Is HemOnc becoming the most competitive medicine subspecialty?

[AmiSansNom]

I see a lot of unmatched candidates in Hemaonc this cycle unfortunately. Is HemOnc becoming the most competitive medicine subspecialty, edging out the traditional GI and Cards? Also, is HemOnc getting more lucrative than RadOnc and SurgOnc amongst candidates?

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[osprey099]

I see a lot of unmatched candidates in Hemaonc this cycle unfortunately. Is HemOnc becoming the most competitive medicine subspecialty, edging out the traditional GI and Cards? Also, is HemOnc getting more lucrative than RadOnc and SurgOnc amongst candidates?

It depends, but generally I would say yes

 

[gutonc]

Still not more competitive that GI or Cards. Still #3 or 4 (depending on how you do the math for the A/I match).

I think that the barrier to entry for Hem/Onc is much lower than Rad Onc and the lifestyle is infinitely better than Surg Onc. On a $/unit time invested basis, Hem/Onc is the clear winner.

 

[HemeOncHopeful19]

No.

Rad Onc prob easier to match and if you’re geographically flexible can still pay well for an essentially 0 call lifestyle

 

[osprey099]

No.

Rad Onc prob easier to match and if you’re geographically flexible can still pay well for an essentially 0 call lifestyle

Call is honestly not that bad for heme onc. Nothing compared to GI or cards. The only down-side of call is I get paid less for those days cause I'm not generating nearly as much revenue in the hospital compared to being in clinic

 

[ONC2023]

I like thinking heme onc is very competitive because it helps me feel better about matching at a program half way down my match list.

 

[HemeOncHopeful19]

Call is honestly not that bad for heme onc. Nothing compared to GI or cards. The only down-side of call is I get paid less for those days cause I'm not generating nearly as much revenue in the hospital compared to being in clinic

I'm not saying H/O is bad. GI is also not bad after fellowship btw. But let's be real, I'm not even sure our Rad Oncs have a call schedule lol

 

[MifflinDunder]

Rad onc is without a doubt a better lifestyle speciality. Being someone’s “primary oncologist” is a blessing and a curse.

Specialties like allergy/rheum/endo also don’t take hospital call. When you account for that, along with off hours work needed in heme-onc, the actual $/hr likely isn’t all that different.

 

[zealously]

I don't think so. According to the fellowship match data for this year, the match rate per specialty was:

GI: 65.0%
Cardiology: 66.3%
Allergy/Immunology: 69.0%
Heme/Onc: 72.8%
Rheumatology: 76.4%
Pulm/CC: 78.0%
Endocrinology: 81.7%
Nephrology: 93.5%
Infectious Disease: 95.1%

 

[MifflinDunder]

Call is honestly not that bad for heme onc. Nothing compared to GI or cards. The only down-side of call is I get paid less for those days cause I'm not generating nearly as much revenue in the hospital compared to being in clinic

It's not as intense as GI/Cardio but these guys are completely detached from inpatient duties once their call week ends. Are you? I get notified +/- asked for recommendations about my patients when they're admitted. Yeah these might not take long, but you're still ON. I even had patients get mad at me for not seeing them inpatient when I was off service.

 

[zealously]

This is an interesting chart that shows Hematology/Oncology as now the second most competitive IM subspecialty, if going by % of positions filled:

 

[HemeOncHopeful19]

That's a really poor marker for competitiveness IMO but go ahead and believe whatever ya wanna believe

 

[IMres85]

This is an interesting chart that shows Hematology/Oncology as now the second most competitive IM subspecialty, if going by % of positions filled:View attachment 395988

There’s no way rheumatology is that competitive unless there’s like 10 spots in the entire country

 

[dozitgetchahi]

There’s no way rheumatology is that competitive unless there’s like 10 spots in the entire country

It’s gotten more competitive than you might think…

 

[Warderino92]

A better marker is number of unmatched applicants imho.

 

[MifflinDunder]

There’s no way rheumatology is that competitive unless there’s like 10 spots in the entire country

Why not? People want lifestyle specialities in 2024.

 

[zealously]

A better marker is number of unmatched applicants imho.

If going by that metric, then the number of unmatched applicants per specialty this year is:

Cardiology: 627
GI: 377
Heme/Onc: 264
Pulm/CC: 158
Rheumatology: 79
Endocrinology: 79
Allergy/Immunology: 73
Nephrology: 22
Infectious Diseases: 16

Of course, this is confounded by the size of each respective fellowship.

 

[whoknows2012]

It is sort of irrelevant if it’s the most competitive 2nd most competitive or 3rd or whatever. As an APD of a large academic program I can tell you definitively based on which applicants are getting IVs how they’re ranked and how high/low we fall on rank list that things are getting way more competitive than 5-10 years ago. It’s not a one off, it’s year after year essentially besides one off immediate Post Covid year ….

This is n=1 (sort of) but suspect other programs are seeing the same trend

 

[gutonc]

It is sort of irrelevant if it’s the most competitive 2nd most competitive or 3rd or whatever. As an APD of a large academic program I can tell you definitively based on which applicants are getting IVs how they’re ranked and how high/low we fall on rank list that things are getting way more competitive than 5-10 years ago. It’s not a one off, it’s year after year essentially besides one off immediate Post Covid year ….

This is n=1 (sort of) but suspect other programs are seeing the same trend

But...are GI, Cards, Rheum, A/I, PCCM seeing the same?

However, I agree with you that it's a somewhat tedious academic (is that redundant?) argument. If it was the 37th most competitive specialty, I'd still want to do it, because it's what I want to do.

 

[whoknows2012]

But...are GI, Cards, Rheum, A/I, PCCM seeing the same?

However, I agree with you that it's a somewhat tedious academic (is that redundant?) argument. If it was the 37th most competitive specialty, I'd still want to do it, because it's what I want to do.

Probably yes! 😂

 

[bobow98]

It is sort of irrelevant if it’s the most competitive 2nd most competitive or 3rd or whatever. As an APD of a large academic program I can tell you definitively based on which applicants are getting IVs how they’re ranked and how high/low we fall on rank list that things are getting way more competitive than 5-10 years ago. It’s not a one off, it’s year after year essentially besides one off immediate Post Covid year ….

This is n=1 (sort of) but suspect other programs are seeing the same trend

Are you saying that you basically don't fall to rank #30+ to fill any more, you can fill a class of 5-7 fellows in the first 20 applicants you rank?

 

[whoknows2012]

Are you saying that you basically don't fall to rank #30+ to fill any more, you can fill a class of 5-7 fellows in the first 20 applicants you rank?

Yes. Some of that could of course be program specific to a degree but when you put it altogether (quality of applicants, where they’re ranked, where ranked applicants who don’t match end up etc) things are clearly more competitive.

 

[randomhemoncpd]

Yes. Some of that could of course be program specific to a degree but when you put it altogether (quality of applicants, where they’re ranked, where ranked applicants who don’t match end up etc) things are clearly more competitive.

50% percentile for # of ranked candidates to fill each spot was 4.0. It was 3.7 in 2023 and 3.5 in 2022.

 

[whoknows2012]

50% percentile for # of ranked candidates to fill each spot was 4.0. It was 3.7 in 2023 and 3.5 in 2022.

Interesting

 

[Splenda88]

If going by that metric, then the number of unmatched applicants per specialty this year is:

Cardiology: 627
GI: 377
Heme/Onc: 264
Pulm/CC: 158
Rheumatology: 79
Endocrinology: 79
Allergy/Immunology: 73
Nephrology: 22
Infectious Diseases: 16

Of course, this is confounded by the size of each respective fellowship.

I wonder who are these applicants that did not match nephrology and ID... IMG that has not completed a US IM residency are matching into nephrology these days.

 

[Splenda88]

But...are GI, Cards, Rheum, A/I, PCCM seeing the same?

However, I agree with you that it's a somewhat tedious academic (is that redundant?) argument. If it was the 37th most competitive specialty, I'd still want to do it, because it's what I want to do.

But these days, most (yes most) US students go by lifestyle, $$$, and prestige.

When locum GI docs are getting 5k/day at my shop, it's not a surprise that GI is extremely competitive.

 

[gutonc]

But these days, most (yes most) US students go by lifestyle, $$$, and prestige.

When locum GI docs are getting 5k/day at my shop, it's not a surprise that GI is extremely competitive.

That's pretty low TBH.

 

[Splenda88]

That's pretty low TBH.

Wow. What is a good rate? I was thinking that is insanely high.

 

[gutonc]

Wow. What is a good rate? I was thinking that is insanely high.

That's more or less the low end for what Hem/Onc locums makes. GI should be making more than that.

(To clarify, I should have said "that sounds pretty low" TBH)

 

[Splenda88]

That's more or less the low end for what Hem/Onc locums makes. GI should be making more than that.

(To clarify, I should have said "that sounds pretty low" TBH)

I guess I should have done hem/onc fellowship then.

 

[MD46]

Wow. What is a good rate? I was thinking that is insanely high.

Got offered 5500 a day with overnight phone call for 1000 a night, south west. Locum rate for 3 month attachment, no weekend call.

 

[checkpointinhibitor]

GI locums at my shop post covid (due to severe shortage) were getting 10K per inpatient shift -but they worked > 14 hrs.

 

[whoknows2012]

Routinely get offers for 4-5k per day.

 

[Splenda88]

Got offered 5500 a day with overnight phone call for 1000 a night, south west. Locum rate for 3 month attachment, no weekend call.

What type of overnight calls hemonc is getting?

 

[gutonc]

I guess I should have done hem/onc fellowship then.

For a lot of reasons. Money being only one of them.

 

[MD46]

What type of overnight calls hemonc is getting?

After 5pm, refills for pain meds, fevers, nausea etc. not many.
After midnight very rare, so pretty much a chill night for 1k.

 

[gutonc]

After 5pm, refills for pain meds, fevers, nausea etc. not many.
After midnight very rare, so pretty much a chill night for 1k.

Usually 5-8p is the worst in terms of volume but it's usually not anything dramatic. Overnight it's usually pretty slow unless you're covering a BMT or CAR-T floor. I always found 6-7am to be the hardest because all the night shift folks are trying to unload things in the ED and the floor and you also get patients calling in about their appointments for the day.

But I can count on 1 finger the number of times I went back to the hospital after leaving for the day in the 11 years I was in my last job. And that was only because the hospitalist flaked on me after initially agreeing and refused to admit the patient.

 

[Splenda88]

Usually 5-8p is the worst in terms of volume but it's usually not anything dramatic. Overnight it's usually pretty slow unless you're covering a BMT or CAR-T floor. I always found 6-7am to be the hardest because all the night shift folks are trying to unload things in the ED and the floor and you also get patients calling in about their appointments for the day.

But I can count on 1 finger the number of times I went back to the hospital after leaving for the day in the 11 years I was in my last job. And that was only because the hospitalist flaked on me after initially agreeing and refused to admit the patient.

The ones at my place don't get overnight calls. We admit and do all the other things for then (even prescribe narcs).

 

[gutonc]

The ones at my place don't get overnight calls. We admit and do all the other things for then (even prescribe narcs).

You take their outpatient calls? Calls from other hospitals? Calls from SNFs? Calls from the lab with critical values? Calls from the ED on people they're planning to send home but "want hem/onc on board"?

 

[Splenda88]

You take their outpatient calls? Calls from other hospitals? Calls from SNFs? Calls from the lab with critical values? Calls from the ED on people they're planning to send home but "want hem/onc on board"?

We dont take their outpatient calls.

We have one hospital for the whole county.

SNFs here send everyone to the ED for any issue.

They usually send patients with critical labs to the ED. "admit to hospital medicine."

ED docs here think it's a lot easier to "admit to medicine," and let the hospitalist sort things out the following day

 

[gutonc]

We dont take their outpatient calls.

We have one hospital for the whole county.

SNFs here send everyone to the ED for any issue.

They usually send patients with critical labs to the ED. "admit to hospital medicine."

ED docs here think it's a lot easier to "admit to medicine," and let the hospitalist sort things out the following day

Sounds like an ER problem.

But most of the after hours calls I get (got...I don't take call in my current job) are from patients. 5 or 6:1 in my last job.

 

[Splenda88]

Sounds like an ER problem.

But most of the after hours calls I get (got...I don't take call in my current job) are from patients. 5 or 6:1 in my last job.

It definitely is...

 

[osprey099]

If I don't make partner at my private practice, I'm planning to do locums. 6 month contract for 5k/day and take the other 6 months of the year off for vacation. Sounds pretty nice to me

 

[MifflinDunder]

Sounds like an ER problem.

But most of the after hours calls I get (got...I don't take call in my current job) are from patients. 5 or 6:1 in my last job.

Curious how this works. I'm seeing a lot of jobs these days with no-call. Does that mean you don't have to round in the hospital either?

 

[gutonc]

Curious how this works. I'm seeing a lot of jobs these days with no-call. Does that mean you don't have to round in the hospital either?

I think I've described my situation before, but I work for a large hospital system at a rural CAH in the system. I'm solo out here (although I hired a partner to join me next year) and there's no way I could take call 24/7/365. So after hours calls go to the large group in town (65 miles away) that cover a large urban and 2 smaller suburban hospitals. Because this is a CAH with 25 beds and minimal specialty support (no pulm, GI, nephro or specialty surgery) anything that would need me to come see the patient emergently also needs to be shipped to another hospital.

I do "round" on patients in the hospital but that works out to 3 or 4 visits a month at the most and the vast majority of them are social visits.

 

[ShuperNewbie]

^Also once you're an attending, some sort of weird switch flips in peoples' minds and folks don't call you all that much anymore and call just becomes a lot more bearable. I no longer get those "blood looks weird" type of questions in the middle of the night; those come to me in clinic (lol). Instead I get "This person is actively hemorrhaging and we need to go to emergency surgery but he has antiphospholipid syndrome and we don't know how to make sense of his PTTs" type of questions, which to be fair, are much less common

 

[gutonc]

^Also once you're an attending, some sort of weird switch flips in peoples' minds and folks don't call you all that much anymore and call just becomes a lot more bearable. I no longer get those "blood looks weird" type of questions in the middle of the night; those come to me in clinic (lol). Instead I get "This person is actively hemorrhaging and we need to go to emergency surgery but he has antiphospholipid syndrome and we don't know how to make sense of his PTTs" type of questions, which to be fair, are much less common

This is the thing I'm constantly having to convince senior fellows about. They just don't believe me until it happens. With few exceptions (there's always "that one dude" who calls from the ED or the floor about literally every abnormal lab) most of the BS magically evaporates once you finish fellowship and get out in the real world.

 

[HemeOncHopeful19]

This is the thing I'm constantly having to convince senior fellows about. They just don't believe me until it happens. With few exceptions (there's always "that one dude" who calls from the ED or the floor about literally every abnormal lab) most of the BS magically evaporates once you finish fellowship and get out in the real world.

GI is very similar in the community but people refuse to believe it

 

[gutonc]

GI is very similar in the community but people refuse to believe it

From my community GI friends, it's rare they have to come in overnight other than for a food impaction. But they would get a lot of "can you scope this dude in the morning, he's already halfway through the gallon of GoLytely" calls at 2am.

 

[HemeOncHopeful19]

From my community GI friends, it's rare they have to come in overnight other than for a food impaction. But they would get a lot of "can you scope this dude in the morning, he's already halfway through the gallon of GoLytely" calls at 2am.

I have a family member in GI who says she could cut down her call burden in half if there was an answering machine that said “Yes, you do have to finish the prep. Yes, seriously, you really do have to finish the prep! If this call is regarding any other question, please press 1…”