Oncology - low procedures field?

[todaystheday]

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Hi guys,

I'm an MS-2, and have started thinking more about potential career options, especially as we've started our clinical skills course. I've always kind of shied away from really procedural oriented specialties ... I haven't had direct experience yet, but a lot of the time, I feel like I have two left thumbs and would just be terrible at it. I recently shadowed my oncologist mentor, and actually really liked what I saw ... he seemed to spend more time talking to patients, reviewing tests, discussing therapy options etc. Is that the norm, i.e. is oncology generally a pretty low procedural field? Or did I just catch him on the wrong day? What other fields (minus psych!) are low on the procedures?

Also, while I am it, anyone else have the experience of feeling totally technically inept before going into rotations? Does that get better with experience/exposure?

Thanks!

 

[link2swim06]

Hi guys,

I'm an MS-2, and have started thinking more about potential career options, especially as we've started our clinical skills course. I've always kind of shied away from really procedural oriented specialties ... I haven't had direct experience yet, but a lot of the time, I feel like I have two left thumbs and would just be terrible at it. I recently shadowed my oncologist mentor, and actually really liked what I saw ... he seemed to spend more time talking to patients, reviewing tests, discussing therapy options etc. Is that the norm, i.e. is oncology generally a pretty low procedural field? Or did I just catch him on the wrong day? What other fields (minus psych!) are low on the procedures?

Also, while I am it, anyone else have the experience of feeling totally technically inept before going into rotations? Does that get better with experience/exposure?

Thanks!

A couple of thoughts. Only a M3 and haven't done a rotation in oncology.

However, to get to oncology you need to do internal medicine first. I know in internal med residency you will be doing things like central lines, paracentesis, thoracentesis, spinal tabs, etc.

Id think anyone who can type on a keyboard could be trained to do procedures. The way I see it is....if you hit 30+ keys with all your fingers quickly on a keyboard then you "technically have the aptitude." You may need more practice than others, but you certainly can learn.

If you include things like biopsies and joint injections then basically ever field besides psych has at least one procedure associated with it. Especially during your residency/training.

 

[evilbooyaa]

Agree with the above.

As for your last question, yes. Welcome to what M3 will be, at least for the first few weeks. You will be inept at notes and presenting H&Ps for a while. At my current rotation location, we aren't allowed to do procedures (like starting IVs, drawing blood, etc.) That's all for the nurses. While I am slightly concerned about not learning that stuff, many people have told me that it is pretty common in this day and age.

 

[45408]

A couple of thoughts. Only a M3 and haven't done a rotation in oncology.

However, to get to oncology you need to do internal medicine first. I know in internal med residency you will be doing things like central lines, paracentesis, thoracentesis, spinal tabs, etc.

Heme/onc would probably involve all the bone marrow biopsies too.

Id think anyone who can type on a keyboard could be trained to do procedures. The way I see it is....if you hit 30+ keys with all your fingers quickly on a keyboard then you "technically have the aptitude." You may need more practice than others, but you certainly can learn.

It's all in your head. Even the people who are "naturals" are still that good because of what's between their ears, not distal to their elbows. The most technically skilled surgeons I've worked with are the ones who know what to do and when, not someone who makes a lot of fancy looking maneuvers.

 

[UTKpremed]

The oncologist I shadowed for over a year basically did not do any procedures except bone marrow biopsies (via iliac crest). Those were done in his office with minimal sedation. It was a rare treat when he did do them. Although, like someone said earlier, to be in heme/onc you'll have to first do internal medicine for a few years. I've also been considering heme/onc pretty heavily but I'm a first year so my mind could change a million times. Good luck!

 

[deleted103644]

It's usually not hard to avoid procedures.

Many docs seek them out because they tend to be better reimbursed (for now at least).

 

[Bangersandmash]

I interned with a hem/onc last summer and the only procedure he did was bone marrow biopsies from the hip. Fairly straightforward and very mechanical (not technical). If he marked off where I needed to biopsy the bone marrow from on a patient's hip, I could have done it myself honestly (I didn't of course).

Nurses took care of chemo treatments and anything else.

 

[yuiness]

Nothing really to add, except to say that you shouldn't rule out procedure-heavy fields just because you feel like you're clumsy. Hand-eye coordination is something that is learned, and the people who are good at procedures are the ones that have practiced the most and done other similar things. It's all about developing your muscle memory and getting used to how things feel when you're doing it the right way. No one is born a surgeon-- that's why a surgical residency takes so long.

 

[drizzt3117]

You do LPs in heme/onc too.

 

[michaelrack]

You do LPs in heme/onc too.

My guess is that in private practice many heme/onc attendings would consult out the LP's (to Neurology or Radiology, perhaps to neurosurgery in certain cases)

 

[drizzt3117]

My guess is that in private practice many heme/onc attendings would consult out the LP's (to Neurology or Radiology, perhaps to neurosurgery in certain cases)

Idk, they do them in clinic for administration of interthecal methotrexate; I know IR does some hard ones but heme does some even in PP.

 

[CaptainSSO]

Idk, they do them in clinic for administration of interthecal methotrexate; I know IR does some hard ones but heme does some even in PP.

intrathecal

 

[VenusinFurs]

Hi guys,

I'm an MS-2, and have started thinking more about potential career options, especially as we've started our clinical skills course. I've always kind of shied away from really procedural oriented specialties ... I haven't had direct experience yet, but a lot of the time, I feel like I have two left thumbs and would just be terrible at it. I recently shadowed my oncologist mentor, and actually really liked what I saw ... he seemed to spend more time talking to patients, reviewing tests, discussing therapy options etc. Is that the norm, i.e. is oncology generally a pretty low procedural field? Or did I just catch him on the wrong day? What other fields (minus psych!) are low on the procedures?

Also, while I am it, anyone else have the experience of feeling totally technically inept before going into rotations? Does that get better with experience/exposure?

Thanks!

Procedures take confidence/ knowing the steps/ practice. That is all.

 

[michaelrack]

Idk, they do them in clinic for administration of interthecal methotrexate; I know IR does some hard ones but heme does some even in PP.

good to know;does heme/onc use any type of fluoroscopic guidance?

 

[DrVanNostran]

Off topic, but I've always been curious know why H/O is reimbursed so well in comparison to the other non-procedure fields? It's obvious why GI/Cards are paid well. I wonder if the complexity of H/O patients, volume, or political reasons play a major role...

 

[Sheldor]

Off topic, but I've always been curious know why H/O is reimbursed so well in comparison to the other non-procedure fields? It's obvious why GI/Cards are paid well. I wonder if the complexity of H/O patients, volume, or political reasons play a major role...

It has to do with how they are reimbursed for infusions of Chemo. Right now, giving chemo pays very well but this is likely to change with healthcare reform.

 

[drizzt3117]

good to know;does heme/onc use any type of fluoroscopic guidance?

Nope. That's all IR.

 

[deleted103644]

It has to do with how they are reimbursed for infusions of Chemo. Right now, giving chemo pays very well but this is likely to change with healthcare reform.

Thought that had already changed?

It had always sounded a bit sketchy - docs getting a percentage of cost of expensive chemo meds.

 

[KinasePro]

It had always sounded a bit sketchy - docs getting a percentage of cost of expensive chemo meds.

Agreed. I heard rheum docs have a similar set up. The idea def sounds sketchy from a distance.

 

[ArcGurren]

It has to do with how they are reimbursed for infusions of Chemo. Right now, giving chemo pays very well but this is likely to change with healthcare reform.

All fields of medicine are going to take a hit to some degree with the healthcare laws (Cardiology has already taken a hit, GI has somehow been spared for the most part though not entirely, Neurosurgery/ortho spine are going to get whacked a bit, and Radiology already has taken quite a beating).

 

[link2swim06]

Non-primary care areas of medicine are going to take a hit to some degree with the healthcare laws (Cardiology has already taken a hit, GI has somehow been spared for the most part though not entirely, Neurosurgery/ortho spine are going to get whacked a bit, and Radiology already has taken quite a beating).

Fixed that for you.

 

[ArcGurren]

Fixed that for you.

Primary care isn't really benefiting all that much either

 

[link2swim06]

Primary care isn't really benefiting all that much either

Nearly every year for the past decade their (PCPs) gross pay has been increased. Considering the movement is to get "more people in primary care" the pay for primary care is likely to continue to rise even with obama care.

I don't foresee a PCPs eclipsing cardiologist's pay anytime soon...but the there is an objective upward trend in pay recently.