Q regarding Hem/Onc

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bla_3x

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If one is wanting to go into hem/onc in the future, is it a big benifit to do research in med school (non-cancer related)? Or could one look into getting a fellowship without doing med school research?
Also, would a dual degree in bioethics be of considerable help in getting a fellowship? How about taking a couple of electives in bioethics?

Is pediatric hem/onc very competitive?
Thanks all!

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Doing medical research is a benefit for all fellowship programs. Of course research in heme onc would be better for heme onc fellowships, but research in the basic medical sciences will help as well. The top academic fellowship programs are looking to train people who want to go into academics, and doing research just helps prove that you are interested in academics. Your undergraduate degree and curriculum won't matter for fellowship purposes. You should focus on getting into med school during undergrad. Pediatrics heme onc is done after completing a pediatrics residency, and it, like most peds fellowships, is not very competetive.
 
Thanks!

I am in med school right now (AZCOM) and I was really thinking about a dual D.O./Master's in bioethics degree. However, if this really wouldn't be a big help in getting a hem/onc fellowship then I could just stick to taking some bioethics elective classes.
 
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Residency programs, much less fellowships, will not know that you took "extra classes" unless your dean's letter or transcript states so (which I doubt they will). Even if they did, I don't think that taking the extra classes will help your CV, so I would only take the classes if you were really interested in them.
 
My wife is about to start her first junior faculty position after a Hem-Onc fellowship and an extra transplant year. Knowing dozens of current and former Hem-Onc fellows, I can tell you that less than half had significant research experience prior to residency and very few had been published. Most got a little taste of research with a Hem-Onc mentor during their IM residency. Again, few had been published. Getting a good Hem-Onc fellowship is nowhere as difficult as Cards or GI currently are. There is a lot of debate as to whether the lack of research background for successful applicants is due to the lack of a competitive process or to a lesser focus on bench research for the discipline in general.

The upshot? Research experience is almost never a bad thing. However, fellowship (and residency) directors know that the value a med student brings to a research project - at least in an intellectual way - is virtually nil. Running some gels and doing some cell culture work does nothing to tech one about the medicine to which it relates. If you know you want to eventually go into academics, though, knowing when you go in if you enjoy being a lab rat will make your future decisions a LOT easier.

Finally, the masters in ethics is nice, but nobody will really care. Take it from someone who spent four whole years getting a degree in medical ethics. It's a nice conversation piece for interviews, but it never actually comes in handy. Practical use of ethics in medicine has nothing to do with comparing and contrasting what philosophers/ethicists had to say on the issue.
 
Thank you guys for the thread. I, too, have an interest in Heme/Onc. Based on the discussion on this thread, if research is not as emphasized then is it safe to assume that letters of rec/connections are the key to getting a strong heme/onc fellowship? If not much is expected during your residency, then why aren't more people applying to the research pathway (combined residency/fellowship in Im/Heme-Onc)?
 
On the subject of heme/onc, does anyone know how the change in Medicare funding will affect oncologists? I've heard that reimbursements to doctors for chemotherapeutic agents will be decreased by the new Medicare bill. I know that many in the field are up in arms over this, and was wondering if anyone has any insight.

Thanks!!
 
Originally posted by rory1215
On the subject of heme/onc, does anyone know how the change in Medicare funding will affect oncologists? I've heard that reimbursements to doctors for chemotherapeutic agents will be decreased by the new Medicare bill. I know that many in the field are up in arms over this, and was wondering if anyone has any insight.

Thanks!!

That remains to be seen. I think that it's already having a pretty dramatic effect on many private practice heme onc docs, particularly those in small towns who give patients chemo agents in their office. Those who do other things to supplement their income (like bone marrow biopsies, hospital consults) may be better able to weather the changes in reimbursement. I read one article that had a oncologist saying that those drug sales in his office accounted for some 75% of his generated income though. Supposedly, medicare has increased reimbursement for services as a way to offset the difference, but the move was ultimately to save the government money which will ultimately come out of physician's pocketbooks. It's hurting patients too, because besides having to drive much further distances to get their chemo treatments, medicare is starting to cut back on spending for many of the experimental therapies that oncologists have been using as "last ditch" efforts, which will probably slow drug development as well.
 
Originally posted by Kalel
That remains to be seen. I think that it's already having a pretty dramatic effect on many private practice heme onc docs, particularly those in small towns who give patients chemo agents in their office. Those who do other things to supplement their income (like bone marrow biopsies, hospital consults) may be better able to weather the changes in reimbursement. I read one article that had a oncologist saying that those drug sales in his office accounted for some 75% of his generated income though. Supposedly, medicare has increased reimbursement for services as a way to offset the difference, but the move was ultimately to save the government money which will ultimately come out of physician's pocketbooks. It's hurting patients too, because besides having to drive much further distances to get their chemo treatments, medicare is starting to cut back on spending for many of the experimental therapies that oncologists have been using as "last ditch" efforts, which will probably slow drug development as well.

Well, let's not forget that a lot of this is in response to outright fraud in billing for outpatient chemo infusions. It's sad that the actions of a few criminals ends up hurting those docs who play by the rules (not to mention the effect on patients). One bright spot is that reimbursement for BMT/HSCT therapies for those who fail primary treatment modalities is on the rise.
 
That's so nice that you're able to associate the pain and suffering Hem/Onc patients go through, particularly those who undergo a BMT to a bright spot as a rise in reimbursement.

Maybe you should reconsider your career!
 
don't be an a$$, MS05'...

the topic of the previous few posts has been reimbursement in heme/onc, and increased reimbursement for BMT IS a bright spot...in the context of financial compensation.

i don't think Adawaal implied or otherwise indicated any sort of disrespect towards patients who undergo BMT.

try not to be so sanctimonious next time by bashing someone's possible career path over a thing like compensation...we all need to get paid. :rolleyes:
 
Actually, I'm going into Rad Onc, so it doesn't affect my practice in any way. My spouse happens to be a stem cell transplanter, so I guess I'm affected by proxy.

My point was that stem cell transplantation has historically been considered to be investigational and so was not covered by many if not most insurance plans. As it has now become standard of care for many hundreds of patients each year, it is nice that insurance companies are now extending coverage so that those not wealthy enough to afford a $75,000+ therapy will not see a lesser standard of care than rich folks.

If MS '05 did a little research into the topic, s/he would realize that a sizable proportion of patients with leukemias and myeloma in particular fail chemotherapy and would die without the benefits of BMT. In fact, for many of these hematological malignancies, BMT is the ONLY cure there is (as opposed to short- or long-term control of their disease state). Whether we're talking autologous, allogeneic (or now single or double cords) transplant, these techniques have become standard of care for those failing primary chemotherapeutics.

For the record, my spouse is in academics and will never profit from any changes in reimbursements anyway, despite the crass assumptions and comments by others. :rolleyes:
 
I've done plenty of research into BMT and the life saving modality it offers, you don't need to preach its necessity to me.

I'm also aware of the fact that insurance companies are somewhat more willing to pay for HSCT now, as you stated, but associating that to a rise in reimbursement is what was disheartening about your previous comment.

If you don?t want crass comments aimed your way, try making less insensitive comments.
 
I'm just curious...how is what Adawaal said in any way considered "insensitive"?

he was talking about reimbursements! next thing you know, people will be saying that surgeons are insensitive due to discussing billing for resection of a tumor that would otherwise kill a patient, or EMT's should feel bad about discussing payment about the guy they had to haul in/manage for a heart attack.

there's nothing insensitive about discussing reimbursements, whether it be for a kid's physical exam or an onc patient. and it's not like he's even blabbing this to the patient's face...it's a comment from a medical student/doctor to a medical student (i'm assuming from your name MS05').

lighten up! don't turn an innocent and benign comment into a poster statement for the politically correct right.
 
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