I am interested in being a Medical Oncologist, but I am confused on the pathway and the finer points of the position.

[NegativeMargin]

My understanding is that a medical oncologist works with radiation and surgical oncologists to plan the best approach and is sort of viewed as the "primary care physician" as a part of the oncology team for patients with cancer. They work as a team with the other oncologists and are often the point of contact for the patient and their families. I loved the idea of this, as it has been my life dream, but as I dug further I found Hem, Onc, and Hem+Onc fellowships and I got confused.

Are medical oncologists any combination of board certified in the above 3 pathways (and IM), or are they only board certified in Onc? Also as far as pay and lifestyle go, I've seen people talk about medical oncologists not tending to make as much as Hem+Onc docs, but I've also seen posts floating around here where people talk about Med-Onc reimbursements being up, and quite frankly all of that is a little above my head. I've always wanted to be an oncologist and I've recently been accepted to an accelerated 3-year MD school. I want to iron out the kinks of my understanding now because I understand because of the loss of year 4 I will likely need to start doing research in my first year to be competitive for top local IM residencies with quality Hem+Onc fellowships. Correct me if I am wrong, but while IM is generally not all that difficult to match into, there are things like AOA (another thing I need to research further) and correlational data for certain IM subspecialties that do tend to show things like STEP scores and average number of research items being higher for people in Hem/Onc than for IM generalists.

My questions are pretty simple: does it seem like I am starting to gain an understanding of what I would be getting myself into, or do I still seem like a fish out of water? I have a somewhat cliché story of diving into cancer research when family members got sick, and coupled with few years of academic research, and 7 years of clinical experience developing longitudinal relationships with 100s of folks who I've had to watch slowly die, I feel like I am uniquely situated to prosper in the field. But what am I missing?

Is "medical oncologist" simply a job title and those doing it have their scope of practice dictated by their boards? Are Medical Oncologists really the PCP's of oncology? And with that, how is their lifestyle compared to other Oncs? Do they tend to do less research? These are all things I've seen insinuated or glossed over in topics that have spanned a pretty wide scope over the better part of the previous decade here. I'd love some clarification. I'm clearly looking at non-surgical Oncology here, what are the different jobs like? What jobs do you have and do you like them? With my focus was I correct in thinking Surgical Onc isn't really what I should be after? And on the topic, why am I seeing such inconsistent data about pay and typical hours worked for various Oncologists? I know focus on research can be required and often hams up people's reported hours which messes up certain data sets, but it is odd that within a single data set I often see Med Oncs and blood cancer docs getting paid more than surgical oncs, which doesn't really add up to me with my rudimentary understanding.

All of this becomes even more confusing the more research I do. I am going to go into this 3 year school with an open-mind, though now more than ever with STEP 1 pass/fail and the fact that I will only have 3-years, I don't think it's too crazy for me to start wrapping my head around all of this now.. especially regarding how I will start approaching research opportunities.

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[bobow98]

Lots to unpack here.

First of all, no one is going to discuss detailed compensation on a public board. But as a physician in the US you're going to be just fine either way.

In short, you end up being like a second PCP for your cancer patients because you see them VERY often while they are on treatment. I see most of my treatment patients 1-2x per month. You can refer out to other specialists for help, or back to the PCP for non oncology things. That's totally up to your style. I do a mix of both. I can manage BP meds for my TKIs, and steroid cream for simple skin reactions, but patients with tachy/brady or difficult Afib/Aflutter go straight to their cardiologist for that.

You have to get IM board cert to take heme or onc boards. So there's that. Most don't maintain IM beyond the first go around.

Medical oncology is fun. But it's not shift work. Your patients really become attached to you (if you're a halfway decent oncologist) and you can't just really leave your work at work. Most of us are checking on patients during off hours, admin/research days, etc.

The pathway is USMD (hard to get into)-> IM (relatively easy to moderate) -> Hemeonc fellowship (moderate). Anytime you are talking top 15 programs then it automatically becomes hard. The currency for top programs is research research research. I think I had 1 Honors in med school and got into a mid tier academic program, and then got plenty of top onc interviews because of my research background alone. If you want to get into a clinical program, just pass and have good reviews and you're fine as a USMD.

To really have a sense of what this is, you need to spend time shadowing oncologists in clinic and talk to them. Do your best to get decent grades, but make sure you really like what we do - you have to get exposed to that. There's ample room for clinical trials in this field, and clinical research, whether in academia, private practice, or industry (oncology has the best exit opportunities in all medicine).

This has been discussed on prior threads to various degrees.
I'm having fun so far.

 

[NegativeMargin]

Lots to unpack here.

First of all, no one is going to discuss detailed compensation on a public board. But as a physician in the US you're going to be just fine either way.

In short, you end up being like a second PCP for your cancer patients because you see them VERY often while they are on treatment. I see most of my treatment patients 1-2x per month. You can refer out to other specialists for help, or back to the PCP for non oncology things. That's totally up to your style. I do a mix of both. I can manage BP meds for my TKIs, and steroid cream for simple skin reactions, but patients with tachy/brady or difficult Afib/Aflutter go straight to their cardiologist for that.

You have to get IM board cert to take heme or onc boards. So there's that. Most don't maintain IM beyond the first go around.

Medical oncology is fun. But it's not shift work. Your patients really become attached to you (if you're a halfway decent oncologist) and you can't just really leave your work at work. Most of us are checking on patients during off hours, admin/research days, etc.

The pathway is USMD (hard to get into)-> IM (relatively easy to moderate) -> Hemeonc fellowship (moderate). Anytime you are talking top 15 programs then it automatically becomes hard. The currency for top programs is research research research. I think I had 1 Honors in med school and got into a mid tier academic program, and then got plenty of top onc interviews because of my research background alone. If you want to get into a clinical program, just pass and have good reviews and you're fine as a USMD.

To really have a sense of what this is, you need to spend time shadowing oncologists in clinic and talk to them. Do your best to get decent grades, but make sure you really like what we do - you have to get exposed to that. There's ample room for clinical trials in this field, and clinical research, whether in academia, private practice, or industry (oncology has the best exit opportunities in all medicine).

This has been discussed on prior threads to various degrees.
I'm having fun so far.

Thank you for the detailed response.

Ideally I'd like to match at the IM residency where I am going to school (MCW), and from there I'd ideally like to get a fellowship at their hem/onc program in Milwaukee. If that is the goal, am I correct in thinking I need to start doing research (with a focus on cancer research if available) as soon as I get to school because of the 3-year accelerated pace? You mention getting top oncology offers because of your research alone, what type of research did you do? Over what time?

I have seen other threads discussing the average number of publications, posters, volunteer opportunities, clinical opportunities etc. and they are often pulled from the attached paper from almost 10 years ago.. they say trends continue but it's hard for me to really ascertain how accurate those statements are. Either way, because the paper details residencies and not fellowships it's hard to track what Hem/Onc fellows tend to have.

Looking at Rad Onc compared to IM, the trends show some pretty obvious things with almost 50% of people matching being in one of the top 40 schools with the most NIH funding and an average number of abstracts, presentations, and publications above 12 for matched individuals. I've heard anecdotally that Rad Onc on the whole is more difficult to get into than Hem/Onc, so it seems like a good upper limit to use for my goals. I'd like to know more about research in med-school vs research in residency. I hear that research while in IM matters more than research done in med-school in most cases, and I'd like to hear your thoughts on that.

Also, I have definitely looked through about a dozen threads on this sub-forum of people talking about specific job offers and going into a fair amount of detail.. Either way, I am not driven to Oncology for the money, as I detailed in the post, but I do want to be open to any relevant information those individuals were willing to share. It isn't my goal to put others in awkward positions, but if people are volunteering the information I would be silly not to take note of it. In any case, it seems my focus should be on research. I have 1.5 years of research in undergrad and have just started getting into cancer biology research, of which I may be able to have a few hundred hours in before matriculating.. hopefully that will be enough, combined with the rest of my resume to get me in the door to doing research at the cancer center at MCW.

 

[gyngyn]

I've heard anecdotally that Rad Onc on the whole is more difficult to get into than Hem/Onc, so it seems like a good upper limit to use for my goals.

There was a time when this was true.
Right now, Rad Onc is having a very hard time filling residency positions. There were over 30 unfilled positions in last year's Match at programs all over the country. There were still plenty of positions after the first round of SOAP.

 

[NegativeMargin]

There was a time when this was true.
Right now, Rad Onc is having a very hard time filling residency positions. There were over 30 unfilled positions in last year's Match at programs all over the country. There were still plenty of positions after the first round of SOAP.

I guess I have heard things like that too, and while I don't have the slightest idea how to really wrap my head around that, my goal really is to just work as hard as I can to not disqualify myself from whatever route I may choose to go down.. and in that respect while I'll certainly be considering these sorts of issues while making residency decisions, it doesn't seem all too important to be worrying about right now as an "M0".

On that note though, is the lack of residency positions and overall issue with that specialty mid-level creep or something? And if you had to view the entirety of oncology in that lens, what specialties are you most worried about, and which one's seem "safe" relatively speaking?

 

[whoknows2012]

Thank you for the detailed response.

Ideally I'd like to match at the IM residency where I am going to school (MCW), and from there I'd ideally like to get a fellowship at their hem/onc program in Milwaukee. If that is the goal, am I correct in thinking I need to start doing research (with a focus on cancer research if available) as soon as I get to school because of the 3-year accelerated pace? You mention getting top oncology offers because of your research alone, what type of research did you do? Over what time?

I have seen other threads discussing the average number of publications, posters, volunteer opportunities, clinical opportunities etc. and they are often pulled from the attached paper from almost 10 years ago.. they say trends continue but it's hard for me to really ascertain how accurate those statements are. Either way, because the paper details residencies and not fellowships it's hard to track what Hem/Onc fellows tend to have.

Looking at Rad Onc compared to IM, the trends show some pretty obvious things with almost 50% of people matching being in one of the top 40 schools with the most NIH funding and an average number of abstracts, presentations, and publications above 12 for matched individuals. I've heard anecdotally that Rad Onc on the whole is more difficult to get into than Hem/Onc, so it seems like a good upper limit to use for my goals. I'd like to know more about research in med-school vs research in residency. I hear that research while in IM matters more than research done in med-school in most cases, and I'd like to hear your thoughts on that.

Also, I have definitely looked through about a dozen threads on this sub-forum of people talking about specific job offers and going into a fair amount of detail.. Either way, I am not driven to Oncology for the money, as I detailed in the post, but I do want to be open to any relevant information those individuals were willing to share. It isn't my goal to put others in awkward positions, but if people are volunteering the information I would be silly not to take note of it. In any case, it seems my focus should be on research. I have 1.5 years of research in undergrad and have just started getting into cancer biology research, of which I may be able to have a few hundred hours in before matriculating.. hopefully that will be enough, combined with the rest of my resume to get me in the door to doing research at the cancer center at MCW.

I think you’re missing the forest for the trees a bit here. If you follow this very simple strategy you still set your self up nicely for your training and career;

1) focus on doing well in your pre-clinical work, doing well on steps (is step 1 p/f yet??!)
2) find a faculty mentor who can guide you to a research opportunity in heme/onc during med school. You do not have to have 7 publications from med school. A single serious research project will suffice (ie one that you could talk about, maybe submit an abstract at a national conference etc)
3) do well in your clinical rotations, as much as possible seek out oncology opportunities for elective time or within core rotations if possible
4) Aim for a solid academic IM training program for residency—>large academic hospitals tend to have better research opportunities; could even focus your attention to programs with better track record for heme/onc to ensure you get both good oncology exposure but also research options
5) wash rinse repeat for applying to heme/onc fellowships. Good letters, hopefully by then have much more involvement in research, some abstracts maybe a publication or 2. Here you’ll need a finer sense of what you want to do because at this point you’ll need to look at programs that’ll be a good fit for your future career aspirations.

The model in academic oncology is Sub specializing, potentially in a single disease. The model you were describing above does exist (serving as a pseudo pcp working with surg onc and rad onc) but not in malignant hematology, for example. In my specialty of leukemia I never interact with surg onc and rarely interact with rad onc, and very much do serve as a pcp for my highly complicated leukemia patients. What your practice will be like in the future will be highly dependent on practice environment (academic cancer center, academic university hospital, hybrid, private practice) AND your sub specialty within oncology should you have one (many in private practice will be generalists).

 

[gyngyn]

I guess I have heard things like that too, and while I don't have the slightest idea how to really wrap my head around that, my goal really is to just work as hard as I can to not disqualify myself from whatever route I may choose to go down.. and in that respect while I'll certainly be considering these sorts of issues while making residency decisions, it doesn't seem all too important to be worrying about right now as an "M0".

On that note though, is the lack of residency positions and overall issue with that specialty mid-level creep or something? And if you had to view the entirety of oncology in that lens, what specialties are you most worried about, and which one's seem "safe" relatively speaking?

Specialty selectivity changes, sometimes rather quickly. The reasons for this are often multi-factorial. Stay open to such changes and review them with trusted faculty in your school as your interests become more clear.
On that note, I'm moving this to the medical student forum.

 

[NegativeMargin]

I think you’re missing the forest for the trees a bit here. If you follow this very simple strategy you still set your self up nicely for your training and career;

1) focus on doing well in your pre-clinical work, doing well on steps (is step 1 p/f yet??!)
2) find a faculty mentor who can guide you to a research opportunity in heme/onc during med school. You do not have to have 7 publications from med school. A single serious research project will suffice (ie one that you could talk about, maybe submit an abstract at a national conference etc)
3) do well in your clinical rotations, as much as possible seek out oncology opportunities for elective time or within core rotations if possible
4) Aim for a solid academic IM training program for residency—>large academic hospitals tend to have better research opportunities; could even focus your attention to programs with better track record for heme/onc to ensure you get both good oncology exposure but also research options
5) wash rinse repeat for applying to heme/onc fellowships. Good letters, hopefully by then have much more involvement in research, some abstracts maybe a publication or 2. Here you’ll need a finer sense of what you want to do because at this point you’ll need to look at programs that’ll be a good fit for your future career aspirations.

The model in academic oncology is Sub specializing, potentially in a single disease. The model you were describing above does exist (serving as a pseudo pcp working with surg onc and rad onc) but not in malignant hematology, for example. In my specialty of leukemia I never interact with surg onc and rarely interact with rad onc, and very much do serve as a pcp for my highly complicated leukemia patients. What your practice will be like in the future will be highly dependent on practice environment (academic cancer center, academic university hospital, hybrid, private practice) AND your sub specialty within oncology should you have one (many in private practice will be generalists).

Thank you x1,000,000 I'm here to learn what my perspective needs to be and telling me candidly what I am missing helps me a lot.

I think I'm actually going to be in the first class that starts medical school with STEP 1 being P/F from the get-go. I'm not going to assume that means it's going to be easier, or if that means that the test makers are going to be raising the bar to compensate.. and even if it is easier, it's still a question of whether the months med students usually spend preparing for STEP 1 will suddenly become more open, or if the med schools will seize the opportunity to increase the number of required things I would need to do.. or if residency programs will adjust to med-students having free time by wanting residency applicants to have more competitive apps in other areas. In any case, gunners are gonna gun and I'll have to adjust accordingly, right?

Again, because I'm in a 3-year accelerated program I do want to start looking at everything I'll need to succeed probably 6-months before the typical med-student would start looking at things, and for me with our orientation starting in June that means that right now I need to be preparing for what I'm going to do in the first 6 months of 2022 to ensure a smooth transition. Once I move, reaching out to the cancer research center and student services early to find mentors seems like a good first step for sure.

I just don't want to be left 3 years from now realizing that STEP 1 going P/F meant I should have been doing more research, and choosing a 3-year program meant I should have started that research earlier, instead of waiting for the M1 summer as most med-students do, because compared to the people I'll be competing against in 2025, my first day is their M1 summer.

 

[GoSpursGo]

Thank you x1,000,000 I'm here to learn what my perspective needs to be and telling me candidly what I am missing helps me a lot.

I think I'm actually going to be in the first class that starts medical school with STEP 1 being P/F from the get-go. I'm not going to assume that means it's going to be easier, or if that means that the test makers are going to be raising the bar to compensate.. and even if it is easier, it's still a question of whether the months med students usually spend preparing for STEP 1 will suddenly become more open, or if the med schools will seize the opportunity to increase the number of required things I would need to do.. or if residency programs will adjust to med-students having free time by wanting residency applicants to have more competitive apps in other areas. In any case, gunners are gonna gun and I'll have to adjust accordingly, right?

Again, because I'm in a 3-year accelerated program I do want to start looking at everything I'll need to succeed probably 6-months before the typical med-student would start looking at things, and for me with our orientation starting in June that means that right now I need to be preparing for what I'm going to do in the first 6 months of 2022 to ensure a smooth transition. Once I move, reaching out to the cancer research center and student services early to find mentors seems like a good first step for sure.

I just don't want to be left 3 years from now realizing that STEP 1 going P/F meant I should have been doing more research, and choosing a 3-year program meant I should have started that research earlier, instead of waiting for the M1 summer as most med-students do, because compared to the people I'll be competing against in 2025, my first day is their M1 summer.

So first of all, just take a breath. You got into med school. Congrats!

Secondly, remember that you have the entirety of your residency to do research as well. If you really want to, I'm sure you could also do research electives or even a research year if you wanted to decellerate in the name of achieving your best possible IM program. But regardless of whether you have 6 years or 7 years, you've got plenty of time to build a research background to be competitive for a heme/onc fellowship. Or rad onc residency, or surg onc fellowship, or what have you.

But bottom line, the most important thing is something that you already identified--finding a mentor at your med school who can help plug you in with the right people. Often times, you'll have a mentor assigned to you when you enter, and even if they aren't involved in IM/med onc they can probably point you in the right direction. So don't go crazy trying to plan the next 6-7 years out on your own, when your mentor is probably going to be able to guide you much more effectively.

 

[NegativeMargin]

So first of all, just take a breath. You got into med school. Congrats!

Secondly, remember that you have the entirety of your residency to do research as well. If you really want to, I'm sure you could also do research electives or even a research year if you wanted to decellerate in the name of achieving your best possible IM program. But regardless of whether you have 6 years or 7 years, you've got plenty of time to build a research background to be competitive for a heme/onc fellowship. Or rad onc residency, or surg onc fellowship, or what have you.

But bottom line, the most important thing is something that you already identified--finding a mentor at your med school who can help plug you in with the right people. Often times, you'll have a mentor assigned to you when you enter, and even if they aren't involved in IM/med onc they can probably point you in the right direction. So don't go crazy trying to plan the next 6-7 years out on your own, when your mentor is probably going to be able to guide you much more effectively.

Thanks. I have research advisors, multi-cultural advisors, and pre-med advisors right now, but at a certain point I just realized I could get the answers faster if I just figured it out myself or asked questions to people online.

Perhaps this is another lesson I will need to learn and adjust to as I move from undergrad to med school.

 

[GoSpursGo]

Thanks. I have research advisors, multi-cultural advisors, and pre-med advisors right now, but at a certain point I just realized I could get the answers faster if I just figured it out myself or asked questions to people online.

Perhaps this is another lesson I will need to learn and adjust to as I move from undergrad to med school.

So, I think SDN is great and there's a wealth of knowledge to be gained here. But there's no substitute for having a mentor at your own institution, who can probably provide you with personalized advice that fits your school better than any advice we can give here 🙂

 

[NegativeMargin]

That would be the class of 2025 and the class of 2024 knew early enough to allow (some) schools to adjust their curriculum. I can tell you that the M1s I know are not working as hard as previous years (then again most will be able to pass since most USMDs average ~230 and even a slight drop from that won't have any real impact). But just like you/everyone said - work hard and you'll get to where you want to be.

I am definitely interested in the opinions of people going through the transition, so thank you very much. If I was to complete everything on time I would technically be class of 2025 starting in 2022.

I have a more broad question about the overlap of what you are taught as an M1/M2 and what you have to teach yourself for STEP 1 and STEP 2. I know a lot of it is probably school specific but in my case... With our curriculum I'd be taking STEP 1 in May of Year 2 which appears pretty typical, but STEP 2 would be taken only 6 months after that, whereas with most 4 year schools I've interviewed at, STEP 2 is usually taken a year after STEP 1. Do you have any thoughts on any of that?

 

[GoSpursGo]

I am definitely interested in the opinions of people going through the transition, so thank you very much. If I was to complete everything on time I would technically be class of 2025 starting in 2022.

I have a more broad question about the overlap of what you are taught as an M1/M2 and what you have to teach yourself for STEP 1 and STEP 2. I know a lot of it is probably school specific but in my case... With our curriculum I'd be taking STEP 1 in May of Year 2 which appears pretty typical, but STEP 2 would be taken only 6 months after that, whereas with most 4 year schools I've interviewed at, STEP 2 is usually taken a year after STEP 1. Do you have any thoughts on any of that?

We did this at my school (1.5yr preclinical, step 1 at ~2.5 years in, step 2 at ~3 years in). It worked fine.

If you're fortunate enough to have multiple acceptances, I still wouldn't base your school choice based on that. Bottom line, your step 2 score will by and large be dependent on your innate ability and your dedication to studying.

 

[Matthew9Thirtyfive]

I am definitely interested in the opinions of people going through the transition, so thank you very much. If I was to complete everything on time I would technically be class of 2025 starting in 2022.

I have a more broad question about the overlap of what you are taught as an M1/M2 and what you have to teach yourself for STEP 1 and STEP 2. I know a lot of it is probably school specific but in my case... With our curriculum I'd be taking STEP 1 in May of Year 2 which appears pretty typical, but STEP 2 would be taken only 6 months after that, whereas with most 4 year schools I've interviewed at, STEP 2 is usually taken a year after STEP 1. Do you have any thoughts on any of that?

My school takes step 2 4-6 months after step 1. It’s not a big deal.

 

[flapjack3d]

Didn't read the rest of the thread but based no your questions you could consider cancer rehab through PM&R. lot of fellowships starting up. hot area. great lifestyle, big impact, shorter training time, relatively "easy" (stats-wise) to get into.