Regrets about heme/onc?

[mleick]

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I was hoping to get some insight from the community on the choice of Heme/onc as a career. I'm an MS3 with a strong research background in oncology starting during undergrad and continuing through medical school and have done very well this year and on step 1 and have always thought that I would pursue oncology as I find the research/genomics/molecular biology and rate of change in the field the most interesting in medicine.

However, in talking with some of the 2nd and 3rd year onc fellows at my institution and seeing some of the attendings at the major centers (including Anderson) -- I feel like many of them are not that happy and feel very overburdened and undercompensated. The intellectual stimulation of the field actually seems to be insufficient to mitigate these other problems (my interest in onc has always been in academics regarding clinical trials and new drugs and in my mind if I do private practice oncology, I might as well pick a different field because it seems they are so disparate). Basically I just wanted SDN's opinion on whether or not academic heme/onc and the relatively low pay (after 6 years of post graduate training) is worth it... or if you could- would you go back and pick something like say Radiology, Plastics, Derm, etc. Thanks in advance for your insight.

 

[TKib]

IMO, a lot of physicians in many different specialties/subspecialties are dissatisfied.

 

[gutonc]

I was hoping to get some insight from the community on the choice of Heme/onc as a career. I'm an MS3 with a strong research background in oncology starting during undergrad and continuing through medical school and have done very well this year and on step 1 and have always thought that I would pursue oncology as I find the research/genomics/molecular biology and rate of change in the field the most interesting in medicine.

However, in talking with some of the 2nd and 3rd year onc fellows at my institution and seeing some of the attendings at the major centers (including Anderson) -- I feel like many of them are not that happy and feel very overburdened and undercompensated. The intellectual stimulation of the field actually seems to be insufficient to mitigate these other problems (my interest in onc has always been in academics regarding clinical trials and new drugs and in my mind if I do private practice oncology, I might as well pick a different field because it seems they are so disparate). Basically I just wanted SDN's opinion on whether or not academic heme/onc and the relatively low pay (after 6 years of post graduate training) is worth it... or if you could- would you go back and pick something like say Radiology, Plastics, Derm, etc. Thanks in advance for your insight.

This sounds like frustration with academics, not hem/onc. And I'll say that, given the current research funding environment and the trend toward doing a year or 2 as a super-fellow or instructor, this is only going to get worse.

And no, there is no way in hell I'd go back and do Derm, Plastics, Rads, Gas, EM, whatever. If I'd had the scores (and the brains), maybe Rad Onc.

 

[texashemonc]

Private practice hem/onc has gotten more stressful in last few years, especially with Medicare changes and drug reimbursement losses. Much worse than other specialties as we actually lose money on purchasing the drugs at our loss. For example, Just other day a Medicaid pt. forgot to renew her insurance and now the insurance won't pay for the costs of the last 3 chemo treatments. That is $20k down the drain. And now with new healthcare initiative more pts are signing up for Medicaid which pays piddly. So we will lose money on any new Medicaid pts I see. When there is financial pressure docs will do anything to recoup. So I do see lots of docs giving more weekly chemotherapy, neupogen shots, billing for more frequent visits. But one has to be careful as the Medicare auditors are out there in full force. One doc I know is in big trouble over a couple of million dollars in overbilling for hospital consults.
My advice is go into another field like derm or radiology.

 

[bronx43]

Private practice hem/onc has gotten more stressful in last few years, especially with Medicare changes and drug reimbursement losses. Much worse than other specialties as we actually lose money on purchasing the drugs at our loss. For example, Just other day a Medicaid pt. forgot to renew her insurance and now the insurance won't pay for the costs of the last 3 chemo treatments. That is $20k down the drain. And now with new healthcare initiative more pts are signing up for Medicaid which pays piddly. So we will lose money on any new Medicaid pts I see. When there is financial pressure docs will do anything to recoup. So I do see lots of docs giving more weekly chemotherapy, neupogen shots, billing for more frequent visits. But one has to be careful as the Medicare auditors are out there in full force. One doc I know is in big trouble over a couple of million dollars in overbilling for hospital consults.
My advice is go into another field like derm or radiology.

Radiology? This isn't even a case of "the grass is greener." This is a case of "I think I heard 5 years ago that the grass may be greener." I would pick heme/onc over rads any day of the week and twice on Sundays, given no difference in interest level.

 

[Shah_Patel_PT]

I was hoping to get some insight from the community on the choice of Heme/onc as a career. I'm an MS3 with a strong research background in oncology starting during undergrad and continuing through medical school and have done very well this year and on step 1 and have always thought that I would pursue oncology as I find the research/genomics/molecular biology and rate of change in the field the most interesting in medicine.

However, in talking with some of the 2nd and 3rd year onc fellows at my institution and seeing some of the attendings at the major centers (including Anderson) -- I feel like many of them are not that happy and feel very overburdened and undercompensated. The intellectual stimulation of the field actually seems to be insufficient to mitigate these other problems (my interest in onc has always been in academics regarding clinical trials and new drugs and in my mind if I do private practice oncology, I might as well pick a different field because it seems they are so disparate). Basically I just wanted SDN's opinion on whether or not academic heme/onc and the relatively low pay (after 6 years of post graduate training) is worth it... or if you could- would you go back and pick something like say Radiology, Plastics, Derm, etc. Thanks in advance for your insight.

I am looking for a job now. jobs are abundant all over the country with good compensation depending on where you want to live. I would do it any day than suffer like the primary docs that are slowly getting replaced by extenders.

 

[bronx43]

I am looking for a job now. jobs are abundant all over the country with good compensation depending on where you want to live. I would do it any day than suffer like the primary docs that are slowly getting replaced by extenders.

PCPs aren't being replaced by extenders more than any other field. The PCP job market is easily the best there is in medicine, so I don't even see how your logic follows.

 

[tallash]

PCPs aren't being replaced by extenders more than any other field. The PCP job market is easily the best there is in medicine, so I don't even see how your logic follows.

Bronx43, you've been totally on point with these last two comments. A tip of the hat to you.

 

[DIce3]

Heme/Onc is pretty saturated compared to other fields, averaged across the US.



http://chws.albany.edu/archive/uploads/2013/03/nyexitsurveyreport2013.pdf

see page 11

 

[mason]

Thanks for that resource.

Though a little surprised that the salary for Heme/Onc is not higher.

 

[Neuronix]

If I'd had the scores (and the brains), maybe Rad Onc.

I know you have the brains. The scores are just a game we all have to play to get in...

There is one bright side: I'll probably never get a job offer in the region where you work. Our job market is very tight.