I need advice regarding my options after not matching in heme-onc this year.

[Grilled_chicken]

I am a non-US IMG (non-visa requiring), currently PGY-3 in a NYC community program. I couple-matched at this program with my wife (US-IMG), and she applied to PCCM fellowship. Our experience in this NYC community program was less than ideal, so we both decided to do our fellowships outside of NY. We prioritized staying together, ended up only getting 3 IV each and ranked 1 program each because other programs were from NY (classic NYC community programs, including in-house). We both did not match. We still want to stay together, and are trying to prioritize one person to match first. I realize that I am not a very competitive applicant as I don't have any real oncology research (my in house heme-onc program does not have good research opportunities), and I do not have any connections. My scores in 24x, 25x, 23x respectively, (hopefully) have strong letters and no financial restrictions.
Following are the things that I am considering as a bridge to heme-onc fellowship:

1- IM hospitalist in a good academic place, where there is a strong research environment and I can hopefully participate in building up my pubs
2- Onc-hospitalist, which seems a bit harder to find.
3- There is a 1 year Non-ACGME oncology hospitalist fellowship offered at a good university program
4- Research fellowship (although I would prefer something more clinical).

I might come off as picky, and maybe I am being picky; however, given the environment at my institution, I would much rather wait a couple years, make myself a more competitive applicant, and then train at a better place than stay here and hate my life.

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[gutonc]

You are being picky, but that's OK. It's your life and career and you need to be happy with it. Recognize however that, by being as selective as you are, you may ultimately not wind up in hem/onc and you need to figure out what plan B looks like if that winds up being the case.

For your case, I would recommend one of the 1 year fellowships in BMT, Phase 1, etc that places like MDACC and other big cancer names do. That will get you the most clinical hem/onc experience, set you up for a good LOR or 2 and probably get you some research as well.

The 2nd best option would be a hospitalist job (oncology or otherwise) at an academic institution where you can spend your off time doing oncology research with someone at that institution. The oncology hospitalist job would be an easier transition to the research side, but it's not mandatory by any means.

The 3rd best option IMO is HPM fellowship which is also a year and has obvious close ties to hem/onc.

I would not do a research only fellowship and I wouldn't waste time an a hospitalist fellow (?!?!) as those sound like a good way for someone to pay you very little for you to do a lot of work for them, with very little upside for you.

 

[ShuperNewbie]

We both did not match. We still want to stay together, and are trying to prioritize one person to match first.

First off, I'm sorry that you did not match. It is a difficult and random process that by no means is a reflection on you nor your wife's achievements or abilities. If it is any consolation, I have 2 friends who have done exactly what you are about to do (did not match their first cycle and, on reapplication, were able to match at name brand institutions both). Congratulations on knowing what you want and choosing the best thing for you in this moment. I am proud of you for choosing to be a spouse above being an oncologist.

Secondly, congratulations on finishing residency, especially coming from an NYC community program, which are often not easy to complete (I personally do not think I could have made it through in NYC community residency; these are notoriously difficult and reflect the level of grit that you and your wife should be proud of). You are now, already, at your present state, more accomplished than 90% of the global population. With dual-medicine attending salaries in the household, you can cleanly enter the top 1% of income earners if you both desired.

I largely agree with what Gutonc has to say and that the above recommendations will probably give you the best shot at matching into an onc position next year.

However, my own personal bias would be towards option #1 -being an internal medicine hospitalist at a good academic place. My time as a hospitalist prior to being an onc fellow were some of the best years of my life. I stayed at an academic institution that paid me a reasonable rate but, more so, did not burn me out aggressively. With the week on week off shift work schedule, I was able to rediscover my passions and take some much-needed respite after residency while building a healthy savings account prior to starting a rigorous onc fellowship. It gave me the time to focus on being human again that was important to me. One might argue that a research fellowship or some other academic endeavor might offer similar time to focus on oneself, but the thing that being an academic hospitalist really gave me that these other options did not offer was perspective. It gave me the perspective that I did not need to be an oncologist in order to be happy. It taught me that even if I were to flame out and drop out of my fellowship or choose not to pursue fellowship out right, that the worst thing that would happen is that I would just be happy where I am. That is not a terrible thing. Let yourself be happy.

Not matching into fellowship can feel like the end of the world but I promise you, it is not. And I am not saying this just to you but to all of the other people who are browsing this forum and who did not match this cycle. You have all already gotten through the worst parts of your careers (so far at least). You are all already more successful than most people will ever be (just think of everyone you went to high school with) and that is something worth celebrating in and of itself.

The perspective that I got from being a hospitalist offered me a lot of comfort. And quite a few of my friends (4 of them at this point) who were offered fellowship positions at the ivoriest of towers ultimately realized through this experience that they were happy being General medicine doctors teaching residents and meds students and living their lives. Medicine is a great calling, one that you can be proud of, one that could fill a lot of holes in your life, but at the end of the day it is just a job and at best it only defines one facet of your character. None of us can choose for you what your path or life will ultimately look like, but I sincerely hope you are happy with whatever you choose

 

[HemOncCheng]

There are BMT programs that are seeking fellows, aka no fellows, but not sure whether they particularly want fellows out of genral hem/onc training already. I vote for the BMT or phase 1 fellowship if you can get one. There are lots of time before July.