Hospitalist vs HemeOnc fellowship

[anonperson]

My wife and I are five kids in, and she would still like to have more.

5 kids and wanting more?!?

My brother in Christ, get the vasectomy before exhaustion kills you

At the same time, my wife brings up the age-old arguments about the prestige of being the "smartest doctor" in the room, being the go-to guy for my patients and the lack of intellectual stimulation as a run of the mill hospitalist

No one really cares about being the smartest person in the room.

Not sure why anyone really wants to be the go to guy for their patients. It's annoying and patients will bring up stuff outside your area of expertise.

I see it in obstetrics.

"Ma'am, I don't know what's going on with your ear pain and even if I looked inside, I don't know what I'm looking for."

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You don't sound like your heart is into the fellowship anyways. No shame. You'll be a board certified internist shortly, that's pretty good in my book

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[Splenda88]

It completely is preference, I would not want to round in the hospital all day and dealing with social stuff either. Also as heme/onc that cubicle to cubicle 4 days a week seeing 16-20 pts a day can make you high 6 figures.

I agree that the money in heme is really good. 500-700k/yr is nothing to scoff at. My extent of dealing with social "stuff" is to spend 15 minutes of my time daily talking to social workers. I think hospitalists dealing with social issues is overblown.

 

[eyeeye_captain]

I agree that the money in heme is really good. 500-700k/yr is nothing to scoff at. My extent of dealing with social "stuff" is to spend 15 minutes of my time daily talking to social workers. I think hospitalists dealing with social issues is overblown.

Even years ago at the county and VA we had social workers on the team. It was great, the students all got their placement rock garden that the residents and attendings could basically wave at from the hallway.

“Did they wake up? No complaints? Good. Moving on.”

 

[MD46]

I agree that the money in heme is really good. 500-700k/yr is nothing to scoff at. My extent of dealing with social "stuff" is to spend 15 minutes of my time daily talking to social workers. I think hospitalists dealing with social issues is overblown.

500-700 is low end, more like 800-1.5 as most of us are seeing more patients by choice, at least I see 25-30 a day.

 

[Splenda88]

500-700 is low end, more like 800-1.5 as most of us are seeing more patients by choice, at least I see 25-30 a day.

You are killing it. That's great money right there.

 

[MifflinDunder]

500-700 is low end, more like 800-1.5 as most of us are seeing more patients by choice, at least I see 25-30 a day.

What’s the common range in non-academic malignant heme?

 

[gutonc]

What’s the common range in non-academic malignant heme?

It's all about how much meat you move.

If you see 30 99123s a day, 4 days a week, 46 weeks a year, you're going to pull in >12K wRVU. At $90-100/wRVU, that's an easy 7 figures.

You'll also probably go insane, but you'll be able to afford a really nice inpatient psych facility.

 

[HemeOncHopeful19]

500-700 is low end, more like 800-1.5 as most of us are seeing more patients by choice, at least I see 25-30 a day.

 

[MD46]

It's all about how much meat you move.

If you see 30 99123s a day, 4 days a week, 46 weeks a year, you're going to pull in >12K wRVU. At $90-100/wRVU, that's an easy 7 figures.

You'll also probably go insane, but you'll be able to afford a really nice inpatient psych facility.

lol, start clinic at 830, home by latest 5, Fridays home by 1p, 1:5 call light, 1:5 weekends where I barely need to go in. 6 weeks off, 1 week CME, not too bad.

 

[HemeOncHopeful19]

lol, start clinic at 830, home by latest 5, Fridays home by 1p, 1:5 call light, 1:5 weekends where I barely need to go in. 6 weeks off, 1 week CME, not too bad.

I’m interested in how you see 30 in that time frame. Are you all malignant Heme or do you have a bunch of IDA / Cirrhosis Cytopenias spattered in there?

 

[MifflinDunder]

lol, start clinic at 830, home by latest 5, Fridays home by 1p, 1:5 call light, 1:5 weekends where I barely need to go in. 6 weeks off, 1 week CME, not too bad.

How many patients would you have to see to make 500k?

And are you using EPIC?

 

[MifflinDunder]

I’m interested in how you see 30 in that time frame. Are you all malignant Heme or do you have a bunch of IDA / Cirrhosis Cytopenias spattered in there?

Also curious. 30 solid onc patients and onc histories daily would make me want to quit medicine. I don’t know how people churn and burn in this specialty.

 

[gutonc]

How many patients would you have to see to make 500k?

Half that many.

 

[Splenda88]

My friend used to work with one heme doc in West Virginia and he told me that guy make > 1 mil every year but he was seeing 30+ patients every day.

I thought the norm for hemonc was 18-20 patients per day to make 500-700k/yr. At least, that is the norm where I am now.

 

[gutonc]

My friend used to work with one heme doc in West Virginia and he told me that guy make > 1 mil every year but he was seeing 30+ patients every day.

I thought the norm for hemonc was 18-20 patients per day to make 500-700k/yr. At least, that is the norm where I am now.

That's pretty typical. But you can work more and make more, or work less and make less.

 

[MD46]

How many patients would you have to see to make 500k?

And are you using EPIC?

Use EPIC for EMR, M Modal for dictation, No NP or PA support. I have an RN and a MA along with a good nurse navigator. Inpatient is light as well which helps focus on clinic more. For 500k like around 16 patients a day would be avg, some partners do about that and make 500kish. Senior partner sees around 40-50 a day 4.5 days a week, she made >2mil last year.

 

[MifflinDunder]

Use EPIC for EMR, M Modal for dictation, No NP or PA support. I have an RN and a MA along with a good nurse navigator. Inpatient is light as well which helps focus on clinic more. For 500k like around 16 patients a day would be avg, some partners do about that and make 500kish. Senior partner sees around 40-50 a day 4.5 days a week, she made >2mil last year.

That’s not bad. I just want to make 450-500k without killing myself but interested in malignant heme which isn’t as lucrative with most jobs being in academia. Hopefully that’ll change in a few years.

 

[randomhemoncpd]

It's all about how much meat you move.

If you see 30 99123s a day, 4 days a week, 46 weeks a year, you're going to pull in >12K wRVU. At $90-100/wRVU, that's an easy 7 figures.

You'll also probably go insane, but you'll be able to afford a really nice inpatient psych facility.

for malignant it will be mostly 99214 / 99215. But it is not sustainable at 30/day for 4x/week.

 

[gutonc]

for malignant it will be mostly 99214 / 99215. But it is not sustainable at 30/day for 4x/week.

I'm aware of both of those things. I was setting a floor on the question that was asked about how much money that amount of work would make.

 

[Splenda88]

That’s not bad. I just want to make 450-500k without killing myself but interested in malignant heme which isn’t as lucrative with most jobs being in academia. Hopefully that’ll change in a few years.

Most people in medicine are not killing themselves because they see a few more (emphasis on "few") patients. Physicians should stop with the exaggeration.

Try to volunteer for Habitat for Humanity for a week (40 hrs) during a summer in south FL, and let me know how you feel after that. I did that for 2 wks to pad my AMCAS application. Oh boy!

 

[MD46]

That’s not bad. I just want to make 450-500k without killing myself but interested in malignant heme which isn’t as lucrative with most jobs being in academia. Hopefully that’ll change in a few years.

Pure malignant heme jobs are hard to find, some jobs I interviewed at where they would have their own service in patient to admit and also do transplants were quite busy. Their RVU values were same however due to being mostly inpatient they could generate more. Main thing is if there is a good team, resident, fellow, pharmacist, mid level, good RNs etc, this can effect the quality of life quite significantly and night time calls etc.

 

[onconconconconc]

Use EPIC for EMR, M Modal for dictation, No NP or PA support. I have an RN and a MA along with a good nurse navigator. Inpatient is light as well which helps focus on clinic more. For 500k like around 16 patients a day would be avg, some partners do about that and make 500kish. Senior partner sees around 40-50 a day 4.5 days a week, she made >2mil last year.

How can people see 30 to 40?!+ patients a day and manage to get through goals of care discussions, scans/treatment change discussions, side effect management, not to mention interruptions for infusion questions and emergencies (especially where there is no NP/PA support)? I am so curious. When I come home after seeing 20 patients in my solid tumor practice, I am so drained

 

[HemeOncHopeful19]

How can people see 30 to 40?!+ patients a day and manage to get through goals of care discussions, scans/treatment change discussions, side effect management, not to mention interruptions for infusion questions and emergencies (especially where there is no NP/PA support)? I am so curious. When I come home after seeing 20 patients in my solid tumor practice, I am so drained

How I imagine their GOC discussions go:

 

[MD46]

How can people see 30 to 40?!+ patients a day and manage to get through goals of care discussions, scans/treatment change discussions, side effect management, not to mention interruptions for infusion questions and emergencies (especially where there is no NP/PA support)? I am so curious. When I come home after seeing 20 patients in my solid tumor practice, I am so drained

I mean I have seen quite a few people do it, it is not easy, also it is outside the norm to do it without mid level support, but happens. However based on my observations, at 40 pts a day quality of care definitely gets effected.

 

[gutonc]

I mean I have seen quite a few people do it, it is not easy, also it is outside the norm to do it without mid level support, but happens. However based on my observations, at 40 pts a day quality of care definitely gets effected.

I know a guy who is the principal partner in his practice (started it on his own >30y ago) who sees ~60 a day. He employs 2 NPs who see ~2/3 of his patients (he walks in, gives them a high five and walks out) and sees the rest himself. He collects all the billings, pays his NPs a good salary and still goes home with ~$2M a year.

I like this person immensely. I hate having to pick up transfer patients from him since his notes and care plans are skeletal at best and mostly just useless.

 

[MifflinDunder]

How can people see 30 to 40?!+ patients a day and manage to get through goals of care discussions, scans/treatment change discussions, side effect management, not to mention interruptions for infusion questions and emergencies (especially where there is no NP/PA support)? I am so curious. When I come home after seeing 20 patients in my solid tumor practice, I am so drained

Agreed, this is not a “one problem and done” specialty. By the time your breast patient is done writing their 5 pages of notes, and you've explained the 10 things your colon patient needs and why they're tired, your time runs out pretty quickly.

 

[gutonc]

Agreed, this is not a “one problem and done” specialty. By the time your breast patient is done writing their 5 pages of notes, and you've explained the 10 things your colon patient needs and why they're tired, your time runs out pretty quickly.

You'll get there. It will take time, but you'll get there. For patients I have a good rapport with, even if they have a million issues, I can generally get it all taken care of and the note done in 20 minutes. It took me a decade to get to that point, hopefully you can do it more quickly.

Also, not really caring...at all...really speeds things up. That's not how I practice, but I know a number of people who see 6-8 an hour who practice like that.

 

[dozitgetchahi]

How can people see 30 to 40?!+ patients a day and manage to get through goals of care discussions, scans/treatment change discussions, side effect management, not to mention interruptions for infusion questions and emergencies (especially where there is no NP/PA support)? I am so curious. When I come home after seeing 20 patients in my solid tumor practice, I am so drained

There is no way you do this in a complex specialty like onc, and do a good job of it.

I’m a rheumatologist. My upper limit is about 22/day or so…anything beyond that and I feel you’re definitely cutting corners. A nearby rheum sees about 30/day, and he isn’t thorough and frankly does not do a good job of taking care of his patients. His documentation is also “skeletal and useless” as described above. (And while our specialty is complex, thankfully GOC discussions aren’t a core part of it. Not sure how you get through all that in 10-20 min visits.)

 

[Splenda88]

There is no way you do this in a complex specialty like onc, and do a good job of it.

I’m a rheumatologist. My upper limit is about 22/day or so…anything beyond that and I feel you’re definitely cutting corners. A nearby rheum sees about 30/day, and he isn’t thorough and frankly does not do a good job of taking care of his patients. His documentation is also “skeletal and useless” as described above. (And while our specialty is complex, thankfully GOC discussions aren’t a core part of it. Not sure how you get through all that in 10-20 min visits.)

What if they have a NP/PA?

 

[MifflinDunder]

What if they have a NP/PA?

This is how I imagine people are doing it:

Patient is here for a FOLFIRI follow-up, they're having diarrhea, sees the NP (side effect visits are about 80-90% of what the NP/PA visits are in oncology).

You yell from outside the door How bad is it? The patient tells you it's bad.

You say Aww that's too bad. Let's delay your next cycle, see you in 2 weeks. Ok bye.

 

[Splenda88]

This is how I imagine people are doing it:

Patient is here for a FOLFIRI follow-up, they're having diarrhea, sees the NP (side effect visits are about 80-90% of what the NP/PA visits are in oncology).

You yell from outside the door How bad is it? The patient tells you it's bad.

You say Aww that's too bad. Let's delay your next cycle, see you in 2 weeks. Ok bye.

You are being a little bit dramatic.

My friend (radonc) worked with an oncologist who sees 35+ patients by himself and he said the guy is good but usually get his work done between 6-7 pm. That guy makes indeed > 1m.

He is an FMG. For some reasons, some of these FMG seem to like working a LOT. Maybe it's a phenomenon in the part of the country that I am.

 

[HemeOncHopeful19]

You are being a little bit dramatic.

My friend (radonc) worked with an oncologist who sees 35+ patients by himself and he said the guy is good but usually get his work done between 6-7 pm. That guy makes indeed > 1m.

He is an FMG. For some reasons, some of these FMG seem to like working a LOT. Maybe it's a phenomenon in the part of the country that I am.

I interviewed with a group that did similar. I really liked them until I asked what they typical day to day was and it ended with "then I get home around 7 to put the kids in bed."

 

[MD46]

I interviewed with a group that did similar. I really liked them until I asked what they typical day to day was and it ended with "then I get home around 7 to put the kids in bed."

Most Oncologist I know pulling 750k-1.2m, dont go home at 7-8. usually by 5, my self included. yeh if you are seeing 40 a day, its not going be at 5 every day.

 

[sloh]

What if they have a NP/PA?

What’s the most you’ve heard/seen a hospitalist rounding on per day? I’ve heard of like 40-50. Hospital cool with it bc he also does clinic and the patients love his rapport in clinic.

 

[Splenda88]

What’s the most you’ve heard/seen a hospitalist rounding on per day? I’ve heard of like 40-50. Hospital cool with it bc he also does clinic and the patients love his rapport in clinic.

~35. These people usually make 600k+. The highest amount I know a hospitalist make ~700k, but that individual works like no one. For instance, she would work 60+ days straight.

 

[MifflinDunder]

Most Oncologist I know pulling 750k-1.2m, dont go home at 7-8. usually by 5, my self included. yeh if you are seeing 40 a day, its not going be at 5 every day.

When do you chart and prepare notes for the next day?

 

[Royster33]

In oncology, it is nearly impossible to give good care once you are seeing 30+ patients per day. A former colleague of mine used to see in the high 20s per day - I would get lots of complaints and people wanting to transfer to me as this person was in an out of the room, spent very little time, no exam, etc.

The beauty of oncology is there are so many options of how much to want to work/make. I am seeing around 12-15 patients per day 4 days per week. Go home at 4 with plenty of time to work out/see the kids. Make around 475K. I know I am leaving a lot of money on the table with other places, but the quality of life is just too good.

 

[Splenda88]

In oncology, it is nearly impossible to give good care once you are seeing 30+ patients per day. A former colleague of mine used to see in the high 20s per day - I would get lots of complaints and people wanting to transfer to me as this person was in an out of the room, spent very little time, no exam, etc.

The beauty of oncology is there are so many options of how much to want to work/make. I am seeing around 12-15 patients per day 4 days per week. Go home at 4 with plenty of time to work out/see the kids. Make around 475K. I know I am leaving a lot of money on the table with other places, but the quality of life is just too good.

I understand oncology is completely different.

As a hospitalist, I used to say that it would be impossible to give good care seeing 25+. However, I no longer hold that view because I have a couple hospitalists I work with that can do it. These guys are so freaking efficient.

 

[MifflinDunder]

In oncology, it is nearly impossible to give good care once you are seeing 30+ patients per day. A former colleague of mine used to see in the high 20s per day - I would get lots of complaints and people wanting to transfer to me as this person was in an out of the room, spent very little time, no exam, etc.

The beauty of oncology is there are so many options of how much to want to work/make. I am seeing around 12-15 patients per day 4 days per week. Go home at 4 with plenty of time to work out/see the kids. Make around 475K. I know I am leaving a lot of money on the table with other places, but the quality of life is just too good.

Life goals. Hopefully, these will be available when I graduate. No interest in seeing 30 oncology patients a day, regardless of how much it pays.

 

[MD46]

When do you chart and prepare notes for the next day?

I dont pre chart at all (used to my 1st year out of fellowship) , every night I skim through the following days Oncology consults only, and make up a quick plan in my head or lookup guidelines so I am better prepared next day.

When a patient checks in, I open their note, prepare the visit prior to going in, as soon as I am in the room I place orders, come back dictate, sign and done. Sounds like it takes too much time but it doesnt.

Followups dont take that long, we do spend a good time on new Onc patients and Onc patients on chemo who have reactions or bad side effects etc but there are patients that are on q2 weeks chemotherapy for example and counts are stable with no complains, thats a quick 5 min visit at most including notes.