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what is the actual lifestyle of a hematologist/oncologist working in private practice. what is call like? how busy is it really?
thanks guys.
thanks guys.
lifestyle of heme-onc
- Thread starter dharmabum7
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I have a family member (future in-law) that is an M.A. for a Hem-Onc group in Las Vegas. She says they are really busy day-to-day in the office, and that isn't counting their hospital visits and such. However, word is that they take "at least" a week off per month. She said that the make a significant amount of $$...whatever that means? This is just at one group and I don't know how the averages play out.
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my cousin in illinois is a partner (practicing for 12 years), works at most 30 hrs/week for 10 months/year.. he has a lot of time to do things other than work.. he makes an unreasonable amount of money and loves his job.. i've followed him around a couple times and from the little exposure i have had i noticed that he was really loved by his patients and their families. i don't know if this helps or not.. but i thought i'd post anyways..
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The above poster is actually correct. Heme/Onc on average enjoy a fairly comfortable lifestyle. In fact this elusive fact has provided the impetus for a tremednous spike in applications to the discipline in the past two years, making the field tremendously competitive.
The backdrop of high compensation with increasing cure rates and treatments has made this one of the most competitive IM fellowships to obtain. Like GI, there are very few slots available to boot.
The backdrop of high compensation with increasing cure rates and treatments has made this one of the most competitive IM fellowships to obtain. Like GI, there are very few slots available to boot.
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Comfortable lifestyle dealing with terminal cancer patients? Are you friggen serious. Lifestyle should never enter the minds of these docs (I'm not calling for altruisim here, but its still fairly selfless to go into heme-onc), if they are to be any good at it. It takes a special person to deal with cancer patients. God bless em cause seeing that every day would break my heart.
Lifestyle, what a joke.
Lifestyle, what a joke.
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Thankfully I only have to do one month of ortho cases. Plenty of depressing things transpiring in every field of medicine everyday. Although I think very few (perhaps neurosurg or neurology) can equally compare to the daily exposure experienced in the field of oncology.
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someone in anesthesia should not preach lifestyle!!
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dharmabum7 said:
That's what I was thinking too! 10 yrs ago, when anesthesia was less lucrative then other fields, you couldn't pay people enough to start an anesthesiology residency because people just didn't think that the opportunities and lifestyle was out there. Seriously though, heme onc isn't all that different of a specialty from a lot of other fields. Patients die in every field of medicine, and there are significant psychosocial aspects of death that need to be dealt with in them too. The mortality of symptomatic heart failure is worse then some cancers! I've heard that some ~10% of patients on dialysis will die very year, and in pulmonary/critical care, I've heard that the mortality of patients in some ICU's is close to 70%. I agree that the general public tends to hear "cancer" and assume that it's a death sentence, but the avg lifespan after being diagnosed with cancer actually isn't all that different then a lot of diseases out there. The fact that there is a such a social stigmatism attached to cancer does mean that patients do oftentimes do need more education and empathy from their practioner to address their psychosocial needs though. And of course, the cancers that affect "young patients", particularly when people are in their "prime" and just starting life, are particularly devastating. As a side note, working with the "cancer" diagnosis actually protects a lot of heme/onc physicians out there from malpractice suits because jurors don't award that much money when they hear that the patient involved had "cancer" because most just assume that he would have died anyways. You don't see that with heart disease, even though heart disease is of course the biggest killer in this country.
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Under the new Medicare Reform Act recently passed, there will ultimately be a tremendous decline in the reimbursement for oncologists' administration of chemotherapeutics for cancer patients. Oncologists have, for many years, have been able to purchase chemotherapeutics from drug companies, often at significant markdown for group-rate purchases, then charged substantial mark-ups on the drug as they oversee the administration. This stands in direct contradiction to the laws governing physicians selling drugs and products in their offices (which is generally not permitted.)
Admittedly there are very significant differences between a physician's office selling a patient a course of Zithromax versus a chemo regimen. However, it is no surprise that the government, in its attempt to be fiscally prudent, is trying to pinch pennies (actually, more like millions) to ensure that other components of the Medicare Reform will be funded and enacted.
With new Medicare standards eventually in place, private insurers will most certainly fall into rank and lower their reimbursements for oncologist-administered chemo. If you are choosing Heme/Onc or simply Oncology for lifestyle/financial concerns, you may want to do a some additional research before doing so to be sure that this subspecialty is right for you...and for the right reasons.
Admittedly there are very significant differences between a physician's office selling a patient a course of Zithromax versus a chemo regimen. However, it is no surprise that the government, in its attempt to be fiscally prudent, is trying to pinch pennies (actually, more like millions) to ensure that other components of the Medicare Reform will be funded and enacted.
With new Medicare standards eventually in place, private insurers will most certainly fall into rank and lower their reimbursements for oncologist-administered chemo. If you are choosing Heme/Onc or simply Oncology for lifestyle/financial concerns, you may want to do a some additional research before doing so to be sure that this subspecialty is right for you...and for the right reasons.
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dharmabum7 said:
Touche my good man. I've watched many of my family members struggle with or die from cancer, so I have a bit of selection bias towards oncologists. I am headed towards critical care at this point, but I may change my mind. Hey see you at the surgicenter! You can park your Porche (designer plates: Kan$$er) next to my Humvee2 ($andmaN). Its the one with the 22inch spinners.
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Scarlet_Fire said:
Scarlett,
Your assesment about payment reform is somewhat acurate, but certainly not specific to heme/onc. Medicare is in crisis, and EVERY discipline will feel the punch. Most private oncologists DON't rely on chemo as their bread and butter, and will hardly feel a dent in their reimbursements if the practice is so structured.
Further, the relative dearth of oncologists will make it easier to affect reform in my opinion. As a tertiary care specialty, most oncologists I have worked with remain little concerned about how this might impact salary, which remain substantial.
Finally, as a frontier field with lots of new therapies coming out, heme/onc enjoys a healthy pipeline of drugs. This pipeline is the most important aspect as a lag exists between treatment options and tort reform.
Heme/oncs enjoy phenomenal lifestyles in terms of hours worked and call schedule. Seeing cancer patients is no different than seeing dialysis, critical care, or chf. In fact most of the latter have shorter life spans. CHF in particular is a very aggressive malignancy of the heart. Just look at the framingham data if you remain unconvinced. The main difference between Heme/Onc and other acute care disciplines is the stigma. This is rapidly changing as many many neoplastic diseases are becoming easier to cure and control.
The advice others point out by heme/onc in the field citing lack of competitveness is innacurate. I strongly suspect some of the non academic guys/gals are citing their own personal experiences, unaware of what has happened specifically in the past two years. Heme/Onc has become extremely competitive. In out program, application far outpaced gi and cardiology interest, something that initially baffled faculty. In fact, several residents went unmatched. Those that went unmatched applied to few programs with minimal research, despite exceptional numbers. Unfortunately they believed heme/onc was 'less competitive'. Getting into the field is not a cake walk, and the exceptional lifestyle and high compensation with the backdrop of very few spots will likely continue to make this a very difficult field to enter.
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VentdependenT said:
It may interest you to know that most academic or university hematologists/oncologists actually do quite a bit of critical care, as many hospitals have ceou. Further, many hospitals also have open door units, specifically extended to hematologists/oncologists, making access to clincal critical care substantial.
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VentdependenT said:
I noticed that you are either interested in or are going into anesthesia. It is interesting that you would callously mock a field that actually has a phenomenal lifestyle! You seem to be confusing the daily grind of dealing with sick patients as having a bad lifestyle.
Most people use 'lifestyle' to mean hours worked, hours a day, vacation time, call schedule, pager call etc... Using these parameters, I assure you heme onc is absolutely exceptional.
You will soon learn that your chosen field, anesthesia, has a particulalry horrific lifestyle. Most gas men continue to work resident like overnight hours well into their 50's, abrasively long cases staring at a mindless machinery, while being a slave to OR tech banter and surgeons. Our program had 5 residents switch out of anasthesia into medicine for this very reason. Heme/onc affords one to have a private practice much more readily while spending the night in one's own bed.
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You win Goofard Mcdoofas! I'll just have to do my best with my "horrific" bone cracking back wrenching life as an anesthesiologst. Keep racking in the bucks and kicken back taking care of those terminal breast cancer patients in accordance with your absolutely exceptional lifestyle.
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VentdependenT said:
Perhaps you enjoy being an idiot, or maybe you like being a hypocrite. I can't really tell which. I will try to make your logical flaws so obvious that even you, yes even YOU, can understand how stupid you sound.
*EVERY specialty in medicine deals with sick (or potentially sick) people. This is a given. If they weren't sick (or checking to see if they're sick) they wouldnt see a doctor.
*All doctors (some exceptions, Drs without Borders, etc, but 99% of the others) make money as compensation for their work. This includes anesthesiologists such as yourself. If people didnt need surgery, they wouldnt need to be knocked out. Your very livelihood depends on people getting sick. So by your own idiotic logic, your own specialty is making money off of sickness
*All doctors implicitly make money from sickness, just like all policemen implicitly make money from crime, firemen with fire, soldiers with war, etc. NONE of these individuals wants more of what they fight. So your accusations toward heme/oncs are completely irrational.
*Lifestyle relates to hours, pay, etc. As stated above, EVERY doctor is "racking in bucks" off of sick people, in the same way police, firemen, soldiers, etc are as well.
*What you are imply is that specialties that DONT deal with terminal illness and death should be viewed on as lifestyle specialties. So basically you look down on doctors for having the courage to face a disease that was once considered terminal automatically. You seem to prefer "lifestyle" specialties that dont deal with death. These are not mutually exclusive things as you make it out to be. And frankly, I respect a heme/onc who fights cancer a great deal more than some ***** anesthesiologist shooting his hypocritical mouth off on an anonymous messageboard.
*You said "You can park your Porche (designer plates: Kan$$er) next to my Humvee2 ($andmaN). Its the one with the 22inch spinners." So basically all you care about is lifestyle anyway, yet you hate on heme/oncs for actually having the fortitude to fight cancer. Does "irony" mean anything to you?
*Lifestyle is not mutually exclusive to taking care of patients. ER docs, ENTs, and opthos are generally considered to have lifestyle specialties as well, but by no means can one state that they care any less about their patients.
*STFU n00b
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guys, getting back to the original question...lets all take a breather and relax...and play it like fonzie...whats fonzie like guys?...
thats right, he's
when i meant lifestyle, i didn't mean so much money...really we are all in a profession where none of us will be starving...what i meant is hours you work and basically call you take...
many of the job listings i have seen in private practice heme onc still have q4 call...but is that a busy call? like do they really call you in the night...or would they call the internist first for most things?
"30" hrs/week? that can't apply to most heme-onc docs...i was thinking they worked more than that?!
thats right, he's
when i meant lifestyle, i didn't mean so much money...really we are all in a profession where none of us will be starving...what i meant is hours you work and basically call you take...
many of the job listings i have seen in private practice heme onc still have q4 call...but is that a busy call? like do they really call you in the night...or would they call the internist first for most things?
"30" hrs/week? that can't apply to most heme-onc docs...i was thinking they worked more than that?!
I respectfully disagree with the poster who wrote "You will soon learn that your chosen field, anesthesia, has a particulalry horrific lifestyle. Most gas men continue to work resident like overnight hours well into their 50's, abrasively long cases staring at a mindless machinery, while being a slave to OR tech banter and surgeons. Our program had 5 residents switch out of anasthesia into medicine for this very reason."
The residency is very tough, I completely agree (as someone in the family always tells me), but as an attending your life is very good. I am saying this only because mommy is an Anesthesiologist and daddy is a Cardiologist. Growing up, I see my mommy all the time, but my daddy I never saw. He comes home weird hours at night (I don't think he was cheating on mommy or anything), it's just that there are just so many people with sick hearts these days. He currently is still working these weird hours and at the same time saw his salary cut from $600k/yr to $400k/yr. Mommy works only four days a week now and is on-call about once a month. She makes okay money (300k/yr), but she gets home so early everyday, I remember. I simply choose not to go into IM because the attaining fellowship nowadays is just too competitive for my blood. If you don't subspecialize these days, good luck paying off your loans. I totally agree with the fact that Heme-Onc. is one of the more competitive fellowships to get out there these days. My buddy tells me that he is applying for this fellowship right at the beginning of his IM internship. It is just too competitive for my blood.
As for the statement about so many residents switching out of gas it has to do with being a resident. Go look at the Gas forum and see for yourself how many people are looking to go into gas from different residencies. I am very surprised myself as I always thought nobody wanted anesthesia.
I hope that no one on this forum will take offense to my post. I just wanted to bring some equilibrium into this forum. Please do not fight anymore, calm down all, we are here with the goal to help patients in which ever chosen specialty .
The residency is very tough, I completely agree (as someone in the family always tells me), but as an attending your life is very good. I am saying this only because mommy is an Anesthesiologist and daddy is a Cardiologist. Growing up, I see my mommy all the time, but my daddy I never saw. He comes home weird hours at night (I don't think he was cheating on mommy or anything), it's just that there are just so many people with sick hearts these days. He currently is still working these weird hours and at the same time saw his salary cut from $600k/yr to $400k/yr. Mommy works only four days a week now and is on-call about once a month. She makes okay money (300k/yr), but she gets home so early everyday, I remember. I simply choose not to go into IM because the attaining fellowship nowadays is just too competitive for my blood. If you don't subspecialize these days, good luck paying off your loans. I totally agree with the fact that Heme-Onc. is one of the more competitive fellowships to get out there these days. My buddy tells me that he is applying for this fellowship right at the beginning of his IM internship. It is just too competitive for my blood.
As for the statement about so many residents switching out of gas it has to do with being a resident. Go look at the Gas forum and see for yourself how many people are looking to go into gas from different residencies. I am very surprised myself as I always thought nobody wanted anesthesia.
I hope that no one on this forum will take offense to my post. I just wanted to bring some equilibrium into this forum. Please do not fight anymore, calm down all, we are here with the goal to help patients in which ever chosen specialty .
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Let it all out guys. Its healing time. Great post Glee. You definitely got that oh so subtle sarcastic remark about the Humvee. More bashing welcome as I am a masochist.
C
Catfish John
She makes okay money (300k/yr)
Wow, I guess everything IS relative.
Wow, I guess everything IS relative.
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Catfish John said:She makes okay money (300k/yr)
Wow, I guess everything IS relative.
That's what I was thinking.
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in a pitiful attempt yet again to go back to my original question...
what kind of hours do private heme-onc docs put in? how bad are their call nights? do they get time off?
thanks to anybody who replies.
what kind of hours do private heme-onc docs put in? how bad are their call nights? do they get time off?
thanks to anybody who replies.
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dharmabum7 said:in a pitiful attempt yet again to go back to my original question...
what kind of hours do private heme-onc docs put in? how bad are their call nights? do they get time off?
thanks to anybody who replies.
You have received several responses that have specifically answered your question. Beyond that, I'm not sure what you want.
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VentdependenT said:
Your not a masochist. Your posts however have the malodorous stench of ignorance and discomfort with chosen profession.
No one is trying to win or lose. That you seem to view this topic as an online boxing match is somewhat amusing, yet in the end, quite disturbing. I truly hope you truly enjoy the profession with the highest suicide rate, as it should suit your masochistic tendencies quite well.
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Sveet07 said:
.................
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Klebsiella said:
okay let me rephrase, do most of you guys concur with the 3 people who responded to the original question ... it seems that the responses don't really concur... i figure this is because it depends on the practice you are in?
so if anybody know people in this area, are the hours good in heme-onc? and if anybody can give their 2 cents on what the call is like when you are in private practice? again i appreciate all your input....
i'm sorry if i keep asking, i just want a few more opinions...
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Klebsiella said:
You win again Poofard Mcdoofas! What a truly compassionate physician you must be. Touting suicide rates, an amazing display of humanity from the good doctor! I applaud your wonderful posts sir. Congrats on expressing your supercilious disdain for the entire field of anesthesiology rather than just focusing your own personal distaste with me on me. A classy move and quite revealing, wouldn't you say?
I think you should run into the OR's and tell every anesthesiologist that they are all suicidal. That'll show us. Finally, I'm not sure how you concluded that suicide is tantamount to masochisim, but I won't dare argue with someone with such an absolutely exceptional lifestyle!
What was the OP's question again?
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VentdependenT said:You win again Poofard Mcdoofas! What a truly compassionate physician you must be. Touting suicide rates, an amazing display of humanity from the good doctor! I applaud your wonderful posts sir. Congrats on expressing your supercilious disdain for the entire field of anesthesiology rather than just focusing your own personal distaste with me on me. A classy move and quite revealing, wouldn't you say?
I think you should run into the OR's and tell every anesthesiologist that they are all suicidal. That'll show us. Finally, I'm not sure how you concluded that suicide is tantamount to masochisim, but I won't dare argue with someone with such an absolutely exceptional lifestyle!
What was the OP's question again?
why do you even take the time to type this cr@p?
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Bump...
Can anyone comment on the typical week of an AVERAGE heme/onc physician?
I realize that this varies tremendously, but is it possible to work 8-5 and be q4-5 or better call?
Thanks.
Can anyone comment on the typical week of an AVERAGE heme/onc physician?
I realize that this varies tremendously, but is it possible to work 8-5 and be q4-5 or better call?
Thanks.
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Just for example, seeing patients M/W/F, doing paperwork/phone calls T/Th. Doing call 1-2 x /week.
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I just completed a rotation with a heme/onc physician who works for a cancer care center with 6 other heme/onc docs, 4 rad/onc, and several surgeons.
The heme/onc guys are in the clinic from about 8am-6pm 4 days a week. They are on call for 7 days every 7th week, which means that they are rounding on all the group's hospitalized patients in the morning then seeing patients in the clinic after lunch, plus dealing with whatever calls/admits/etc. might happen in the afternoon or overnight.
About 80% oncology, 20% hematology.
Relationships with the patients are outstanding, they love you.
Don't know what the compensation is like.
The heme/onc guys are in the clinic from about 8am-6pm 4 days a week. They are on call for 7 days every 7th week, which means that they are rounding on all the group's hospitalized patients in the morning then seeing patients in the clinic after lunch, plus dealing with whatever calls/admits/etc. might happen in the afternoon or overnight.
About 80% oncology, 20% hematology.
Relationships with the patients are outstanding, they love you.
Don't know what the compensation is like.
Are you saying that this guy, for the most part, works 4 days a week?
So, compared to other IM specialties (GI, Cards), would you say Heme/Onc is the least stressful?
What are the job prospects for Heme/Onc?
Is the lifestyle of Heme/Onc comparable to RadOnc?
This post is factually incorrect. I am an administrator in Oncology and Hematology and do all of the purchasing of chemo. The reimbursement for chemo drugs was EXCLUDED from the health care reform bill entirely. And is also excluded from the SGR formula as well. Medicare moved to ASP plus 6% for reimbursement for drugs in 2003 and that hasn't changed since then.
This topic has a lot of twists and turns to it but this poster has no firsthand knowledge. Onc reimbursement HAS been decreasing for several years to be sure but that has nothing to do with Health Care Reform, which will bring more patients into the system at a time of rising overall cancer incidence.
This depends on the size of the practice. My friends at MD Anderson have minimal call. Docs in my practice rotate between themselves. However, I know one Hem Onc doc in another state who basically scripted management of neutropenic fever and chemo induced nausea and vomiting for int med docs that he employed to take all of his call, offering himself as 24/7 back/up. He gets about 2 calls per year and pretty much sleeps every night. His cost is about $150,000 per year to ensure he sleeps basically every night. There are different ways to skin the cat so to speak. The call is not particularly busy but it is somewhat stressful to take care of the terminally ill- perhaps draining is the better word, and it takes a special type of personality to be both compassionate as well as energy-maintaining.
Forget lifestyle. It doesn't matter how many days a week you work if you dislike what you do. It hurts just as much to work 4 days a week as 7 days a week if you come to dislike it.
Just pick a field because you really love it.
Just pick a field because you really love it.
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what if you love money
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True, but I bet that was the attitude of most neurosurgeons (I mean, they knew the lifestyle would be terrible going into it, right?), and look how satisfied they are:
http://www.biomedcentral.com/1472-6963/9/166/table/T3
I'm just a pre-med, but isn't it is possible to pick a field that appeals to one's interests AND allows one to maintain a comfortable lifestyle? Just because it sucks to do something you dislike doesn't mean you shouldn't even consider lifestyle. Like compensation, level of interest, type of patients seen, autonomy, amount of pressure/stress - lifestyle is another factor, and there's no reason it should be given 0 weight when making a specialty decision.
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It may be a small point, but keep in mind traditionally the major proven roles for chemotherapy are actually in the adjuvant or neoadjuvant setting. People do proof of concept trials in the sick & metastatic, but the eventual goal for most drug companies ideally is to find a role in the adjuvant population. Walk into an infusion center. The majority of patients receiving therapy in practice are not "terminal". Granted, if you aren't comfortable with death & dying, it is the wrong field for you. About 30 - 40% of your practice may be metastatic and another 20-30% relapsed /refractory, but with the drugs that are already on the market, these people on average are living a bit longer.
There will also be a lot less toxicity from XRT as people get better at IMRT and stereotactic techniques. I think one problem in onc (and others, like cards) that will become a big headache is pts complaining about drug cost.
There will also be a lot less toxicity from XRT as people get better at IMRT and stereotactic techniques. I think one problem in onc (and others, like cards) that will become a big headache is pts complaining about drug cost.
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I haven't had much heme/onc exposure yet. I was wondering, what procedures do they do? Is there a turf battle between them any other specialty (i.e. RadOnc)?
It is one the least procedural fields in medicine. There isn't a turf battle with other specialties.
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There's no turf to fight over. We give chemo. That's what we do. There are some (dangerous) surgeons who will give chemo but they're rare. And many of the Gyn Onc folks give their own chemo (which is fine with most of us). Quite honestly, the Rad Onc and Surgery folks are usually more than happy to hand their dying patients off to us.
As far as procedures go, you can do as few or as many as you like. The only things that we definitely do are bone marrow biopsies and LPs with intra-thecal chemotherapy. During training you will do more procedures (diagnostic and therapeutic thora- and paracentesis, diagnostic LP, maybe CVC placement) but once you're in practice the marrows and LPs with chemo are about all you need to do routinely and then only if you do a lot of leukemia or metastatic breast cancer.
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Lifestyle between these two fields are VERY different both during training and afterwards in practice. The heme service of any hospital is usually very busy and hectic with lots of patients, many of whom have acute issues. Hours are generally long. In terms of outpatient clinics, the volume of patients that you see is also significantly higher than compared to that in rad onc.
Heme/oncs like med oncs are internists by training so they tend to have to admit and deal with a lot more "medical issues" even if it's not related to their disease, making their practice a lot busier. The rad oncs tend to not admit but rather act as a consult service.
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This is the opposite of true.
Ok I ll bite. Why do you say that.
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What's the least stressful of the IM specialties then? Rheum? Allergy?
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Those are good.
I wouldn't call Hem/Onc high stress per se, but the fact that a large number of your patients is going to die (or in my case - I focus on pancreatic cancer and metastatic colorectal cancer - nearly 100%) no matter how heroic your actions can be emotionally exhausting. Depending on your coping abilities this could manifest as stress.
