards physicians. My personal belief is that hospitalists and ED docs have gotten the biggest middle finger from admin as there have been plenty of pay cuts across the board although they are expected to shoulder more responsibilities. From what I've read and head, there is less of this bureaucratic bs in outpatient specialty private practices.

Thanks to all who made insightful comments above!
Click to expand...
Thanks for the update! Good luck with the Match!
 
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