Lifelong questions - First year hem/onc fellow about the present and future

[burgodelia]

Hi,

I always enjoy reading your guys' discussions even though I hardly ever post. I remember reading a bunch of posts during each phase of training. I finally made it and I'm a hem/onc fellow at a reputable university program.

1. Any advice on what to read for early fellowship? Attendings throw out a couple of studies daily for me to go over but I feel I need a foundation to build on before I go into these specifics. While I've learned a lot these past couple of months, I believe I still need basic knowledge in certain areas. There are some things which are mostly judgement based - dose reductions, schedules, premeds, etc.. Any insight?

- Washington manual?
- Bethesda manual?
- Blood and AJH have nice periodic reviews but some of the topics have not been reviewed in a couple of years now and some are advanced to a certain degree.
- Pharma reference?

2. Career discussion: I always thought I would be interested in academics. I like doing clinical research and I love education. Talking to some of the more senior fellows (from various institutions) and some junior faculty, academics has become harder. One junior faculty is leaving our institution to go to private practice. He was very forthcoming about his plans and told me that money had nothing to do with it. He outlined his life as a junior faculty as involving attending on a lot of inpatient services (consults and inpatient onc) while continuing with his clinic work (follow-ups, phone calls, etc). He also has his research and has grant deadlines and measures he has to fulfill to continue supporting himself. That that has put a strain on his personal life with him having kids and missing a lot on their activities and vacations. As I understand, private practice has its own challenges too associated with running a business - insurance company negotiations, hiring and firing, etc, but you get to be a partner eventually and you start off with double the income. Thoughts?

Thanks,

---

Members don't see this ad.

 

[gutonc]

Hi,

I always enjoy reading your guys' discussions even though I hardly ever post. I remember reading a bunch of posts during each phase of training. I finally made it and I'm a hem/onc fellow at a reputable university program.

1. Any advice on what to read for early fellowship? Attendings throw out a couple of studies daily for me to go over but I feel I need a foundation to build on before I go into these specifics. While I've learned a lot these past couple of months, I believe I still need basic knowledge in certain areas. There are some things which are mostly judgement based - dose reductions, schedules, premeds, etc.. Any insight?

- Washington manual?
- Bethesda manual?
- Blood and AJH have nice periodic reviews but some of the topics have not been reviewed in a couple of years now and some are advanced to a certain degree.
- Pharma reference?

As with all things, read what you need to know for the patients you're dealing with. The Blood "How I Treat" series is solid gold for heme stuff, even if a bit outdated.

But I've said it before and I'll say it again, you need 3 things to be a "good" oncologist:
UpToDate
NCCN Guidelines
Cancertherapyadvisor.com (It keeps changing names so this may no longer be correct)

2. Career discussion: I always thought I would be interested in academics. I like doing clinical research and I love education. Talking to some of the more senior fellows (from various institutions) and some junior faculty, academics has become harder. One junior faculty is leaving our institution to go to private practice. He was very forthcoming about his plans and told me that money had nothing to do with it. He outlined his life as a junior faculty as involving attending on a lot of inpatient services (consults and inpatient onc) while continuing with his clinic work (follow-ups, phone calls, etc). He also has his research and has grant deadlines and measures he has to fulfill to continue supporting himself. That that has put a strain on his personal life with him having kids and missing a lot on their activities and vacations. As I understand, private practice has its own challenges too associated with running a business - insurance company negotiations, hiring and firing, etc, but you get to be a partner eventually and you start off with double the income. Thoughts?

Everybody goes in thinking they want to do academics. Then they do it and it sucks. No shame in that.

But you should assume that the classic PP experience will no longer exist when you're done with training. It's still out there, but hospital employed and large multi-specialty groups are becoming the norm. That shouldn't really influence your thinking, but just be aware of it.

 

[burgodelia]

As with all things, read what you need to know for the patients you're dealing with. The Blood "How I Treat" series is solid gold for heme stuff, even if a bit outdated.

But I've said it before and I'll say it again, you need 3 things to be a "good" oncologist:
UpToDate
NCCN Guidelines
Cancertherapyadvisor.com (It keeps changing names so this may no longer be correct)

Everybody goes in thinking they want to do academics. Then they do it and it sucks. No shame in that.

But you should assume that the classic PP experience will no longer exist when you're done with training. It's still out there, but hospital employed and large multi-specialty groups are becoming the norm. That shouldn't really influence your thinking, but just be aware of it.

Thanks for the advice! I'll definitely keep that in mind.

 

[visari]

1) it's normal to feel overwhelmed by the amount of new stuff you have to learn. We've all been there no matter how well you think you're prepared for fellowship. Don't expect that you're gonna be there in 6 months or a year. It's a process. Just keep reading on patients (I think uptodate is an excellent source) and reading recent review articles can also be helpful.

2) academics vs private. we can go on for hours about that. I agree that academics is currently a pain in the ***. But academics is a loose term. do you mean being a physician-scientist running a lab?or write protocols and lead industry clinical trials? teach? work in a place with the name "university" attached to it? the levels of difficulty vary among the above but overall it needs a lot of dedication and you're gonna be very busy making less money. And save me the "money doesn't matter to me" because the difference is not subtle and it matters when you have big loans and a big family. I went into fellowship thinking only academics and here I am probably going to end up in a "hybrid" job which is basically PP for all that matters.

 

[burgodelia]

And save me the "money doesn't matter to me"

Prophylaxis right there!

Thanks..I guess.

If you wana elaborate about your "hybrid" job, feel free to do so. I'm just sitting here procrastinating because I got tired at staring at the stack of "to read" trials and papers I piled up in the last 3 months.

 

[visari]

Prophylaxis right there!

Thanks..I guess.

If you wana elaborate about your "hybrid" job, feel free to do so. I'm just sitting here procrastinating because I got tired at staring at the stack of "to read" trials and papers I piled up in the last 3 months.

by hybrid job I mean the job where you mainly work for a PP group which is affiliated with an academic place and you do have some minor role at the main institution but you're not under pressure to get grants or publish.

 

[gutonc]

If you wana elaborate about your "hybrid" job, feel free to do so. I'm just sitting here procrastinating because I got tired at staring at the stack of "to read" trials and papers I piled up in the last 3 months.

I have a "hybrid" job. I refer to it as "academish".

I work for the university but work out of an office that used to be a PP group that the University purchased 8 or so years ago (well before I joined the group, so I got none of that sweet 8 figure buyout package). We are also affiliated with another community hospital system in town that has it's own IM residency program.

I sit on committees at both hospitals. I have a fellow from the university with me half a day a week and a rotating resident from the community hospital another half day a week. I am PI on 4 clinical trials (1 through the university, 2 through the community site which has it's own research office and one of my own IITs). I get paid 80th %ile for academics and 30th %ile for PP for the region. I get paid salary+ RVU based bonus. I can pursue tenure if I'm so inclined but am under no pressure to do so. I get paid to move the meat (with a 0.1 FTE supplement for the numerous committees I sit on). I dreamed of a career with 90% of my time spent in the lab and as little time as possible in the clinic.

I love my job.

 

[drgrant]

I'm also a first year fellow and am feeling a bit overwhelmed and thinking of quitting or changing fields. I see the academic guys in our program being worked to the bone and it is pretty disheartening as I'd like to have some semblance of time for myself. In the hybrid/private world what is your sense of the work life balance. As an attending do you have to spend all your time at home reading papers to keep up?

 

[gutonc]

I'm also a first year fellow and am feeling a bit overwhelmed and thinking of quitting or changing fields. I see the academic guys in our program being worked to the bone and it is pretty disheartening as I'd like to have some semblance of time for myself. In the hybrid/private world what is your sense of the work life balance. As an attending do you have to spend all your time at home reading papers to keep up?

Again...I work in the office 3 days a week and take call 4 weekends a year. I read papers for about an hour a day, 3 or 4 days a week.

I was off yesterday. I got up late (7...late for me), took my kid to school, drank a bunch of coffee, went on a 2 hour bike ride, day drank, wrote a few notes, answered a few emails, played Ticket to Ride with my kid until bedtime, then read a few abstracts from JCO.

I've been asked to "come back to the mothership" on several occasions and the answer is always a firm and hearty "f*** no".