Questions about Heme/Onc in practice

[maruchan]

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[gutonc]

Hey, MSIII here deciding between radonc and heme/onc, leaning towards the latter. Would appreciate insight into any of these few questions:

- I should do heme/onc rather than rad onc if I like _______________________

Working harder than necessary, being on call and rounding on the weekends.

Honestly, if you're smart enough to pass all the rad onc boards, you should do rad onc. Good for you for thinking about this while you still have a chance to choose.

- As an attending, how often are you on call? One week out of four?
- What does being on call entail? How often do you come in on the weekends, and for what?

This will differ from group to group. Don't get hung up on it. But here are 2 real world examples. My group has 12 docs and we cover 7 different hospitals. We split our call between weeknights and weekends. It works out to 2 weeknights a month and 4or 5 weekends (Friday 5p to Monday 8a) a year.

Nights involve a few phone calls. Weekends involve rounding wherever we have inpatients. Some weekends it's a couple of hours a day, some are 7 to 7 driving between 6 different hospitals.

As a counter example, a good friend of mine joined a small group of 3 docs. They do a classic call schedule of every 3rd week but have far fewer patients and only cover 1 hospital.

- How does the above differ between academics and private practice?

Dramatically.

- What percentage of cases do you treat palliatively, as opposed to for cure?

This question pisses me off. Nobody ever asks the pulmonologist how many of their COPD patients they treat curatively, or the cardiologist how many of their CHF patients they treat curatively. News flash...everybody dies. Some do it sooner than others. As an oncologist, a lot of your patients will die, many of them from cancer. You either figure out how to deal with that or you do rheumatology.

 

[maruchan]

Thanks!

 

[medgator]

This question pisses me off. Nobody ever asks the pulmonologist how many of their COPD patients they treat curatively, or the cardiologist how many of their CHF patients they treat curatively. News flash...everybody dies. Some do it sooner than others. As an oncologist, a lot of your patients will die, many of them from cancer. You either figure out how to deal with that or you do rheumatology.

It shouldn't. It's a legit question. Copd and chf are chronic diseases of malfunctioning organs. Cancer is an acute disease process that can sometimes end up being managed for years after is diagnosed when it recurs/persists etc, but in the early stages and certain locally advanced stages, it can be cured.

Rad onc and surg onc have their fair share of curative cases. In fact, pretty much every surgical case is usually "definitive." In radiation oncology, we probably have a 50/50 split.

Medical oncology treatment in solid tumors is mostly palliative unless you are sensitizing with radiation or giving adjuvant/neoadjuvant with surgery and/or radiation.

Leukemia/lymphoma/germ cell tumors are the exceptions to this, generally.

 

[haujun]

Good point. Also break down is not easy as black and white (cure vs palliative) as one patient can present with locally advanced tumor s/p surgery or definitive XRT for a cure and that same patient will come back one year with metastasis and the goal of care would then be palliative...Overall goal would be providing personal care to patient to improve quality of life. I have seen too many cancer that would relapse after 5 years...

 

[carrigallen]

I think the palliative vs. curative is a dismal simplification. No patients walk into the clinic asking for "palliative treatment only, please". Our goal is to help that patient live as long as possible. There are a lot of patients walking around with Stage 4 cancer who are in remission. Conversely, up to two-thirds of the locally advanced adjuvant or definitive cases will recur in a few years, depending on the tumor type. I think that patient outcomes usually depend on an important interaction with their socioeconomic situation, family support, and coping skills.

 

[medgator]

I think the palliative vs. curative is a dismal simplification. No patients walk into the clinic asking for "palliative treatment only, please". Our goal is to help that patient live as long as possible. There are a lot of patients walking around with Stage 4 cancer who are in remission. Conversely, up to two-thirds of the locally advanced adjuvant or definitive cases will recur in a few years, depending on the tumor type. I think that patient outcomes usually depend on an important interaction with their socioeconomic situation, family support, and coping skills.

Agree that there can be a spectrum, but upfront, you kinda have an idea of which way you are trying to go. You are going to try and cure those locally-advanced non metastatic patients upfront, and then obviously it becomes palliative if/when they recur or met out.