Hospitalist vs HemeOnc fellowship

[Syndicate]

Hello everyone, I am a rising PGY3 (in <1 week!) IM resident currently debating whether or not to do heme onc fellowship vs just practicing as a Hospitalist. I hope SDN can give me thoughts and advice. I will preface this by saying that I have thought about this throughout my entire 2 years so far during residency. When starting residency, I had planned on doing heme onc. However, I have been more and more attracted towards inpatient Hospitalist medicine throughout my residency.

I absolutely love shift work. Whether it’s 7on/7off or some combination of this, I really can see myself doing this long term. I am engaged (no kids) and my fiancé is NP working outpatient 9-5 and she is fine with whatever I decide. I realize that in the future, I won’t be there for some of my kids’ activities but I feel like that’s just life. There will always be things that you’ll miss regardless of what specialty you choose in medicine (maybe outside of derm).

I know I can match into an academic heme onc program but I just cannot see myself doing heme onc for the long term. The field does not excite me and I do not enjoy research. If I were to do heme onc, I would join a private practice in the community. Part of me just doesn’t really fully understand the day-to-day of private practice outpatient heme onc but I don’t think I would enjoy clinic every day and seeing 30+ patients on a daily basis in clinic. I find the acuity of Hospitalist medicine more attractive in the sense that once they’re discharged, they are no longer your patient/problem. I don’t have to follow up labs or imaging on my days off, I don’t have to document on days off, etc.

Financially, heme onc probably makes 1.5-2x more than Hospitalist. Money is not too important to me and I feel like I would be very happy already with a $250k+ Hospitalist salary working half of the year. As a Hospitalist, I could always moonlight or take on side gigs such as SNF director to supplement income.

I can see how hospitalists can be dumping group and not garner respect from other specialities. I personally don’t really care about this. As a IM resident, I’m constantly being dumped on by other services and hounded by admin and honestly, I would happily comply with whatever they want if I was getting paid an attending salary.

Are there any other thoughts or considerations I have not stated? My heme onc fellowship application is already completed but I am having serious doubts about submitting it.
Thank you all in advanced for any advice!

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[Meridian32]

Sounds like you would be happier as a hospitalist! I'm headed in the opposite direction - have been a hospitalist for a couple of years and starting Heme/Onc fellowship next week. Compared to residency, being a hospitalist has been amazing in every sense, including autonomy, pay and huge amounts of free time to spend with my kids and family. If I weren't really interested in Heme/Onc, there's no way I'd be going back to training - and, even so, part of me still wonders whether I wouldn't be happier just remaining a hospitalist. If you aren't that interested in Heme/Onc and can't see yourself doing it long term, I think being a hospitalist is a better move. However, if your fellowship application is ready to go, one thing you could do is apply and do fellowship interviews while also looking into hospitalist jobs over the next several months. If you decide on hospitalist over fellowship, you can then not submit a rank list and there won't be any adverse consequences.

 

[cookiegrub]

Sounds like you would be happier as a hospitalist! I'm headed in the opposite direction - have been a hospitalist for a couple of years and starting Heme/Onc fellowship next week. Compared to residency, being a hospitalist has been amazing in every sense, including autonomy, pay and huge amounts of free time to spend with my kids and family. If I weren't really interested in Heme/Onc, there's no way I'd be going back to training - and, even so, part of me still wonders whether I wouldn't be happier just remaining a hospitalist. If you aren't that interested in Heme/Onc and can't see yourself doing it long term, I think being a hospitalist is a better move. However, if your fellowship application is ready to go, one thing you could do is apply and do fellowship interviews while also looking into hospitalist jobs over the next several months. If you decide on hospitalist over fellowship, you can then not submit a rank list and there won't be any adverse consequences.

have you explored how the call will be comparably? I'm guessing with hospitalist contract you had none?

 

[gutonc]

have you explored how the call will be comparably? I'm guessing with hospitalist contract you had none?

Call as a fellow? Or attending?

My call as a fellow kind of sucked. As a hem-onc attending, I'm on call ~Q13, which works out to 1-2 weeknights a month and 4 weekends a year. I'm hiring 2 more docs to drop that down to Q15.

 

[cookiegrub]

Call as a fellow? Or attending?

My call as a fellow kind of sucked. As a hem-onc attending, I'm on call ~Q13, which works out to 1-2 weeknights a month and 4 weekends a year. I'm hiring 2 more docs to drop that down to Q15.

I should have clarified, I meant an attending's to compare with OP's attending hospitalist schedule. Your call schedule seems to compare with my preceptor's who is in private practice as well. Just a follow-up, are you practicing in the city or rural locale? And do you think that matters for your field?

 

[Syndicate]

Sounds like you would be happier as a hospitalist! I'm headed in the opposite direction - have been a hospitalist for a couple of years and starting Heme/Onc fellowship next week. Compared to residency, being a hospitalist has been amazing in every sense, including autonomy, pay and huge amounts of free time to spend with my kids and family. If I weren't really interested in Heme/Onc, there's no way I'd be going back to training - and, even so, part of me still wonders whether I wouldn't be happier just remaining a hospitalist. If you aren't that interested in Heme/Onc and can't see yourself doing it long term, I think being a hospitalist is a better move. However, if your fellowship application is ready to go, one thing you could do is apply and do fellowship interviews while also looking into hospitalist jobs over the next several months. If you decide on hospitalist over fellowship, you can then not submit a rank list and there won't be any adverse consequences.

I absolutely love that idea. Thanks for suggesting that cause I actually never really thought of doing that. But I guess that would give me more time to decide.

In your opinion, do you feel like burn out is as bad as what people make it to be for hospitalist? I realize it's very real but I personally would much rather shift work with block on/block off rather than M-F clinic seeing patients every minute. I think I would definitely burn out more in the clinic setting, especially since I'm not particularly interested in the field.

 

[Syndicate]

How do you know you'll match academic Heme Onc for sure?

And is research required for Heme Onc fellowship?

The PD of heme onc at the hospital I’m training in IM at told me I should come here next year.

Research probably not required. I’ve done some research during residency though. I think as long as you are a US allopathic from an university program with an average/above average step 1, that’s all that’s really necessary.

 

[CaliforniaAppli]

Huh? Research is definitely required. If anything research is more important in heme/onc than any other speciality, not because it is more competitive but because it is one of the most rapidly progressive fields. Research and heme onc go hand and hand.
PDs select based on your research background and publications and expect you to produce during fellowship.

 

[NITRAS]

Hello everyone, I am a rising PGY3 (in <1 week!) IM resident currently debating whether or not to do heme onc fellowship vs just practicing as a Hospitalist. I hope SDN can give me thoughts and advice. I will preface this by saying that I have thought about this throughout my entire 2 years so far during residency. When starting residency, I had planned on doing heme onc. However, I have been more and more attracted towards inpatient Hospitalist medicine throughout my residency.

I absolutely love shift work. Whether it’s 7on/7off or some combination of this, I really can see myself doing this long term. I am engaged (no kids) and my fiancé is NP working outpatient 9-5 and she is fine with whatever I decide. I realize that in the future, I won’t be there for some of my kids’ activities but I feel like that’s just life. There will always be things that you’ll miss regardless of what specialty you choose in medicine (maybe outside of derm).

I know I can match into an academic heme onc program but I just cannot see myself doing heme onc for the long term. The field does not excite me and I do not enjoy research. If I were to do heme onc, I would join a private practice in the community. Part of me just doesn’t really fully understand the day-to-day of private practice outpatient heme onc but I don’t think I would enjoy clinic every day and seeing 30+ patients on a daily basis in clinic. I find the acuity of Hospitalist medicine more attractive in the sense that once they’re discharged, they are no longer your patient/problem. I don’t have to follow up labs or imaging on my days off, I don’t have to document on days off, etc.

Financially, heme onc probably makes 1.5-2x more than Hospitalist. Money is not too important to me and I feel like I would be very happy already with a $250k+ Hospitalist salary working half of the year. As a Hospitalist, I could always moonlight or take on side gigs such as SNF director to supplement income.

I can see how hospitalists can be dumping group and not garner respect from other specialities. I personally don’t really care about this. As a IM resident, I’m constantly being dumped on by other services and hounded by admin and honestly, I would happily comply with whatever they want if I was getting paid an attending salary.

Are there any other thoughts or considerations I have not stated? My heme onc fellowship application is already completed but I am having serious doubts about submitting it.
Thank you all in advanced for any advice!

I feel like you are trying to talk yourself out of fellowship. I’m not sure why you would do a fellowship in a field that didn’t excite you.

The money is to some degree a separate issue. There is a time value to money, and earning probably well over $250k a year more for several years will be really hard to make up. Respect will be very dependent on where you work, but Hospitalist make the hospital run usually.

What do you want to have done/be doing when your 50? Go make the life you want.

 

[blue.jay]

I was in a very similar situation. I really liked hemonc but I don't like working in a clinic setting. Seeing how grateful most onc patients are made my days very meaningful during my elective months. I had to choose hospitalist route so I can live close to my spouse when she started residency.

My initial plans were to start some research during my free time (I only had to work 10-12 days a month) and apply in 2 years. I work in a big academic hospital but it wasn't easy to find a mentor to work on projects. I eventually lost interest in doing research and enjoyed just working clinical medicine.

I always wonder if I should have applied, if I would be more satisfied having long term continuity of care, and being the go-to guy for my patients. I also wonder if I'm not being grateful for my less stressful hospitalist job. The pay is decent as a hospitalist and you can find a sustainable schedule with a good group. You've geographic flexibility but like ER docs you will be no one. You will feel dispensable unlike an oncologist who has a panel of patients who are very attached to them. The hospital will at least try to hold on to the oncologist rather than a hospitalist who can be replaced easily.

Overall, as an hospitalist you still practice medicine, earn well, work 35-40 hr week on average, have ton of time for hobbies but you will never get the respect of oncology (if that matters to you). For eg, everyone in my hospital knows Dr. x the oncologist but know one cares about Dr. Whoever hospitalist probably because of the high turnover. Don't forget that you chances for matching goes down every year you are out of residency, you can take 1-2 yr gap, work as oncology hospitalists in an academic program and figure out if that is something you want to do for the rest of your life.

 

[Syndicate]

I feel like you are trying to talk yourself out of fellowship. I’m not sure why you would do a fellowship in a field that didn’t excite you.

The money is to some degree a separate issue. There is a time value to money, and earning probably well over $250k a year more for several years will be really hard to make up. Respect will be very dependent on where you work, but Hospitalist make the hospital run usually.

What do you want to have done/be doing when your 50? Go make the life you want.

I hope to be almost retired by 50 (currently 27). Did some calculations and money-wise, I’ll approximately break even between Hospitalist vs heme-onc around age 43. Honestly, I will likely just apply heme-onc and look for jobs at the same time. If I don’t absolutely love any program that I interview at, will just not submit a rank list.

 

[Syndicate]

I was in a very similar situation. I really liked hemonc but I don't like working in a clinic setting. Seeing how grateful most onc patients are made my days very meaningful during my elective months. I had to choose hospitalist route so I can live close to my spouse when she started residency.

My initial plans were to start some research during my free time (I only had to work 10-12 days a month) and apply in 2 years. I work in a big academic hospital but it wasn't easy to find a mentor to work on projects. I eventually lost interest in doing research and enjoyed just working clinical medicine.

I always wonder if I should have applied, if I would be more satisfied having long term continuity of care, and being the go-to guy for my patients. I also wonder if I'm not being grateful for my less stressful hospitalist job. The pay is decent as a hospitalist and you can find a sustainable schedule with a good group. You've geographic flexibility but like ER docs you will be no one. You will feel dispensable unlike an oncologist who has a panel of patients who are very attached to them. The hospital will at least try to hold on to the oncologist rather than a hospitalist who can be replaced easily.

Overall, as an hospitalist you still practice medicine, earn well, work 35-40 hr week on average, have ton of time for hobbies but you will never get the respect of oncology (if that matters to you). For eg, everyone in my hospital knows Dr. x the oncologist but know one cares about Dr. Whoever hospitalist probably because of the high turnover. Don't forget that you chances for matching goes down every year you are out of residency, you can take 1-2 yr gap, work as oncology hospitalists in an academic program and figure out if that is something you want to do for the rest of your life.

Thank you for sharing this. I definitely love the patients in oncology; they are some of the best patient encounters I’ve had during residency. However, I just cannot do research for the life of me and I cannot stand clinic. Shift work is for the kind of person I am. When I’m off, I’m off and I don’t have to think about my patients. Also, I technically don’t really have my “own” patients since I’m just in the hospital a week at a time but that’s ok.
The respect aspect is whatever. I used to care about it but nowadays, I would gladly be a nobody in the hospital if it means I can spend more time with my family.

 

[gutonc]

Thank you for sharing this. I definitely love the patients in oncology; they are some of the best patient encounters I’ve had during residency. However, I just cannot do research for the life of me and I cannot stand clinic. Shift work is for the kind of person I am. When I’m off, I’m off and I don’t have to think about my patients. Also, I technically don’t really have my “own” patients since I’m just in the hospital a week at a time but that’s ok.
The respect aspect is whatever. I used to care about it but nowadays, I would gladly be a nobody in the hospital if it means I can spend more time with my family.

Just to address these 2 issues.

1. You only need to do enough research in fellowship to check the "scholarly inquiry" box. You might find it more interesting when the question is more relevant to you though.
2. I used to think I couldn't stand clinic. I almost took an inpatient leukemia job because of that. Now, 8 year in to my almost 100% outpatient career, my soul dies a little bit every time I have to walk onto an inpatient floor.

In the end, you need to do what interests you and what you find rewarding, or at least tolerable. Nobody here can really make that decision for you.

 

[Syndicate]

Just to address these 2 issues.

1. You only need to do enough research in fellowship to check the "scholarly inquiry" box. You might find it more interesting when the question is more relevant to you though.
2. I used to think I couldn't stand clinic. I almost took an inpatient leukemia job because of that. Now, 8 year in to my almost 100% outpatient career, my soul dies a little bit every time I have to walk onto an inpatient floor.

In the end, you need to do what interests you and what you find rewarding, or at least tolerable. Nobody here can really make that decision for you.

I think another thing is that our IM program has literally no exposure to outpatient oncology. It’s hard for me to imagine what outpatient oncology is like. I personally cannot tolerate outpatient internal medicine clinic and feel like outpatient oncology may share many similar aspects to internal med? Is this wrong to assume?

 

[blue.jay]

I think another thing is that our IM program has literally no exposure to outpatient oncology. It’s hard for me to imagine what outpatient oncology is like. I personally cannot tolerate outpatient internal medicine clinic and feel like outpatient oncology may share many similar aspects to internal med? Is this wrong to assume?

You really have to do out-patient oncology. That's where you see patients getting better, your treatment working, and see those grateful patients. In patient oncology can be depressing and steer people away from oncology. They also did a study to prove it

Inpatient Hematology-Oncology Rotation Is Associated With a Decreased Interest in Pursuing an Oncology Career Among Internal Medicine Residents - PubMed

An inpatient hematology-oncology ward rotation does not lead to increased interest and, for some residents, may lead to decreased interest in the field. Encouraging outpatient hematology-oncology rotations and the cultivation of resilience, empathy, and meaning regarding death experiences may...

pubmed.ncbi.nlm.nih.gov

 

[cookiegrub]

I think another thing is that our IM program has literally no exposure to outpatient oncology. It’s hard for me to imagine what outpatient oncology is like. I personally cannot tolerate outpatient internal medicine clinic and feel like outpatient oncology may share many similar aspects to internal med? Is this wrong to assume?

outpatient oncology is great, I love it and it is nothing similar to outpt IM and the ivory towers are academically stimulating and fulfilling for inpatient oncology (there I feel the academics prevent you from the depression of inpatient service). You need to go work as a hospitalist in a program with this type of setup for better exposure and from what you are telling us, you aren't ready to apply for fellowship lest you burn out from improper exposure/knowledge of the field. My mentor took a year off working as an academic and did a ton of research in the field. He would do that 100x over than chief residency and said that time out before fellowship was not a big deal.

 

[Meridian32]

I absolutely love that idea. Thanks for suggesting that cause I actually never really thought of doing that. But I guess that would give me more time to decide.

In your opinion, do you feel like burn out is as bad as what people make it to be for hospitalist? I realize it's very real but I personally would much rather shift work with block on/block off rather than M-F clinic seeing patients every minute. I think I would definitely burn out more in the clinic setting, especially since I'm not particularly interested in the field.

You're welcome! One of my hospitalist colleagues applied and interviewed this past cycle, intending to do a gap year, but ultimately didn't submit a rank list and is staying on in our group because of the realization that they prefer hospitalist work to fellowship.

I personally have had zero burnout from being a hospitalist and in fact have had the reverse - part of the reason I decided to do a hospitalist year was burnout from residency, which has been completely erased. I think my job is amazing and wake up excited to go to work most days. That said, my position is somewhat unique - I'm on a dedicated heme/onc service at an academic hospital, which has lots of benefits including very motivated patients (nonadherence, dispo challenges, etc. are much less common compared to general medicine), great mix of stable chemo + acute medically interesting patients, longer length of stay (so fewer admissions/discharges + you get to know patients better), lots of learning, really smart colleagues, amazing ancillary support (e.g., I don't have to do discharge med recs because my pharmacy team handles that) and even some longitudinal patient relationships because most of our patients are regularly admitted so I've gotten to know a number of them and their families over time (even got invited to a memorial service, which never happened during residency). So it has been really great for me, though obviously this will vary a lot depending on the specific hospitalist position you are considering.

 

[Syndicate]

You're welcome! One of my hospitalist colleagues applied and interviewed this past cycle, intending to do a gap year, but ultimately didn't submit a rank list and is staying on in our group because of the realization that they prefer hospitalist work to fellowship.

I personally have had zero burnout from being a hospitalist and in fact have had the reverse - part of the reason I decided to do a hospitalist year was burnout from residency, which has been completely erased. I think my job is amazing and wake up excited to go to work most days. That said, my position is somewhat unique - I'm on a dedicated heme/onc service at an academic hospital, which has lots of benefits including very motivated patients (nonadherence, dispo challenges, etc. are much less common compared to general medicine), great mix of stable chemo + acute medically interesting patients, longer length of stay (so fewer admissions/discharges + you get to know patients better), lots of learning, really smart colleagues, amazing ancillary support (e.g., I don't have to do discharge med recs because my pharmacy team handles that) and even some longitudinal patient relationships because most of our patients are regularly admitted so I've gotten to know a number of them and their families over time (even got invited to a memorial service, which never happened during residency). So it has been really great for me, though obviously this will vary a lot depending on the specific hospitalist position you are considering.

In terms of timeline, do you think I could apply for Hospitalist positions in the next several months (to begin July 2021) without folks from my program knowing? I’m not too familiar with the interview process for Hospitalist positions but I would rather keep under the radar when I’m applying for both Hospitalist and fellowship. Granted, my ERAS is essentially complete (letters are all submitted) and ill only be applying to a handful of geographically desired fellowship programs and Hospitalist positions.
Rank list for fellowship is due sometime around 11/15. Do you think I would be able to receive/review Hospitalist offers by that time if I were to start sending out emails around August/September?

 

[Meridian32]

n terms of timeline, do you think I could apply for Hospitalist positions in the next several months (to begin July 2021) without folks from my program knowing? I’m not too familiar with the interview process for Hospitalist positions but I would rather keep under the radar when I’m applying for both Hospitalist and fellowship. Granted, my ERAS is essentially complete (letters are all submitted) and ill only be applying to a handful of geographically desired fellowship programs and Hospitalist positions.
Rank list for fellowship is due sometime around 11/15. Do you think I would be able to receive/review Hospitalist offers by that time if I were to start sending out emails around August/September?

This may be tough because you'll need references from your current institution to apply to hospitalist positions. Re: timing, the places I applied to made offers in December - I don't know if there are other places that make offers sooner.

 

[gutonc]

I think another thing is that our IM program has literally no exposure to outpatient oncology. It’s hard for me to imagine what outpatient oncology is like. I personally cannot tolerate outpatient internal medicine clinic and feel like outpatient oncology may share many similar aspects to internal med? Is this wrong to assume?

It is very wrong to assume. You should also know that, unless you plan to practice in an academic teaching primary care clinic, the experience of your resident IM clinic has almost nothing in common with a typical IM PC clinic as an attending.

Your program is doing you a disservice by not providing you exposure to outpatient oncology. That's where essentially all of oncology happens (barring acute leukemia, BMT and a few rare solid tumor diagnoses such as sarcoma and testicular cancer).

 

[collegestud2013]

The PD of heme onc at the hospital I’m training in IM at told me I should come here next year.

Research probably not required. I’ve done some research during residency though. I think as long as you are a US allopathic from an university program with an average/above average step 1, that’s all that’s really necessary.

A PD telling you that is far away does at all mean he/she will rank you highly. Plenty of people get burned every year when applying to residency/fellowship by limiting their applications and interviews just because their home program told them something positive. You you still apply broadly if you want to maximize your chances of matching.

Research is pretty much required from all successful applicants for heme/onc. Being a U.S. M.D. and coming from a university program help and having a solid Step scores help but the average U.S. M.D. that matches usually has around 9 pubs.

Also, IM hospitalists do have a very high burnout rate for a variety of reasons. The ones that don't burn out and stay in it full time for the long-term probably found a position with a manageable workload (eg reasonable patient load, good ancillary staff, help from midlevels or residents) but these positions probably also pay least, and this is considering that hospitalists are already on the lower end of salary compared to physicians in other specialties. So if you end up doing hospitalist in the long run you'll need to find the right job. Also, as mentioned above factors contributing to burnout is that hospitalists get much less respect, are not experts in any one area (hence they rely on consultants), the Medicine service being the dumping ground in most hospitals for patients other services don't want to deal with, and in many practice situations there's a high percentage of time spent doing what many perceive to be scutwork than high-level medicine, even as an attending. If you like inpatient shift work, you can also work solely as a heme/onc hospitalist after doing heme/onc fellowship.

As you mentioned, the pay for heme/onc right now is much higher than IM hospitalist, especially in non-academic settings. Even when you factor in the 3 years of additional training time, you'll end up significantly ahead financially in the long-run.

 

[tantacles]

It is very wrong to assume. You should also know that, unless you plan to practice in an academic teaching primary care clinic, the experience of your resident IM clinic has almost nothing in common with a typical IM PC clinic as an attending.

Your program is doing you a disservice by not providing you exposure to outpatient oncology. That's where essentially all of oncology happens (barring acute leukemia, BMT and a few rare solid tumor diagnoses such as sarcoma and testicular cancer).

I realized the difference between the clinics when I found out that one of our preceptors, who has her own primary care clinic, was dumping her non-adherent patients on our resident clinic, presumably to save herself time when dealing with her less time-consuming cases.

 

[boxin]

Do these pubs all have to be in Heme-Onc? What's the latest you can decide you want to start trying to match into Heme-Onc? Am also interested in other fellowships

Ideally, yes all pubs need to be in Hem-Onc. If in residency, earlier you decide, the better since you will have time to work on projects and mentors as you will apply at the beginning of third year. But some decide later and may not feel their application is sufficient and may take a 1 or 2 as hospitalist before applying.

 

[boxin]

Hello everyone, I am a rising PGY3 (in <1 week!) IM resident currently debating whether or not to do heme onc fellowship vs just practicing as a Hospitalist. I hope SDN can give me thoughts and advice. I will preface this by saying that I have thought about this throughout my entire 2 years so far during residency. When starting residency, I had planned on doing heme onc. However, I have been more and more attracted towards inpatient Hospitalist medicine throughout my residency.

I absolutely love shift work. Whether it’s 7on/7off or some combination of this, I really can see myself doing this long term. I am engaged (no kids) and my fiancé is NP working outpatient 9-5 and she is fine with whatever I decide. I realize that in the future, I won’t be there for some of my kids’ activities but I feel like that’s just life. There will always be things that you’ll miss regardless of what specialty you choose in medicine (maybe outside of derm).

I know I can match into an academic heme onc program but I just cannot see myself doing heme onc for the long term. The field does not excite me and I do not enjoy research. If I were to do heme onc, I would join a private practice in the community. Part of me just doesn’t really fully understand the day-to-day of private practice outpatient heme onc but I don’t think I would enjoy clinic every day and seeing 30+ patients on a daily basis in clinic. I find the acuity of Hospitalist medicine more attractive in the sense that once they’re discharged, they are no longer your patient/problem. I don’t have to follow up labs or imaging on my days off, I don’t have to document on days off, etc.

Financially, heme onc probably makes 1.5-2x more than Hospitalist. Money is not too important to me and I feel like I would be very happy already with a $250k+ Hospitalist salary working half of the year. As a Hospitalist, I could always moonlight or take on side gigs such as SNF director to supplement income.

I can see how hospitalists can be dumping group and not garner respect from other specialities. I personally don’t really care about this. As a IM resident, I’m constantly being dumped on by other services and hounded by admin and honestly, I would happily comply with whatever they want if I was getting paid an attending salary.

Are there any other thoughts or considerations I have not stated? My heme onc fellowship application is already completed but I am having serious doubts about submitting it.
Thank you all in advanced for any advice!

This is an interesting dilemma...I am currently in hem onc fellowship and after one year, thinking that it may not be for me and might want to do hospital medicine instead. While the pathology in hem onc is interesting, the acuity of hospital medicine is definitely not there. Any hem onc fellowship will require some form of research as it is a field that is rapidly evolving and requires to be aware of the changes in treatment options. You are right that you have to follow up a lot after clinic which I find myself doing a lot after I see my patients and do notes. I still use a lot of internal medicine on a day to day basis so I do not feel like I am losing touch of it.

Financially, hem onc can make more than hospitalist but academic hem onc may make about the same or less and given how broad the field is since it is a specialty that deals with the entire body (unlike cards, GI), a lot of graduates feel comfortable focusing on one area for career which is really amenable for academics where you will need to continue with research, see patients, etc.

I am in a sticky situation cause it took me a year to realize that maybe this is not for me and wanted to say something to help avoid this situation for you perhaps. You can certainly interview at the places and decide before rank list submission. By that time, you will also have done more IM rotations and may help you decide further.

 

[Syndicate]

This is an interesting dilemma...I am currently in hem onc fellowship and after one year, thinking that it may not be for me and might want to do hospital medicine instead. While the pathology in hem onc is interesting, the acuity of hospital medicine is definitely not there. Any hem onc fellowship will require some form of research as it is a field that is rapidly evolving and requires to be aware of the changes in treatment options. You are right that you have to follow up a lot after clinic which I find myself doing a lot after I see my patients and do notes. I still use a lot of internal medicine on a day to day basis so I do not feel like I am losing touch of it.

Financially, hem onc can make more than hospitalist but academic hem onc may make about the same or less and given how broad the field is since it is a specialty that deals with the entire body (unlike cards, GI), a lot of graduates feel comfortable focusing on one area for career which is really amenable for academics where you will need to continue with research, see patients, etc.

I am in a sticky situation cause it took me a year to realize that maybe this is not for me and wanted to say something to help avoid this situation for you perhaps. You can certainly interview at the places and decide before rank list submission. By that time, you will also have done more IM rotations and may help you decide further.

Thank you for sharing your experience. This is the type of advice I was hoping to receive. Do you feel like seeing 20+ patients daily in outpatient clinic in the future as part of a group private practice would be very tedious? One of the big things for me is that although I love patient care (especially oncology patients), I am not passionate about the advancements and research in the field. Although you probably use standard of care for most patients in clinic, I would assume you have to spend significant time to always be in-the-know of any advancements in the field. No matter how I imagine it, I just cannot see myself enjoying this aspect of the job.

Hospitalists on the other hand can pretty much just recite in their sleep the common stuff that gets admitted to the hospital. The treatment for COPD/CHF exacerbation, AKI, cellulitis, etc is not going to change at least in my lifetime. In contrast, heme onc rapidly changes (CAR-T was not even a thing when I started medical school) and I would be doing a disservice to my patients if I wasn’t keeping up to date with the latest advancements.
I personally feel like being a Hospitalist is an easier job or a “pathway of least resistance.” I am used to the daily ins and outs and have had many ward months performing Hospitalist tasks as an intern/resident. I feel comfortable doing the job. Heme onc, on the other hand, is more of an unknown to me and hard for me to gauge if it is something I don’t have to stress going into work everyday for.
Would you say my assessments are accurate?

 

[boxin]

Thank you for sharing your experience. This is the type of advice I was hoping to receive. Do you feel like seeing 20+ patients daily in outpatient clinic in the future as part of a group private practice would be very tedious? One of the big things for me is that although I love patient care (especially oncology patients), I am not passionate about the advancements and research in the field. Although you probably use standard of care for most patients in clinic, I would assume you have to spend significant time to always be in-the-know of any advancements in the field. No matter how I imagine it, I just cannot see myself enjoying this aspect of the job.

Hospitalists on the other hand can pretty much just recite in their sleep the common stuff that gets admitted to the hospital. The treatment for COPD/CHF exacerbation, AKI, cellulitis, etc is not going to change at least in my lifetime. In contrast, heme onc rapidly changes (CAR-T was not even a thing when I started medical school) and I would be doing a disservice to my patients if I wasn’t keeping up to date with the latest advancements.
I personally feel like being a Hospitalist is an easier job or a “pathway of least resistance.” I am used to the daily ins and outs and have had many ward months performing Hospitalist tasks as an intern/resident. I feel comfortable doing the job. Heme onc, on the other hand, is more of an unknown to me and hard for me to gauge if it is something I don’t have to stress going into work everyday for.
Would you say my assessments are accurate?

Yes, I think seeing that many patients would be tedious. While all specialties deal with complex cases on their own, seeing oncology patients are complicated in their own right. Seeing new diagnosis can be challenging and explaining the options and recurrence and progression cases can also be tough in their own regard.

Yes, you have to be up to speed on the latest advancements for sure and it is rapidly changing and have to know the data to make informed decisions for patients. This is what I am realizing that I may not be as passionate about doing a year of fellowship.

Your assessment is accurate about hospital medicine. I don't feel comfortable with hem onc and quite frankly, not sure if I feel even after finishing fellowship. I feel much more comfortable doing hospital medicine after IM residency.

Hope this helps.

 

[gutonc]

Thank you for sharing your experience. This is the type of advice I was hoping to receive. Do you feel like seeing 20+ patients daily in outpatient clinic in the future as part of a group private practice would be very tedious? One of the big things for me is that although I love patient care (especially oncology patients), I am not passionate about the advancements and research in the field. Although you probably use standard of care for most patients in clinic, I would assume you have to spend significant time to always be in-the-know of any advancements in the field. No matter how I imagine it, I just cannot see myself enjoying this aspect of the job.

Hospitalists on the other hand can pretty much just recite in their sleep the common stuff that gets admitted to the hospital. The treatment for COPD/CHF exacerbation, AKI, cellulitis, etc is not going to change at least in my lifetime. In contrast, heme onc rapidly changes (CAR-T was not even a thing when I started medical school) and I would be doing a disservice to my patients if I wasn’t keeping up to date with the latest advancements.
I personally feel like being a Hospitalist is an easier job or a “pathway of least resistance.” I am used to the daily ins and outs and have had many ward months performing Hospitalist tasks as an intern/resident. I feel comfortable doing the job. Heme onc, on the other hand, is more of an unknown to me and hard for me to gauge if it is something I don’t have to stress going into work everyday for.
Would you say my assessments are accurate?

I don't honestly think your assessments are accurate.

Is oncology changing daily? Yes. Is that fun and exciting? Also yes. You're right that there's a lot to keep up on, but that's actually the fun thing. CAR-T didn't exist when I started practice as an attending. And all I need to know is that it exists as a thing for some leukemia/lymphoma players, and make sure I send them to the transplant center when appropriate.

If all you want to do is punch a clock, I suppose hospitalist medicine is the closest thing to the "right choice" for you. But it's not like there aren't practice changing advances going on in that realm either. The only reason it doesn't look like that to you is that you don't have the benefit of experience and perspective.

Do what you like, if oncology doesn't seem like something you'd enjoy, don't do it.

 

[Syndicate]

What do you guys think are some available getting-out options for Hospitalists later down the road? So far, I can think of going into administration, SNF director, locums, primary care. What are some other jobs you can do as Hospitalist and decide not to want to work as many inpatient weeks once you turn 50?

 

[blue.jay]

What do you guys think are some available getting-out options for Hospitalists later down the road? So far, I can think of going into administration, SNF director, locums, primary care. What are some other jobs you can do as Hospitalist and decide not to want to work as many inpatient weeks once you turn 50?

Older physicians in our group do 0.6 FTE (minimum to get full benefits) which comes to 14-15 weeks a year. Our day schedule is 7:30-5 and pt cap is 14 without codes. I can't think of any job less stressful than this. But we don't know if this will exist 10-20 years later with glut of midlevels.

 

[Syndicate]

Older physicians in our group do 0.6 FTE (minimum to get full benefits) which comes to 14-15 weeks a year. Our day schedule is 7:30-5 and pt cap is 14 without codes. I can't think of any job less stressful than this. But we don't know if this will exist 10-20 years later with glut of midlevels.

What are these older physicians making at 0.6 FTE in your area?

 

[blue.jay]

What are these older physicians making at 0.6 FTE in your area?

1FTE is about 220 ish, so I would assume they make around 135k

 

[collegestud2013]

Do these pubs all have to be in Heme-Onc? What's the latest you can decide you want to start trying to match into Heme-Onc? Am also interested in other fellowships

This number was based on the Charting the Outcomes 2018 data (https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2018/10/2018-Charting-Outcomes-SMS.pdf). On pg 114 it reports that average matched U.S. M.D. has 9.1 pubs, vs 8.0 for unmatched. It's unlikely that these are all heme-onc related since nearly all heme-onc applicants have done other research in the past (eg in undergrad and med school before deciding on heme-onc). Also by "pubs" they include any publication, abstract, presentation listed on ERAS (even submitted papers that have not been accepted). Of course some of those should be heme or onc related but not all. Also notice the number of publications, abstracts, presentations alone isn't a good predictor of matching for U.S. M.D.s since the difference between 9.1 and 8 is pretty small. And this is just to match anywhere, and of course it's a different story if you're dead set on an academic career and want to match at a big-name research institution.

 

[Splenda88]

As some posters suggested, apply for fellowship and hospitalist positions simultaneously and if you find a hospitalist position that fits you career goal, do not submit a rank list. 2 residents in my program who applied to rheumatology bailed out by the time of ROL submission after getting hospitalist position that they think will suit their career goal.

I was also interested in fellowship, but already made up my mind to become a hospitalist since I have found out I like hospital medicine.

 

[QuizzicalApe]

For what it's worth, I hated my IM clinic but have really enjoyed outpatient heme/onc as an attending in the last year. There's a lot of headaches that get resolved by having a relatively well-defined role as a specialist and being able to defer appropriate things to the primary care doctor and work on your own issue and its related problems. I also despise performing research, having done the bare minimum to graduate fellowship before transitioning into private practice.

All that being said, don't be the guy who was in my 1st year fellowship class and then quit to be a hospitalist 6 months in. Follow your heart.

 

[WonderBoy]

Hello everyone, I am a rising PGY3 (in <1 week!) IM resident currently debating whether or not to do heme onc fellowship vs just practicing as a Hospitalist. I hope SDN can give me thoughts and advice. I will preface this by saying that I have thought about this throughout my entire 2 years so far during residency. When starting residency, I had planned on doing heme onc. However, I have been more and more attracted towards inpatient Hospitalist medicine throughout my residency.

I absolutely love shift work. Whether it’s 7on/7off or some combination of this, I really can see myself doing this long term. I am engaged (no kids) and my fiancé is NP working outpatient 9-5 and she is fine with whatever I decide. I realize that in the future, I won’t be there for some of my kids’ activities but I feel like that’s just life. There will always be things that you’ll miss regardless of what specialty you choose in medicine (maybe outside of derm).

I know I can match into an academic heme onc program but I just cannot see myself doing heme onc for the long term. The field does not excite me and I do not enjoy research. If I were to do heme onc, I would join a private practice in the community. Part of me just doesn’t really fully understand the day-to-day of private practice outpatient heme onc but I don’t think I would enjoy clinic every day and seeing 30+ patients on a daily basis in clinic. I find the acuity of Hospitalist medicine more attractive in the sense that once they’re discharged, they are no longer your patient/problem. I don’t have to follow up labs or imaging on my days off, I don’t have to document on days off, etc.

Financially, heme onc probably makes 1.5-2x more than Hospitalist. Money is not too important to me and I feel like I would be very happy already with a $250k+ Hospitalist salary working half of the year. As a Hospitalist, I could always moonlight or take on side gigs such as SNF director to supplement income.

I can see how hospitalists can be dumping group and not garner respect from other specialities. I personally don’t really care about this. As a IM resident, I’m constantly being dumped on by other services and hounded by admin and honestly, I would happily comply with whatever they want if I was getting paid an attending salary.

Are there any other thoughts or considerations I have not stated? My heme onc fellowship application is already completed but I am having serious doubts about submitting it.
Thank you all in advanced for any advice!

Sounds like you really don't want to do Heme/Onc. Do yourself a favor and the future program a favor by not applying. Let someone who really wants to do it. Do your hospitalist gig and if you don't like it you can apply next cycle. Getting dumped on gets old after a year or two, even if money is good but hey you may like it and be in a good place. Good luck!

 

[MD46]

Also first year as a heme Onc fellow can be even more taxing than 1st yr intern in IM, at least mine was and most of my friends said the same thing. If you are on the edge about heme onc now, 1st year may actually makes things worse for you. Good luck

 

[stillpremed]

Yes, I think seeing that many patients would be tedious. While all specialties deal with complex cases on their own, seeing oncology patients are complicated in their own right. Seeing new diagnosis can be challenging and explaining the options and recurrence and progression cases can also be tough in their own regard.

Yes, you have to be up to speed on the latest advancements for sure and it is rapidly changing and have to know the data to make informed decisions for patients. This is what I am realizing that I may not be as passionate about doing a year of fellowship.

Your assessment is accurate about hospital medicine. I don't feel comfortable with hem onc and quite frankly, not sure if I feel even after finishing fellowship. I feel much more comfortable doing hospital medicine after IM residency.

Hope this helps.

Heme onc all the way... but only if you like/enjoy the field. Fellowship sucks but the end result is well worth it. Helping patients make decisions re: treatment, benign heme with no hospice talks to balance out the onc, keeping up with new treatments on the reg, not admitting patients and having hospitalists admit for you are just a few of the benefits of the heme/onc life. I tried to send you a DM re: heme/onc private practice but was unable to.

 

[2126]

I hope to be almost retired by 50 (currently 27). Did some calculations and money-wise, I’ll approximately break even between Hospitalist vs heme-onc around age 43. Honestly, I will likely just apply heme-onc and look for jobs at the same time. If I don’t absolutely love any program that I interview at, will just not submit a rank list.

How much does hemonc vs Hospitalist make, considering doing some extra gigs as Hospitalist, maybe like work for 3 weeks and 1 week off.

 

[aafisahar]

How much does hemonc vs Hospitalist make, considering doing some extra gigs as Hospitalist, maybe like work for 3 weeks and 1 week off.

hospitalist would win in the first couple years, then heme/onc blows it out of the water, mostly because most people will have eaten their gun doing 3 on 1 off

 

[collegestud2013]

How much does hemonc vs Hospitalist make, considering doing some extra gigs as Hospitalist, maybe like work for 3 weeks and 1 week off.

As the previous poster said hospitalist will end up ahead initially just by virtue of training being 3 years shorter than heme/onc, and as a hospitalist it's probably easier to scale up just by doing extra shifts. Heme/onc on average dose make a bit more than hospitalist on a per hour basis but consider that you start 3 years later and being an outpatient heavy specialty you need to scale up your patient volume which takes some time and starting salaries right out of fellowship training are typically only slightly higher on a per hour basis than being a hospitalist.

What limits hospitalist income in the long run is that is that most hospitalist jobs that are out there currently are strictly employed with no opportunity for partnership or some type of ownership (though there are a few exceptions out there), and that their revenue stream relies mostly on E&M billing (in some places they can do procedures to supplement) while most of their patients are probably not sick enough bill for critical care time as often as ED physicians or intensivists (who bill critical care time for nearly all their patient encounters). Also, unlike in some other specialties it's very hard for most hospitalists to see 30-40 patients safely in a 12 hour shifts

Heme/onc can make more than hospitalist only in the long run (at least historically) if you end up in a non-academic position such as PP (academic heme/onc often pays the same or less than hospitalist) and become a partner (so you essentially can make money off someone else's work) and generate revenue from more than just E&M billing (eg from diagnostics or chemo profits). However, with they way the job market is changing, these types of jobs will be harder and harder to find and probably nearly all heme/oncs will be strictly in employed in the future and when that happens their hourly pay rate will probably have a lower cap (in a strictly employed position they don't own anything so nearly all the extra revenue from stuff like chemo and diagnostics goes to their organization).

Also keep in mind that at the tax brackets most physicians are in, possibly 40-50% of any additional wage income will just be going to taxes (probably closer to 50% if you live in a high-income tax state and if Biden's tax plan goes through) so there are diminishing returns.

 

[Splenda88]

I thought most heme/onc docs make 500-700k/yr (25th to 75th percentile), so they should be able to catch up easily in 10 yrs.

 

[collegestud2013]

I thought most heme/onc docs make 500-700k/yr (25th to 75th percentile), so they should be able to catch up easily in 10 yrs.

That sounds more on the higher end, probably for those who are have been in practice for a while and have large patient panel, and those making closer to $600k-700k are probably the more senior partners with some practice ownership. Probably closer to $350-450k right out of fellowship if in PP and for academics closer to high $200s - low $300s. And with the trend of more and more physicians becoming solely employed those partnership jobs are going to be harder to come by for future grads.

 

[Osteoth]

That sounds more on the higher end, probably for those who are have been in practice for a while and have large patient panel, and those making closer to $600k-700k are probably the more senior partners with some practice ownership. Probably closer to $350-450k right out of fellowship if in PP and for academics closer to high $200s - low $300s. And with the trend of more and more physicians becoming solely employed those partnership jobs are going to be harder to come by for future grads.

In Southern California I’ve been told Heme onc starts right around 300, which is about where hospitalists start all in as well

 

[rokshana]

I think another thing is that our IM program has literally no exposure to outpatient oncology. It’s hard for me to imagine what outpatient oncology is like. I personally cannot tolerate outpatient internal medicine clinic and feel like outpatient oncology may share many similar aspects to internal med? Is this wrong to assume?

While not hem/onc, I had the same concerns for endocrine, since I could not stand my residency IM clinic…but it’s different with the specialty clinics.

can you get an elective in an outpt hem/onc clinic in the next few months as you apply for fellowship.
I remember my inpt hem/onc attendings say that clinic was a very different thing from inpt.

and I too, prefer inpt, but like endocrine clinic as well.