Soon to be hem/onc fellow AMA

[whoknows2012]

I'm bored so I've ventured in to the allopathic forum. I'm an IM resident starting a hem/onc fellowship in July and am here if anyone has any questions about IM, oncology, life after med school, medicine in general or anything that you can think of. Ask me anything!

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[Roxas]

How tough is it to land hem/onc as a DO? Is research a must?
Did you enter IM knowing you wanted to do that?

 

[cripplepundit]

3 questions:

Did you do research before/in med school?

If yes, do you feel it played a significant part in securing your fellowship?

Or do you feel your research in residency was more important in achieving this?

Thanks.

 

[whoknows2012]

How tough is it to land hem/onc as a DO? Is research a must?
Did you enter IM knowing you wanted to do that?

Hey! The key for entering h/o as a DO is landing a really solid community program or if at all possible an academic program for residency. Do as much research starting in medical school but really throughout residency as you can. Research isn't exaclty a must, and if you were fine matching at a community program and being a community/outpatient oncologist you could probably get by with not as much research. It is so much the backbone of the field though so I'd recommend at least trying it out! (Research that is)

I've known I wanted to be an oncologist since junior year of college (2008). I wavered in terms of peds/IM but knew this is what I wanted to do. Love the science love the patients and love the feeling that you can be contributing to the advancement of the field.

 

[whoknows2012]

3 questions:

Did you do research before/in med school?

If yes, do you feel it played a significant part in securing your fellowship?

Or do you feel your research in residency was more important in achieving this?

Thanks.

Research in residency >>>>research in med C school. Certainly it'll matter what you've done in med school especially if you publish something relevant to hem/onc. It's a double edged sword though as research in residency tends to be more difficult due to time constraints. Most programs give you ample time to do research it's just that you have to apply at the end of 2nd year and a lot of times intern year is a wash in terms of research. I had little research in med school, just some projects that I worked on that never amounted to anything. Stuff I could talk about on IM interviews but nothing substantial. I started doing research in residency and have 3 publications and 4 first author abstracts in addition to two manuscripts in submission. Definitely doable but takes A LOT of motivation and hard work. It definitely paid off for me though. My recommendation is if you can find a project in med school that's interesting to you go for it, but realize the research you do in residency is much more important.

 

[ronnicus]

Research in residency >>>>research in med C school. Certainly it'll matter what you've done in med school especially if you publish something relevant to hem/onc. It's a double edged sword though as research in residency tends to be more difficult due to time constraints. Most programs give you ample time to do research it's just that you have to apply at the end of 2nd year and a lot of times intern year is a wash in terms of research. I had little research in med school, just some projects that I worked on that never amounted to anything. Stuff I could talk about on IM interviews but nothing substantial. I started doing research in residency and have 3 publications and 4 first author abstracts in addition to two manuscripts in submission. Definitely doable but takes A LOT of motivation and hard work. It definitely paid off for me though. My recommendation is if you can find a project in med school that's interesting to you go for it, but realize the research you do in residency is much more important.

Can you explain the process of publishing? I've had a few presentations but I don't know what it takes to get a paper submitted.

 

[docster2017]

Hate to be that guy but is the earning potential much greater in hem/once compared to general IM?


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[eteshoe]

Research in residency >>>>research in med C school. Certainly it'll matter what you've done in med school especially if you publish something relevant to hem/onc. It's a double edged sword though as research in residency tends to be more difficult due to time constraints. Most programs give you ample time to do research it's just that you have to apply at the end of 2nd year and a lot of times intern year is a wash in terms of research. I had little research in med school, just some projects that I worked on that never amounted to anything. Stuff I could talk about on IM interviews but nothing substantial. I started doing research in residency and have 3 publications and 4 first author abstracts in addition to two manuscripts in submission. Definitely doable but takes A LOT of motivation and hard work. It definitely paid off for me though. My recommendation is if you can find a project in med school that's interesting to you go for it, but realize the research you do in residency is much more important.

What types of projects were you involved in during residency? And how is it structured since you seem to have been quite productive?

 

[whoknows2012]

Hate to be that guy but is the earning potential much greater in hem/once compared to general IM?


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Ehh depends. In a big city like SF, Boston, NYC, etc probably not much more. From some friends who recently started in NYC as attendings they've been in the 200-250 range. I've heard of people starting out as low as 180 though which is pretty terrible. This is only in academics. As far as IM 140-150 for outpatient up to 200 with bonus (if the hospital provides a "billing" or RVU bonus). Private practice not sure but maybe 250. Again big caveat here is this is the NYC area which is all
I'm familiar with. In private practice oncology earning potential is however way more than IM. 250-300 starting even in NYC suburbs with greater than 400 potential within 5 years. There was an onc attending that left my hospital for Midwest private practice job starting at 600k so you can imagine in less desirable places to live and in areas where there is a lot of need salaries are very high.

 

[whoknows2012]

Can you explain the process of publishing? I've had a few presentations but I don't know what it takes to get a paper submitted.

Write a manuscript based on your work (you can look up a general structure depending on if it's a review, a retrospective analysis or prospective anyalysis). Once written submit it to your journal of choice. They will review it and either ask for revisions or give you an outright no. If they ask for revisions they'll give you explanations and why they want them to be fixed but no guarantee even with the revisions it'll be accepted. If they give you an outright no then you shop it around at as many relevant journals as you can until you get a bite. It can be quite frustrating at times, but if you're willing to go for a low impact journal as long as it's a relevant scientific paper it can probably be published somewhere.

 

[FindMeOnTheLinks]

Why heme/onc and not rad onc?

Are you private practice or at an academic center?

If private practice, do you do a variety of both heme and cancer cases or do you focus on one? I am considering heme/onc and one of the draws for me is the ability to do both, though I hear in academics most stick to one or the other.

How often do you get called for urgent/emergent stuff in the middle of the night?


Sorry for multiple questions

Edit: just read title a little closer and saw you are incoming fellow so probably can't yet answer some of these questions from your own experience, my bad!

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[whoknows2012]

What types of projects were you involved in during residency? And how is it structured since you seem to have been quite productive?

I did mostly clinical and translational research. I was also able to mix in 10 weeks of basic science research which yielded me a 5th author pub and an first author abstract. My most meaningful project was a translation project that started as clinical research using data mining software we have at our insitution.

The structure probably depends on where you are for residency but for me we were able to use up to 3 months of elective time as research. Also we were offered a research track where you get 3 months of dedicated research time with only 1 continuity clinic per week. Many people interested in basic science do this. I started research my intern year on my vacations and that was actually really helpful for me because by the time 2nd year came around I was a seasoned vet when it came to working on a project. Also intern year is a good time to find a mentor for your research and the most motivated interns usually accomplish this early on. This last aspect also depends on your program and how muh advising you get.

 

[whoknows2012]

Why heme/onc and not rad onc?

Are you private practice or at an academic center?

If private practice, do you do a variety of both heme and cancer cases or do you focus on one? I am considering heme/onc and one of the draws for me is the ability to do both, though I hear in academics most stick to one or the other.

How often do you get called for urgent/emergent stuff in the middle of the night?


Sorry for multiple questions

Edit: just read title a little closer and saw you are incoming fellow so probably can't yet answer some of these questions from your own experience, my bad!

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It's ok! I can still answer your questions. I'll be starting at a large academic center in NYC. You are correct that in academics most stick to one area, but in the area of heme you could do benign heme and malignant heme but most do one or the other. It's basically in private practice only (I don't know maybe at a community hospital as well?) where you get to do both. At many large academic institutions some oncologists focus on only 1 cancer! (Leukemia, lung, head and neck etc). But you'll still probably have some time on service or on consults where you'll see all solid tumors ( if you're solid tumor person, breast GI, GU etc) or all liquids if your a malignant heme person. There are also separate board exams for heme and onc that's a decision point also whether you want to take both (most do). You do get called in the the middle of the night but much more rarely than GI or cards (where some programs still have call overnight in the hospital!). Mostly acute leukemias and ttp are the stuff you need to come in urgently to look at the smears. At most programs I've heard anything from once every 3-5 calls you have to come in overnight. At many large programs calls may only be at most once per week.

I thought about rad onc but to me it was WAY too competitive and not nearly as interesting. Plus I felt like it was fairy limiting in that you could only treat cancers that can be irradiated. The pay and lifestyle are excellent though and it is still very fulfilling and rewarding and interesting as well.

Edit: made some edits to my above post. Damn autocorrect!

 

[eteshoe]

Are you planning on being double boarded in heme and onc or just one of them once you decide what you like?

 

[whoknows2012]

Are you planning on being double boarded in heme and onc or just one of them once you decide what you like?

One program I interviewed at recommended only single boarding in onc. The program I matched at mostly everyone double boards which is likely what I'll do. I'd like to have a focus on leukemia and do as little or no benign heme as possible, but if it affects future job prospects I may as well take both. You only NEED oncology boards though even if you specialize in malignant heme. Like I said though most double board though and it isn't that big of a deal.

 

[AlteredScale]

I'm bored so I've ventured in to the allopathic forum. I'm an IM resident starting a hem/onc fellowship in July and am here if anyone has any questions about IM, oncology, life after med school, medicine in general or anything that you can think of. Ask me anything!

First of all congratulations on the match to heme/onc!

I know you said you were interested in heme/onc since your junior year of college but was there anything in medical school that helped ground that desire even further?

In terms of research, how important was finding a research mentor? Did you find it necessary to write up your manuscripts?

Is there any type of cancer you are specifically interested in?

Thanks ahead!

 

[whoknows2012]

First of all congratulations on the match to heme/onc!

I know you said you were interested in heme/onc since your junior year of college but was there anything in medical school that helped ground that desire even further?

In terms of research, how important was finding a research mentor? Did you find it necessary to write up your manuscripts?

Is there any type of cancer you are specifically interested in?

Thanks ahead!

Thank you!

Definitely my pathophys classes reinforced my interest in my 2nd year. 3rd year during peds I did an awesome peds hem/onc elective and then during medicine I had a ton of cancer patients and did a pall care elective. All of these experiences collectively reaffirmed my interests.

A research mentor during residency is pretty important especially if you have your sights on an academic career. For me it also influenced my interests as well. In terms of writing manuscripts you don't need a mentor to write this but once you have a draft it's helpful to have someone who knows what they're doing take a look at it and help you decide where to submit it to. Pretty difficult to do without a mentor.

I'm particularly interested in MDS and leukemia and plan to make a career focused on these two. I have a particular interest in the resistance of leukemic stem cells to therapy and Factors that influence MDS transformation to AML. I want to have some amount of research and feel like I'd be best suited as a translational scientist. I also love taking care of patients so I hope at least 1/3 to 1/2 my time is dedicated to direct patient care (clinic, service, consults etc).

 

[AlteredScale]

Thank you!

Definitely my pathophys classes reinforced my interest in my 2nd year. 3rd year during peds I did an awesome peds hem/onc elective and then during medicine I had a ton of cancer patients and did a pall care elective. All of these experiences collectively reaffirmed my interests.

A research mentor during residency is pretty important especially if you have your sights on an academic career. For me it also influenced my interests as well. In terms of writing manuscripts you don't need a mentor to write this but once you have a draft it's helpful to have someone who knows what they're doing take a look at it and help you decide where to submit it to. Pretty difficult to do without a mentor.

I'm particularly interested in MDS and leukemia and plan to make a career focused on these two. I have a particular interest in the resistance of leukemia stem cells to therapy and Factors that influence MDS transformation to AML. I want to have some amount of research and feel like I'd be best suited as a translational scientist. I also love taking care of patients so I hope at least 1/3 to 1/2 my time is dedicated to direct patient care (clinic, service, consults etc).

Great response thanks so much whoknows.

Do you think heme/onc is on the same level of competitiveness as that of pursuing GI? I'm also coming from a DO school so am definitely taking your advice about getting the best possible IM residency, community or university, seriously. Have you met any DO IM docs or DO heme/onc docs through your training so far?

We are 1 week into our heme/onc pathphys class so I'm thankful I even know what MDS stands for. Sounds like you have a very strong career ahead of you!

 

[whoknows2012]

Great response thanks so much whoknows.

Do you think heme/onc is on the same level of competitiveness as that of pursuing GI? I'm also coming from a DO school so am definitely taking your advice about getting the best possible IM residency, community or university, seriously. Have you met any DO IM docs or DO heme/onc docs through your training so far?

We are 1 week into our heme/onc pathphys class so I'm thankful I even know what MDS stands for. Sounds like you have a very strong career ahead of you!

Definitely not nearly as competitive as GI. As far as competitiveness it looks like this;

GI>cards>pccm=heme/onc

Allergy is also somewhat competitive and the rest aren't (generally speaking).

The DO's I've met in heme/onc have generally trained at solid community programs or at an academic program. A DO friend of mine from several years ago matched at Jefferson for heme/onc from a community program in NY. Definitely possible to match in heme/onc but it is a lot easier if you go to a better residency program. Kill step 1 and 2, ace your clerkships and put your self in the best position to succeed. Thanks for your kind words! Always glad to help out

 

[FootballFoot]

How many hours per week do heme/oncs work in private practice? What about academics? Would you say they are not that burnt out as a whole?

 

[neusu]

Why don't you guys have your own service?

 

[FlatIsJustice]

How had is it to get into a Heme/Onc fellowship as a US MD grad from a below average community IM program?

 

[whoknows2012]

How many hours per week do heme/oncs work in private practice? What about academics? Would you say they are not that burnt out as a whole?

In private practice probably 50ish hours per week. In academics about the same on average but if you have a job that there is a lot of research time it's probably less unless you are on service or doing consults.

Definitely would say that as a whole the academic oncologists I've worked with are not burnt out at all. The caveat here is that many of the attendings are on the younger side (<45) and the older ones who are around may be a self selected group who loved academics and stuck with out. Many of the outpatient oncologists who admit to my hospital are anywhere from 50-70 years old but also do not seem to be burnt out and seem to enjoy their job.

 

[whoknows2012]

Why don't you guys have your own service?

We do. At many large academic centers including the place I'll be doing fellowship we have a BMT service, leukemia service, myeloma and lymphoma services. Solid tumors are consults only but that's changed recently and was previously its own service. At the fellowship program where I did my residency they have a liquid service (myeloma, leukemia and lymphoma) BMT service and a solid service. Only real consult only is benign heme. It varies from place to place but this is the general structure and is consult only at smaller hospitals and community hospitals.

 

[whoknows2012]

How had is it to get into a Heme/Onc fellowship as a US MD grad from a below average community IM program?

Definitely a bit of an uphill battle especially if you're interested in an academic program but if you're willing to go to a community program in a maybe not as desirable location you will definitely match somewhere.

 

[eteshoe]

Some broad questions (but interesting to hear your thoughts):

What are (some of) your predictions of how academic heme/onc practices will change in the next decade or so (I'm at least a decade from finishing my training)? More specifically things like immunotherapy, the integration of big data, and precision medicine?

 

[whoknows2012]

Some broad questions (but interesting to hear your thoughts):

What are (some of) your predictions of how academic heme/onc practices will change in the next decade or so (I'm at least a decade from finishing my training)? More specifically things like immunotherapy, the integration of big data, and precision medicine?

I'm so fascinated with how big data will change the field. Precision medicine is basically a fancy way of saying next gen sequencing and it's already a huge part of research in oncology and on the clinical side is gaining a ton of momentum as the amount of "actionable " mutations increase with more drugs being available now. In one of the translational research projects I'm working on we're using next gen myeloid molecular profiling to help stratify our MDS and AML patients by mutational status. It's really interesting stuff and I think holds a ton of promise. Immunotherapy is also "in" right now and within the next couple years will go from being approved for lung ca and melanoma to rcc, breast ca and probably GBM. In the end though I feel like immunotherapy will just be another tool we use in the future I don't know necessarily if it will be a transformational treatment but that remains to be seen. Big data with the infusion of all the next gen sequencing we're doing is definitely the wave of the future.

 

[whoknows2012]

It's a really awesome and fun field (in my biased opinion) and if you're interested IM it's definitely worth considering h/o it's not all doom and gloom I promise!

 

[notcool]

I'm sorry, I know this is going to sound bad, but I wanted to ask if it's difficult to take vacation in private practice hem/onc? I'm asking because I've heard hem/onc patients can (very understandably) become attached to their hematologist/oncologist. They always want to be in contact with their cancer doctor. I had a new oncologist attending tell me he would have a difficult time scheduling vacations for more than 1 week at a time. I'm interested in oncology, I definitely don't mind working hard week by week, but I was concerned because I could see myself burning out, especially in a specialty where some people suffer from compassion fatigue. That's why I was wondering about how vacations worked in hem/onc. Thank you for any insight!

 

[whoknows2012]

I'm sorry, I know this is going to sound bad, but I wanted to ask if it's difficult to take vacation in private practice hem/onc? I'm asking because I've heard hem/onc patients can (very understandably) become attached to their hematologist/oncologist. They always want to be in contact with their cancer doctor. I had a new oncologist attending tell me he would have a difficult time scheduling vacations for more than 1 week at a time. I'm interested in oncology, I definitely don't mind working hard week by week, but I was concerned because I could see myself burning out, especially in a specialty where some people suffer from compassion fatigue. That's why I was wondering about how vacations worked in hem/onc. Thank you for any insight!

I'm sure this happens but it's not an experience I've seen. Most of the academic oncologists I've worked with did not have this problem (and they still have their "own" patients they see in their respective clinics). Compassion fatigue on the other hand is definitely a real concern but and that is something I've seen even from fellows. I think it's hard to combat this but keeping in mind you're taking care of people who are very sick and may have a terminal illness will help you retain your compassion and empathy. It is definitely tough at times and there is no sugar coating that aspect. My recommendation is during med school and residency to immerse yourself in onc experiences as much as possible both inpatient and outpatient to get an idea if this is something you could see yourself doing.

 

[ChrisMack390]

I'm sorry, I know this is going to sound bad, but I wanted to ask if it's difficult to take vacation in private practice hem/onc? I'm asking because I've heard hem/onc patients can (very understandably) become attached to their hematologist/oncologist. They always want to be in contact with their cancer doctor. I had a new oncologist attending tell me he would have a difficult time scheduling vacations for more than 1 week at a time. I'm interested in oncology, I definitely don't mind working hard week by week, but I was concerned because I could see myself burning out, especially in a specialty where some people suffer from compassion fatigue. That's why I was wondering about how vacations worked in hem/onc. Thank you for any insight!

I work at a cancer center. All of our oncologists are paired with a nurse practitioner. Patients generally see the MD or NP at alternating visits, and obviously they work together regarding vacations and such.

 

[EEtoPre-Med]

1. What are important considerations in selecting an IM residency if one wants to match into Hem/Onc?

2. How do most people deal with the compassion fatigue that you are talking about?

3. In an academic center how much of the job is research and how much is seeing patients? (I'm sure this varies.)

4. What are the pros/cons of Hem/Onc? What sort of person generally enjoys it?

Thank you very much for answering these questions!

 

[whoknows2012]

1. What are important considerations in selecting an IM residency if one wants to match into Hem/Onc?

2. How do most people deal with the compassion fatigue that you are talking about?

3. In an academic center how much of the job is research and how much is seeing patients? (I'm sure this varies.)

4. What are the pros/cons of Hem/Onc? What sort of person generally enjoys it?

Thank you very much for answering these questions!

1) Ideally you'd want an academic program with a history of matching their resident decently in h/o. Additionally it can't hurt to be at a place itself has a strong h/o fellowship. Lastly I think a program that has strong research opportunities in onc is also very beneficial. This is all generally information that can be looked up or gathered on interview day.

2) As you might imagine not everyone suffers from compassion fatigue and honestly haven't encountered it a ton even from attendings who've been around forever. A current fellow or attending might be able to comment better on how to combat it.

3) The clinical time/research time is completely variable. My mentor is 70/30 research. I know several attendings who are 50/50. If research is an interest of yours it does not appear to be difficult to have a 30/70 (research/clinical) breakdown if not 50/50. I plan to have a 50/50 ish breakdown but who knows how I'll feel in 3 years. Many MD's or MD/PHDs who have their own labs can get by with much more protected research time.

4) I think generally speaking the type of person who likes h/o is someone who enjoys learning about the scientific (biochemical molecular genetic etc) aspects of disease, who is particularly empathic and compassionate, who enjoys research and who doesn't mind taking care of really sick patients. I find the "scientific" aspect of what I said to be most fitting to people who go into h/o, but all apply to some degree IMO.

Pros:
- really innovative field with a lot of new research going on
- hope of next gen sequencing altering the treatment landscape
- diseases in which your decisions greatly affect a patients outcome
-decent hours
-good pay

Cons:
- sick patients, some who are young and who will die no matter what you do which can be very sad
- emotionally and intellectually demanding (2nd part especially if you have a research career)
- lack of procedures except lp and bone marrows which for procedurally inclined people could be a downside
- big differential in pay between academia and outpatient oncology

 

[RooibosTea]

Other than lp and bone marrow biopsies, do you forsee any more procedures performed by hene/onc in the future?

 

[whoknows2012]

Other than lp and bone marrow biopsies, do you forsee any more procedures performed by hene/onc in the future?

Nope this has been the standard for quite some time. Even so, much of his is done as a fellow once you are an attending you're probably not doing a ton of your own marrows (either fellows or mid levels like np/pas). Other procedures are done by other specialists ie thoras by pulm para's by GI etc etc. heme/onc is just not a very procedurally heavy field.

 

[machete fred]

Why do you think heme/onc is less competitive than other IM specialties like cards or GI?

 

[Warderino92]

Why do you think heme/onc is less competitive than other IM specialties like cards or GI?

I'd imagine cards is competitive is simply because of the prestige of being a cardiologist. GI deals with scopes all day and doesn't have near the prestige but makes bank to make up for it.

 

[eteshoe]

I would also imagine the type of patient population (e.g. a lot of terminally ill) that heme/onc tend to deal with also plays into the equation

 

[bashwell]

According to NRMP (2016):

Cards
836 matched
1108 applied
75.5%

GI
462 matched
718 applied
64.3%

Heme/Onc
513 matched
693 applied
74%

At face value, heme/onc looks to be slightly tougher than cards, whereas GI looks much tougher than both.

However, this is only for 2016. I didn't bother to look at previous years to see what the trend would be.

Also, this doesn't tell us the background of the applicants who are applying to each of the subspecialties (e.g., MDs/DOs/IMGs, research/publications), which could make a significant difference.

There are other questions to ask too.

 

[whoknows2012]

Why do you think heme/onc is less competitive than other IM specialties like cards or GI?

Available spots + match rate + eventual pay= competitiveness. for GI there are less spots and more pay with a lower match rate. Cards has similar spots similar match rate higher pay. Obviously this is a real simplistic view but it generally holds true.

 

[notcool]

Thanks again, @whoknows2012. I wanted to ask another question please. I know for some med students and even residents it's difficult to speak with oncology patients about their cancer, because there's often a lot of tears, hand-holding, and so on. Yet most oncologists seem naturally able to relate so well to their cancer patients, not only as physicians, but also as counselors and more. I love the biology of cancer, but as an introvert I worry I won't be able to relate so well to cancer patients like most oncologists seem able to do. Do oncologists get trained in relating to patients at some point in fellowship or is it more of their natural personality in relating well to patients that attracts these people to oncology? Thanks again!

 

[dcc23]

Hi @whoknows2012, I'm a M3 interested in Hem/Onc but also torn between doing IM or another field. I know if I do IM, I want to do Hem/Onc. I am a US MD with a Step 1 in the low 220's and trying to determine if I will be competitive enough to get into a decent academic IM residency, since it sounds like that's quite important for landing the fellowship. Will my lower step score be a big hurdle for getting me into a residency that can set me up to match Hem/Onc in the future?

Basically I know I can match IM somewhere, but only want to make that choice if it's at a program good enough to prepare me for a career in Hem/Onc.

 

[numbersloth]

What was your major in college? I'm asking because I've heard from some current hem/onc fellows that their humanities educations has really helped with the large amount of palliative care type-work they do.

Is it possible to do both malignant onc as well as a fair amount of benign heme (sickle cell, hemophilia, iron deficiency anemia, etc.) or do most people really specialize?

How did you choose between IM and peds? Do you know any people in hem/onc who entered through meds-peds?

 

[whoknows2012]

Thanks again, @whoknows2012. I wanted to ask another question please. I know for some med students and even residents it's difficult to speak with oncology patients about their cancer, because there's often a lot of tears, hand-holding, and so on. Yet most oncologists seem naturally able to relate so well to their cancer patients, not only as physicians, but also as counselors and more. I love the biology of cancer, but as an introvert I worry I won't be able to relate so well to cancer patients like most oncologists seem able to do. Do oncologists get trained in relating to patients at some point in fellowship or is it more of their natural personality in relating well to patients that attracts these people to oncology? Thanks again!

You're spot on with your assessment about the emotional nature of taking care of cancer patients. There are plenty of oncologists that have trouble displaying their compassion and empathy but I'd said more so than most fields these personality characteristics are SO important. If you're not spending a ton of time taking care of patients and you're more on the research side it's not as big of deal. Also being an introvert isn't the same thing as lacking the ability to connect with patients and deliver empathic care. I think to your last question for people whose personalities are not particularly well suited for the field, it may be that they get weeded out by a lack of interest in the emotional aspect of cancer care and thus they don't pursue the career.

 

[whoknows2012]

Hi @whoknows2012, I'm a M3 interested in Hem/Onc but also torn between doing IM or another field. I know if I do IM, I want to do Hem/Onc. I am a US MD with a Step 1 in the low 220's and trying to determine if I will be competitive enough to get into a decent academic IM residency, since it sounds like that's quite important for landing the fellowship. Will my lower step score be a big hurdle for getting me into a residency that can set me up to match Hem/Onc in the future?

Basically I know I can match IM somewhere, but only want to make that choice if it's at a program good enough to prepare me for a career in Hem/Onc.

Absolutely not. Averag-ish step scores can land you a decent IM program especially if you're coming from an above average med school. Even if you're coming from an average or below average med school step scores are far from the whole picture and you can still probably match into a good academic program even if it's not mgh or Columbia (granted it does help to have a solid CV including research, good EC's, letters and preclinical grades). Do as much as you can now to improve your app for residency including honoring your medicine clerkship and Sub-I and maybe getting your hand into some research if possible.

 

[whoknows2012]

What was your major in college? I'm asking because I've heard from some current hem/onc fellows that their humanities educations has really helped with the large amount of palliative care type-work they do.

Is it possible to do both malignant onc as well as a fair amount of benign heme (sickle cell, hemophilia, iron deficiency anemia, etc.) or do most people really specialize?

How did you choose between IM and peds? Do you know any people in hem/onc who entered through meds-peds?

I was a bio major in college. I just missed the credit minimum for a psychology minor and definitely agree that solid humanities background can help with the palliative aspect.

To your second question, yes many people do both solid tumor/malignant heme and benign heme but that's almost exclusively private oncologists in the community setting. In academics at a minimum you generally choose benign heme or oncology and most are choosing even within that to do solid tumor oncology or malignant hematology. At the highest level of specialization academic oncologists will only treat one tumor type (i.e. Breast, lung, leukemia etc).

I actually had a tough time deciding between peds and IM. I did think about med-peds but felt it wasn't quite right for me. Eventually I decided on IM bc I felt he pathology was more interesting. Additionally I did think about my prospects for heme/onc fellowship and there are 3x as many fellowship positions for IM heme/onc (500's) as compared to coming from peds (150ish) which meant matching might be more difficult especially given my interest to essentially complete all my training in NYC. I do actually have a friend that did med-peds then because a clinician educator in IM then went to H/o fellowship (adults). He loved his med-peds background but it's longer training and I'd recommend picking one, but that's just me!

 

[dcc23]

Absolutely not. Averag-ish step scores can land you a decent IM program especially if you're coming from an above average med school. Even if you're coming from an average or below average med school step scores are far from the whole picture and you can still probably match into a good academic program even if it's not mgh or Columbia (granted it does help to have a solid CV including research, good EC's, letters and preclinical grades). Do as much as you can now to improve your app for residency including honoring your medicine clerkship and Sub-I and maybe getting your hand into some research if possible.

That's really encouraging, I appreciate the response.
Fortunately I'll have 1 first author (non-cancer) and 3-4 non-first author oncology related publications by the time I apply next year, so it's good to know programs will see more than just a below average step score.

 

[whoknows2012]

That's really encouraging, I appreciate the response.
Fortunately I'll have 1 first author (non-cancer) and 3-4 non-first author oncology related publications by the time I apply next year, so it's good to know programs will see more than just a below average step score.

Ya that research is significant and will definitely help you out.

 

[rashmile]

Is there less research in surgical oncology than in medical oncology?

 

[whoknows2012]

I can't say with certainty but I imagine a lot less research. That being said one of my mentors was a surgical oncologist and I worked in his lab.