Inpatient-only oncology positions

[colognecancer]

Some academic centers now have oncologists who focus exclusively on inpatient care, e.g., this group at DFCI: Oncology Hospital Medicine (Inpatient Care) - Dana-Farber Cancer Institute | Boston, MA. I am wondering if taking such a position straight out of fellowship could potentially be a career-limiting move. For example, if I wanted to do inpatient-only oncology for a few years then move into a more traditional outpatient heme/onc role later on (either in academia vs. community), would it be detrimental to take a position like this because inpatient oncology is a niche role and my outpatient heme/onc experience may be rusty by then? Thanks for your thoughts.

---

Members don't see this ad.

 

[whoknows2012]

Some academic centers now have oncologists who focus exclusively on inpatient care, e.g., this group at DFCI: Oncology Hospital Medicine (Inpatient Care) - Dana-Farber Cancer Institute | Boston, MA. I am wondering if taking such a position straight out of fellowship could potentially be a career-limiting move. For example, if I wanted to do inpatient-only oncology for a few years then move into a more traditional outpatient heme/onc role later on (either in academia vs. community), would it be detrimental to take a position like this because inpatient oncology is a niche role and my outpatient heme/onc experience may be rusty by then? Thanks for your thoughts.

I run the inpatient leukemia service at my large academic center. I too had concerns about being pigeon holed by doing inpatient only and it’s a risk benefit calculation you have to make yourself. I love my job and wouldn’t trade it for any outpatient position but it’s definitely something to consider before taking an inpatient only position.

A couple pieces of advice that were given to me;

1) taking care of complicated inpatient oncology patients could potentially be seen as a plus given the clinical experience and presumably excellent clinical care you would be able to provide were you to switch to an outpatient position

2) if you do take an inpatient position make sure you are constantly re assessing your career goals so you don’t miss an opportunity to pivot should one arise.

For me two opportunities to pivot to a more traditional leukemia gig have arisen and I’ve turned them down

 

[Mehena]

Yes, currently it makes a perfect sense to have and be able to run inpatient leukemia service. IMHO i see no meaningful purpose for a certified oncologist to run inpatient oncology service on daily basis.

Pre fellowship i've worked for a hospitalist group which handled all admitted patients for a local busy oncologist group and i don't recall many clinical or logistical issues that required significant input from the oncologist. Between admission and discharge, most of the patient cases required no oncologist input.
May be DFCI have too many Sarcoma or SCLC patients requiring inpatient chemo or HD IL-2 treatment ?

 

[Art Nostrand]

If you are working for short term ( 1-2 years) I think that can be a fair , however longer than that it can turn to be frustrating, overwhelming and not rewarding , remember none of the patients you are seeing are yours so you don't establish that good relationship and you will act often as middleman for primary oncologists. That's my thoughts.

 

[gutonc]

Makes total sense for leukemia/BMT/Cell Therapy to have dedicated inpatient oncologists. Leukemia and other high grade heme malignancies remain inpatient diseases, despite CMS's efforts to the contrary.

Even in a Sarcoma Center of KillMeNow Excellence however, it's completely ridiculous to do this for any solid tumor. In our (actual, real life) sarcoma center, they have stopped even having an inpatient solid tumor admitting service and all chemo patients go the the hospitalists with the sarcoma attendings writing the chemo and rounding on the patients with the fellows and/or the sarcoma PA.

So, if you want to be a leukemia/BMT/Cellular Therapy doc, then an inpatient-only gig may be a reasonable way to go. For anything else, forget it.

 

[whoknows2012]

Makes total sense for leukemia/BMT/Cell Therapy to have dedicated inpatient oncologists. Leukemia and other high grade heme malignancies remain inpatient diseases, despite CMS's efforts to the contrary.

Even in a Sarcoma Center of KillMeNow Excellence however, it's completely ridiculous to do this for any solid tumor. In our (actual, real life) sarcoma center, they have stopped even having an inpatient solid tumor admitting service and all chemo patients go the the hospitalists with the sarcoma attendings writing the chemo and rounding on the patients with the fellows and/or the sarcoma PA.

So, if you want to be a leukemia/BMT/Cellular Therapy doc, then an inpatient-only gig may be a reasonable way to go. For anything else, forget it.

Yes I highly recommend against doing this for solid tumor oncology. It’s pretty grueling and not fun nor worth it IMO unless as mentioned above you were thinking along the lines of heme malignancies/bmt

 

[dieABRdie]

Some academic centers now have oncologists who focus exclusively on inpatient care, e.g., this group at DFCI: Oncology Hospital Medicine (Inpatient Care) - Dana-Farber Cancer Institute | Boston, MA. I am wondering if taking such a position straight out of fellowship could potentially be a career-limiting move. For example, if I wanted to do inpatient-only oncology for a few years then move into a more traditional outpatient heme/onc role later on (either in academia vs. community), would it be detrimental to take a position like this because inpatient oncology is a niche role and my outpatient heme/onc experience may be rusty by then? Thanks for your thoughts.

If you can handle full inpatient oncology only... you can handle outpatient oncology no problem. As a medical student I only saw the inpatient side of heme/onc. Where I practice now it is almost entirely outpatient and is a VERY different world.

 

[caulfield830]

In my fellowship, I saw a hem/onc doc practicing solid onc inpatient for three years, then transitioning to a private practice onc outpatient job in the same area (practice affiliated with the mothership). It seemed transitioning to outpatient was not that difficult... But I don't know if employers see the inpatient-only experience as a negative.

 

[gutonc]

In my fellowship, I saw a hem/onc doc practicing solid onc inpatient for three years, then transitioning to a private practice onc outpatient job in the same area (practice affiliated with the mothership). It seemed transitioning to outpatient was not that difficult... But I don't know if employers see the inpatient-only experience as a negative.

I wouldn't see it as a negative per se. But I'd assume you were basically at the level of a newly graduated fellow in terms of outpatient management.

 

[whoknows2012]

Does inpatient oncology (NOT oncology hospitalist) = less income?

Not necessarily. At my institution the starting pay by level is actually a bit more for inpatient only. Also billing potential is much higher if not on a standard hospitalist schedule and if billing bonuses are offered that could lead to more pay….