is hem/onc hospitalist after the fellowship a bad idea?

[caulfield830]

Hi, I'm a 3rd-year hem/onc fellow interested in continuing research after graduation. To make living (as I don't want to live off of a postdoc salary), is becoming a hem/onc hospitalist in my current institution a bad idea? I find inpatient work to be pretty easy (I still have a residency mindset I guess). I think my PI would be fine with me working 7 on 7 off(=research). Is this a downward spiral as I won't have enough time devoted to research, not get any grant and become unemployable in a couple of years? I would appreciate any inputs.

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[bobow98]

Sounds pretty rough to me. Most academic jobs = 2 days clinic, meaning 4 clinical days out of every 14 rather than 7. Factor in 6 weeks inpatient and 4 weekend calls, that's still under 3 days a week. 3/7 vs 7/14. You do the math and decide.

 

[caulfield830]

Sounds pretty rough to me. Most academic jobs = 2 days clinic, meaning 4 clinical days out of every 14 rather than 7. Factor in 6 weeks inpatient and 4 weekend calls, that's still under 3 days a week. 3/7 vs 7/14. You do the math and decide.

Thanks for the input.

 

[CatFactorial]

Don’t do it. You won’t have time for research, grants are hard to come by, and if you don’t get that K at the end, the time/work you put into it will have been for nothing. Last year I was in a similar situation and happily took the clinical route, despite a heavy research background.

 

[ChordaEpiphany]

Don’t do it. You won’t have time for research, grants are hard to come by, and if you don’t get that K at the end, the time/work you put into it will have been for nothing. Last year I was in a similar situation and happily took the clinical route, despite a heavy research background.

I'm an MD/PhD student thinking of pursuing this route. In general, do people still pursue K grants after fellowship? I'll be 39 by that time and the thought of still trying to secure funding after fellowship sounds exhausting. If you don't have your own lab, how on earth are you supporting your research? More post-doc'ing? What sort of position would you even take at that point?

I figure I'll apply for a K in my late 2nd/early 3rd year of fellowship and plan to bow out of research basically entirely if it doesn't work out. Is this the more normal route?

 

[caulfield830]

Don’t do it. You won’t have time for research, grants are hard to come by, and if you don’t get that K at the end, the time/work you put into it will have been for nothing. Last year I was in a similar situation and happily took the clinical route, despite a heavy research background.

Thanks, can you elaborate on what you mean by "took the clinical route" - you mean you took the 2 full-day clinical job and do research on the other days?

 

[caulfield830]

I'm an MD/PhD student thinking of pursuing this route. In general, do people still pursue K grants after fellowship? I'll be 39 by that time and the thought of still trying to secure funding after fellowship sounds exhausting. If you don't have your own lab, how on earth are you supporting your research? More post-doc'ing? What sort of position would you even take at that point?

I figure I'll apply for a K in my late 2nd/early 3rd year of fellowship and plan to bow out of research basically entirely if it doesn't work out. Is this the more normal route?

More post-doc'ing seems to be the answer, unfortunately. Some institutions pay you PGY salary, but there are places that want to pay you postdoc salary (30K lower in my institution) or not even that depending on your PI. Most don't have enough prelim data to apply for K in the late 2nd/3rd year of fellowship.

 

[aafisahar]

Heme/Onc hospitalist usually means tending to the chemoradiation dumps (nausea, vomiting, dysphagia, bleeding/clotting, FTT) or new cancer diagnosis (f/u outpatient). Is this a bone marrow job, because you might actually use your training at least. Otherwise, heme/Onc hospitalist is what an IM grad does to get to where you are right now.


Do you really want to write more retrospective junk in the hopes of doing an investigator led study or suck the teat of industry? Slaving away for 1/3rd the pay and working just as hard? Cash out homie.

 

[CatFactorial]

I'm an MD/PhD student thinking of pursuing this route. In general, do people still pursue K grants after fellowship? I'll be 39 by that time and the thought of still trying to secure funding after fellowship sounds exhausting. If you don't have your own lab, how on earth are you supporting your research? More post-doc'ing? What sort of position would you even take at that point?

I figure I'll apply for a K in my late 2nd/early 3rd year of fellowship and plan to bow out of research basically entirely if it doesn't work out. Is this the more normal route?

If you’re doing lots of research in fellowship, expect to be applying for funding as a fellow. T32 or if you can swing it, an F32. Also if your institution has institutional grants, definitely apply for those. Then in your 2nd/3rd year, a young investigator award from ASCO/ASH/ASTCT/other agencies. If you’re doing clinical research ASH CRTI or ASCO VAIL, the AACR snowmass thing, many other programs/grants/workshops. A K in 2nd or 3rd year is ambitious, YIAs are more plausible (though also hard to get).

When you’re done with fellowship and if you’ve been successful with the above alphabet soup (particularly if you can nail an F32), you’ll be in good shape to apply for a K08 or K23. My program has a pretty robust K12 that alot of junior faculty are on as well while they apply for K08/K23.

Note that if you‘re getting the above things, your research is probably pretty sexy and it won’t be too hard to keep adding more grants in a virtuous cycle. The (really) hard part is getting the first one.

Thanks, can you elaborate on what you mean by "took the clinical route" - you mean you took the 2 full-day clinical job and do research on the other days?

Postdoc 100% protected lab time (and PGY 7+ salary) vs 1 year clinical HCT year. While I miss the research, grants were too risky; opportunity cost of passing on an attending position is too high (plus I like clinical HCT).

 

[gutonc]

I'm an MD/PhD student thinking of pursuing this route. In general, do people still pursue K grants after fellowship? I'll be 39 by that time and the thought of still trying to secure funding after fellowship sounds exhausting. If you don't have your own lab, how on earth are you supporting your research? More post-doc'ing? What sort of position would you even take at that point?

I figure I'll apply for a K in my late 2nd/early 3rd year of fellowship and plan to bow out of research basically entirely if it doesn't work out. Is this the more normal route?

In short, yes. If you don't get K-style funding at the end of your fellowship (or 1 year after) and you don't have a super generous mentor (like HHMI level support) then you're basically never going to get off the post-doc hamster wheel.

 

[ChordaEpiphany]

In short, yes. If you don't get K-style funding at the end of your fellowship (or 1 year after) and you don't have a super generous mentor (like HHMI level support) then you're basically never going to get off the post-doc hamster wheel.

I imagined this was the case. With so many positions around it's really hard to look at a list of faculty and tell who's actually doing what, and who has room for advancement.

It seems like the main options upon failing to get a K-award or R01 are:
1) Go 100% clinical either in PP or employment
2) Take a hybrid academic job, which all seem to have a pretty distinct ceiling on pay and influence
3) Go into industry

Obviously not every tenure-track professor in all departments does lab research. Plenty of department chairs never even had a lab, and the majority of surgeons have never stepped foot in one. Is a fourth option, become a tenure-track professor without a lab doing primarily clinical/translational research? If so, what is that pathway like, and does the MD/PhD help in any regard?

 

[gutonc]

I imagined this was the case. With so many positions around it's really hard to look at a list of faculty and tell who's actually doing what, and who has room for advancement.

It seems like the main options upon failing to get a K-award or R01 are:
1) Go 100% clinical either in PP or employment
2) Take a hybrid academic job, which all seem to have a pretty distinct ceiling on pay and influence
3) Go into industry

Obviously not every tenure-track professor in all departments does lab research. Plenty of department chairs never even had a lab, and the majority of surgeons have never stepped foot in one. Is a fourth option, become a tenure-track professor without a lab doing primarily clinical/translational research? If so, what is that pathway like, and does the MD/PhD help in any regard?

In many (most?) places, this is actually the most common pathway for academic oncologists. I wouldn't say that the PhD helps, but it won't hurt.

Also, if maximizing compensation is your goal, a PP, production based job where you move the meat at top speed (like @HOIV is doing) is the way to go. If maximum influence is your goal, buckle up, because whatever path you take to get there (2, 3 and 4 are all ways to do it), that's a decade or 3 in the future for you.

 

[ChordaEpiphany]

Also, if maximizing compensation is your goal, a PP, production based job where you move the meat at top speed (like @HOIV is doing) is the way to go. If maximum influence is your goal, buckle up, because whatever path you take to get there (2, 3 and 4 are all ways to do it), that's a decade or 3 in the future for you.

Oh I'm well aware of this, but if influence weren't the goal (hard work, money, and burnout be damned) for a MD/PhD student, wouldn't it be kinda depressing? It would be like running into a teenage Republican 🤢🤮

When I play around with my retirement/savings/tax/compound interest calculator, option 1 starts to look very appealing. I've got another 10 years or so to sort out my priorities, but it's also nice to know that the bail out/fail out option at least has some extra tropical vacations built in.

 

[HoldTheCoffee]

To answer OP's original question, I would probably advise against it. That much inpatient time will almost undoubtedly affect your research (even 1 day of outpatient clinic per week can be a lot if you're going down a physician-scientist route). Not to mention that once you start the hospitalist gig, you're probably no longer seeing outpatients which is where the bulk of your clinical practice will be.

I'm an MD/PhD student thinking of pursuing this route. In general, do people still pursue K grants after fellowship? I'll be 39 by that time and the thought of still trying to secure funding after fellowship sounds exhausting. If you don't have your own lab, how on earth are you supporting your research? More post-doc'ing? What sort of position would you even take at that point?

You probably would need a K or something similar (ASCO CDA, Damon Runyon) in most instances unless your mentor(s) are willing to pony up some of their funds to cover your salary, or if your institution is ridiculously supportive. There really isn't a good answer IMO besides trying to find a well-funded and supportive mentor (unfortunately Venn diagram overlap for those isn't 100%). If you're unable to get any funding, my general sense is that you're usually SOL. Options are to lean more heavily into clinical research, or continue collaborating with a lab PI as their "translational" person in clinic. I've known people who've done those and are very happy with their current roles. Alternatively, I know a lot of people who are currently in this position and have gone into industry or are considering it. I'm in academics myself, so I can't speak to the industry path, but I do think we get brainwashed a bit into thinking academics is best when there is a whole world of other career opportunities for people with both clinical and science expertise. The people I know of who went into industry are also (currently) very happy, though to be fair they've only been doing it for a few years

 

[caulfield830]

To answer OP's original question, I would probably advise against it. That much inpatient time will almost undoubtedly affect your research (even 1 day of outpatient clinic per week can be a lot if you're going down a physician-scientist route). Not to mention that once you start the hospitalist gig, you're probably no longer seeing outpatients which is where the bulk of your clinical practice will be.



You probably would need a K or something similar (ASCO CDA, Damon Runyon) in most instances unless your mentor(s) are willing to pony up some of their funds to cover your salary, or if your institution is ridiculously supportive. There really isn't a good answer IMO besides trying to find a well-funded and supportive mentor (unfortunately Venn diagram overlap for those isn't 100%). If you're unable to get any funding, my general sense is that you're usually SOL. Options are to lean more heavily into clinical research, or continue collaborating with a lab PI as their "translational" person in clinic. I've known people who've done those and are very happy with their current roles. Alternatively, I know a lot of people who are currently in this position and have gone into industry or are considering it. I'm in academics myself, so I can't speak to the industry path, but I do think we get brainwashed a bit into thinking academics is best when there is a whole world of other career opportunities for people with both clinical and science expertise. The people I know of who went into industry are also (currently) very happy, though to be fair they've only been doing it for a few years

Thank you for your thoughtful response. You're right that I feel I may have been brainwashed into thinking that academia is the only way forward when in reality, there are a lot of MD/PhDs happy in other roles (industry, etc).

 

[causalinference]

I think it depends on what you want to do with your life. I am in my fourth year of fellowship and will be pursuing the hospitalist route. I want to stay in academics, and want the opportunity to work on research on the side, but don't want my job to depend on it. I also don't particularly want to deal with all the other issues that go along with having your own outpatient practice, even though the comp would be higher. There are pros/cons with any route you choose. I agree with others that hospitalitist is not a good idea if you want to be a researcher since you won't get enough protected time.

 

[ChordaEpiphany]

I am in my fourth year of fellowship

PSTP? I wasn't aware of any 4 year heme/onc fellowships.

 

[causalinference]

PSTP? I wasn't aware of any 4 year heme/onc fellowships.

BMT