Lifestyle of private practice heme/onc?

[iqureshi7]

I was wondering if anyone could fill me in on lifestyle of private practice heme/onc doctors. What are hours like,call,patient load. From what i heard there was a trend toward more outpatient work and having hospitalist manage c omplications. But from browsing job boards it seems most jobs have a 1:3 or 1:4 call ! I would appreciate any input. Thanks in advance.

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[gutonc]

I was wondering if anyone could fill me in on lifestyle of private practice heme/onc doctors. What are hours like,call,patient load. From what i heard there was a trend toward more outpatient work and having hospitalist manage c omplications. But from browsing job boards it seems most jobs have a 1:3 or 1:4 call ! I would appreciate any input. Thanks in advance.

Call doesn't necessarily mean being in the hospital admitting patients. Somebody has to answer those calls from patients at night and on the weekend. The call schedule will generally be based on the size of the pool of docs to draw from. If the group only has 3 docs, unless they share call w/ another group in the area, you're going to be 1:3 (whether that's days or weeks can depend on the group and how busy they are).

That said, even if you have hospitalists handling your middle of the night admits, the ER is still going to call you before admitting them, and there are some cases that you're just going to have to and see yourself, no matter how good your hospitalists are. Acute leukemics (esp those w/ leukocytosis) need to be seen by an oncologist ASAP while the N/V/ARF post-chemo can probably be taken care of by the hospitalist.

As for the other questions, many groups will let you tailor your hours and patient load to what you want to make. More patients = more Benjamins. If you want to work fewer hours/see fewer patients, that's not usually a problem (except in small groups) but you have to be willing to get paid less.

There's a group near me that has about a dozen docs in it. They have one guy who sees 60-70 patient a day plus rounds on 5-10 inpatients twice a day. He starts around 6a and usually leaves the hospital around 7 or 8p. One of his newer partners sees ~20 patients a day in clinic and rounds on hospitalized folks once a day (or more as needed). Guy 1 makes way more money, Guy 2 sometimes gets to see his wife and kids. You can usually choose which way you want to roll.

 

[staup]

Gutonc,
How is it possible to see 60-70 patients a day? Anyway, do you have any idea actually how much each guy makes?

thanks for any help.

 

[gutonc]

Gutonc,
How is it possible to see 60-70 patients a day? Anyway, do you have any idea actually how much each guy makes?

thanks for any help.

I have no idea how he does it. He triple and quadruple books 20 minute slots and apparently has a well-oiled back office machine going but I could never do it.

As for their salaries, I would say they range from $Plenty to $A Metric Crapload. Asking your colleagues how much money they make is kind of gauche.

 

[carrigallen]

There's a group near me that has about a dozen docs in it. They have one guy who sees 60-70 patient a day plus rounds on 5-10 inpatients twice a day.

I guess that's do-able...in an eight hour day, that is like 7 minutes per patient with no breaks in between. You would have to have like 6 rooms and massive support staff though.

 

[gutonc]

I guess that's do-able...in an eight hour day, that is like 7 minutes per patient with no breaks in between. You would have to have like 6 rooms and massive support staff though.

He usually has 3-4 rooms going and they're full all the time. I guess if you're moving that kind of meat, you can afford to pay the support staff it would take. Our faculty clinic usually has 2-3 MAs for 3-6 docs. I would bet that he has at least 2 MAs of his own. Again, not my bag but if he likes it and his patients can deal with it then more power to him.

 

[Reddpoint]

Gutonc,
How is it possible to see 60-70 patients a day? Anyway, do you have any idea actually how much each guy makes?

thanks for any help.

Thats exactly the type of person I want treating me when I have cancer.

 

[bkpa2med]

Thats exactly the type of person I want treating me when I have cancer.

I agree with you 100%. I can understand an FP or Internist trying to keep a tight schedule to be efficient in the patients that they see, but an oncologist? C'mon, reimbursement is better for them than the primary care folks. They need to kick it down a notch and improve patient care. For God sake, these patients have their life on the line and I think it's totally inappropriate to treat them like that.

 

[deltamed]

yeah that's kinda crazy.... most dermatologists leave at least 10 minutes per patient! 7 for a heme/onc pt seems sorta.... negligent.

 

[gutonc]

I agree with you 100%. I can understand an FP or Internist trying to keep a tight schedule to be efficient in the patients that they see, but an oncologist? C'mon, reimbursement is better for them than the primary care folks. They need to kick it down a notch and improve patient care. For God sake, these patients have their life on the line and I think it's totally inappropriate to treat them like that.

I think you underestimate the importance and difficulty of Primary Care and overestimate the importance and difficulty of Oncology.

Manage the symptoms (of the disease or the treatment), review the labs and imaging, sign the chemo orders that your nurse coordinator wrote for you, lather, rinse, repeat.

Onc is pretty cookbook once you get the diagnosis. You need NCCN.org and chemoregimen.com and you're in business. Once things get too dicey, a referral to the closest academic medical center and you're on to your 10:15.

 

[Reddpoint]

Onc is pretty cookbook once you get the diagnosis. You need NCCN.org and chemoregimen.com and you're in business. Once things get too dicey, a referral to the closest academic medical center and you're on to your 10:15.

Even if this was the case, my point is that an oncologist has a huge job helping patients deal with their illness. I cannot understand how someone could be interested in oncology if they did not want to help patients and their families to deal with the patient's diagnosis. If making money is the plan go into GI and scope a zillion people a day.

 

[carrigallen]

Even if this was the case, my point is that an oncologist has a huge job helping patients deal with their illness.

As gutonc mentioned, the key is your support staff. Pretend you are a patient. In a single visit, you are seen by an MA for 7 minutes, an experienced NP who you have a relationship with for 15 minutes, maybe also a social worker for 5-10 minutes. And good support staff means that patients can call the clinic can get their issues resolved over the phone, so planned patient visits aren't buried in a lot of unexpected issues.

Also oncology patients are usually being seen in followup by many other people - surgery staff, xrt, etc so it is a bit less likely for things to slip through the cracks.

 

[gutonc]

Even if this was the case, my point is that an oncologist has a huge job helping patients deal with their illness. I cannot understand how someone could be interested in oncology if they did not want to help patients and their families to deal with the patient's diagnosis. If making money is the plan go into GI and scope a zillion people a day.

Something else to understand is that there are 2 different kinds of people with cancer. Oncology patients and cancer victims. They may have exactly the same disease(s) and respond to therapy in exactly the same way but are completely different in every other way.

The oncology patients get their diagnosis, get their treatment and go on with their lives. The cancer victims get their diagnosis, get their treatment and then let their diagnosis and therapy completely rule their lives.

The first group of patients can be seen in a 5 minute visit every 2-6 weeks (whenever they need to be seen), the second group is what will keep you in clinic until 8p.

 

[texashemonc]

I usually see between 15-20 patients a day in my private practice although this past week it was a little over 20/day. I see 65% onc/35% heme.
I honestly don't see how anyone can see 60 patients in the office in a day, unless they are coding a level 1 visit, which i don't think any oncologist does. The most I've heard is 30 pts/day. Most likely this oncologist employs 1 or 2 PA or NP to see patients.
Usually there are also new visits, which take usually 30-60 minutes, as well as drop-in emergencies that occur on a daily basis.

I also round at least at 2 hospitals, which takes at least 2 hours/day. I leave my house by 6:45 am and don't usually get home until 8 or 9pm. And that is when I'm not on call!

I can honestly tell you its awfully hard to give bad news in a 15 minute period. Burnout is extremely common in this profession. Thank goodness my wife doesn't work (and she's a physician) and takes care of our kids.

 

[chief6124]

A lot of heme/onc docs see pt on chemo days which can be once a week. The schedule them for an office visit prior to getting chemo, thow a steth on their chest real quick and take advandage of a billling oppt. When you see a pt once a week the vist is fast, but still > 50 is near impossible.

 

[ghettomd]

Two of the attending physicians in my hospital regularly sees between 60-80 outpatients per day (they do only have 2 long clinic days a week). They have 3 full time PAs and a fellow, and will always see the patient after an initial assessment is done... they are in clinic for 10-12 hours, with a short note after one by fellow/PA.. its not the best approach but I have definitely seen it in person...

A lot of heme/onc docs see pt on chemo days which can be once a week. The schedule them for an office visit prior to getting chemo, thow a steth on their chest real quick and take advandage of a billling oppt. When you see a pt once a week the vist is fast, but still > 50 is near impossible.

 

[texashemonc]

I guess I could double my income by charging an office visit if I did that, seeing patients every time right before they got their chemo every week, but why?

I do know that some oncologists do that sort of thing taking advantage of the system, and the insurance companies can't do much about it.

Don't let me even get started about oncologists and epo shots, neulasta, and iron.

 

[hsans23]

mostly to texashemeonc; can a hemeonc in practice have a slightly more laid-back lifestyle if they choose the decrease in pay? i feel like i have read job ads describing 4-day work week practices with, say, qmonth weekend home call. this to me seems do-able (as a lady w family someday entering the field). is this kind of position out there and practical?

 

[drfunktacular]

mostly to texashemeonc; can a hemeonc in practice have a slightly more laid-back lifestyle if they choose the decrease in pay? i feel like i have read job ads describing 4-day work week practices with, say, qmonth weekend home call. this to me seems do-able (as a lady w family someday entering the field). is this kind of position out there and practical?

Yeah, I wonder this as well. I am interested in Heme/Onc patients and diseases, but I would prefer a 7a-5p average day to yours, and I'd be willing to take the pay hit for that even if it were disproportionate.

 

[texashemonc]

It is possible to work less hours in this profession but for the new doctors starting out often not feasible if trying to build up a new practice. For the older docs already with established referral base (surgeons, urologists) they can pick and choose who to see and often stay at just one office location and hospital.

It may be best to join a larger group with more shared call if lifestyle is an issue. There is so much more pressure in a small group of solo or 2 docs just in managing the business practice to keep income stream going and I do not recommend this. I do think that docs in small groups tend to abuse the system more as there is not as much accountability in their treatment plans.

Regardless, most days I feel as I'm always running around squashing fires. That's what private practice life as all about!

 

[OntheRoof55]

how much time in general is spent rounding on patients in the hospital? i know varies on how many patients are there...but in general? is this usually done after clinic in the evening? i am also considering this field as i like the patient population (also considering derm) but lifestyle is a major concern for me...

 

[texashemonc]

It depends on how many inpatients I have, how many new consults, and how many hospitals I go to. I try to see as many inpatients in morning before clinic, but it gets tough when there are 2 hospitals to go to and there are new consults to see. Also, I try to be thorough and look at scans of any new cancer pts before seeing them with the radiologists (who often are not there until after 8 or 9am) as well as review peripheral smears of any hematology cases. So it's usually a morning rush!

I try to see any urgent new consults that can't wait until next day after finishing clinic in evenings. That can be time consuming as usually at that hour there are always family around at that hour and it slows down rounding.

 

[staup]

In practice, how much critical care for oncologists do? How many oncologists function as the main doc for their patients when they reach the ICU? How common are open critical care units these days?

 

[gutonc]

In practice, how much critical care for oncologists do? How many oncologists function as the main doc for their patients when they reach the ICU? How common are open critical care units these days?

I would say it's rare and getting moreso. There are certainly still open ICUs out there but w/ the shift to hospitalists, even if an oncologist's patients are in the hospital, the hospitalist is more than likely the primary (since they're in-house) and the oncologist is a consultant. In practical terms, it's likely that the oncologist is largely running the show but should that patient end up in the unit and the unit is open, it's probably the hospitalist that will be the primary.

 

[staup]

Thanks... although I enjoy oncology, I am not a great fan of critical care and your answer helps me....

I still hope there is a way to not work super hard in private practice though.

 

[staup]

is there much critical care in the usual fellowship?

 

[gutonc]

is there much critical care in the usual fellowship?

Only insofar as most BMT patients can become unit players if you look at them funny. Obviously it depends on how the hospital(s) you work at are run but in both of our hospitals the ICUs are closed so once the decision is made to transfer to ICU, my job is sign-out, make disease specific recs and back the hell up to let the MICU team do their job.

I actually like CCM and toyed (very briefly) with the idea of doing an add-on crit care year at the end of my onc fellowship but it would strictly be for academic interest, I doubt that I will ever be primarily managing patients in the ICU again.

 

[staup]

So how hard is it to get an academic job at a good but not superb middle of the road place such as north carolina or virginia in hem/onc? Is it possible to get a good academic job coming from a non top 5 fellowship?