Answered some questions that I thought might be useful over the in the hem/onc fellowship sub forum. See below from
@Cremaster reflex
“ I appreciate the response. I may be misguided/uninformed in this manner (i.e. what it means to be PP vs. academic in heme/onc) but throughout my rotations I have found myself enjoying the office visit setting much more than actually being in the hospital. With that being said I have 0 interest in primary care as that would bore me to tears. Further I like the idea of being able to form a long-term relationship with patients and would look forward to continually seeing them q6months or whatever and hopefully telling them they continue to have NED
I hope this makes sense. Thank you”
Answer
“Ah ok this definitely helps. The academic vs pp distinction isn’t really predicated on outpt vs in hospital or inpatient. All academic oncology jobs are mostly outpatient (unless of course you’re an oncology Hospitalist which is rare). The main difference as far as pp vs academic is whether you’re employed by the hospital or by yourself or a group. Sometimes hospitals also own a group so it’s sort of an “affiliated” practice
@gutonc can comment more about the pp side. The other major difference is pay, which is of course higher on the pp side. You often do not have the ability to specialize as much as you would with an academic position. Academic positions often are associated with more research or scholarly activity. Availability of clinical trials are also more prevalent within academic institutions. There are many other differences but these are just a few. As far as salary you can probably expect to make anywhere between 75-80% of what you could make in private practice in academics. Where you practice is also very important as that determines your compensation. Ie nyc pp and academic salaries are fairly low (250-300pp 180-250 academic) vs areas in south or Midwest where pp and academic salaries are high.
Overall hours worked can be higher in pp especially in the beginning but that all depends on your practice and call responsibilities. Stresses on the academic side usually come in the form of bureaucracy (ie billing, compliance) and research requirements (if any). Another difference with academic vs pp is that as an academic oncologist you will have some inpatient duties that vary from minimal (solid tumor) in the form of wknd and occasional inpatient consult coverage, to more significant if you do heme malignancies like leukemia or are BMT.
Lifestyle in fellowship depends highly on the type of program you train in. At cancer centers (ie mskcc, mdacc, farber) 18-24 months of your time is spent doing research. Versus community programs (which based on your stats I’m sure you won’t even be applying to when it comes time) where nearly all 3 yrs are spent doing clinical work. At high ranked academic institutions your schedule and call duties are heavily weighted towards 1st yr as thereafter you’ll be mostly focused on research. As an example from my academic oncology program 1st yr I averaged 50h/wk plus one night on call each wk (home call, answering clinic phone calls, rarely needed to come one for an acute leukemia or ttp) and 12 wknds per year on call (6 inpatient covering consults 6 outpatient covering outpatient clinic phone calls). As a 2nd yr the schedule is vastly improved no weeknight call, working 7 wknds (half inpatient/outpatient). I’m on research now and so in that regard I essentially make my own hours but have deadlines and so occasionally I have to work more some days/weeks than others.
I know I probably didn’t answer all your questions but happy to address anything more specifically either here or via pm.”
Next question
“First of all thank you so much for your helpful input, I can't tell you how much I appreciate it. The distinction between PP vs. academic and inpatient vs. outpatient is much more clear to me now. I understand that with high grade malignancies like certain leukemias and lymphomas there is greater risk for tumor lysis syndrome with rapid cell turnover but other than that, I don't really understand what else you would be getting called about in the middle of the night? Also, when on call what is a reasonable amount of times to be getting called as both a fellow and attending? Just trying to get an idea of how "call" works for the field and what I could expect.
Furthermore, I know it is probably highly variable but in general how many days a week, average weekly hours worked, and call frequency do you see PP and academic Heme/Onc doc with?
I have no interest in living in large cities like NYC, LA, Boston and would prefer to live around medium size cities in the SE so I guess it won't be an issue paying off ~$300k in med school loans then.
Again, thank you so much for answering my questions. I know they are mostly based on lifestyle/salary and these are far from the only things I care about but I tend to be someone who is pretty good at what I do but get kind of tired quickly if I am not engaged so this is really important to me. I am starting to panic as I need to schedule for M4 year in a couple of weeks and I am still deciding on Rad Onc vs. Heme/Onc. Anesthesia vs. a few other fields.”
Answer
“1) What types of calls while “on call”
As a fellow, the types of calls we get vary heavily as we cover both fellow and attending patients as well as inpatient consults on all hem/onc services. Which means we could get a patient phone call complaining of nausea or constipation to a 90 day post BMT patient complaining of a fever of 103 to an IM intern calling a consult for platelet count of 110 (can’t that wait until
Morning???) to an ED pa calling about mild anemia with a wbc count of 20 with 90% blasts (how could you miss that!!??). On average I received ~10 calls per night (highly variable of course) and only went in for a consult after hours 8 times throughout the whole year. My co fellows varied from 5-10 times (maybe as much as 12 for one fellow). Other calls? Solid tumor onc emergencies including cord compression and SVC syndrome. ITP with plt count less than 20 with or without bleeding. R/o TTP (which requires a smear review in the appropriate setting). And any type of phone call you could imagine from the patients.
As an attending this is vastly different. In an academic job the fellow usually fields most of the calls and only reaches out in the setting of an emergency or if there is a urgent clinical question. As a pp oncologist there is no fellow for you so you’d be covering your patients via an answering service in some way shape or form. In academics, when on inpatient for 2 wks let’s say for consults (solid tumor) or on service as a specialist in one of the heme malignancy areas (bmt, leukemia, lymphoma, myeloma) then you cover those patients at night (with or without fellow coverage) and so you can get calls in the middle of the night but never have to come in.
2) PP vs academic wkly
As you mentioned highly variable. PP mostly 9-5 seeing patients but likely some time spent before and after on admin stuff like phone calls note writing, sometime seeing patients inpatient if admitted etc. wknd coverage in pp is usually a rotation but someone with more experience
@gutonc can comment. Academic hours depend if on or off service. When you’re doing purely outpatient it’s usually 2-4 days a week or clinic seeing 10-20 patients a day. Other days of week are spent on research duties(trials, clinical research) or admin (phone calls, tumor boards, meetings etc). When on service you usually do 1-2 wks straight AND see clinic patients and have admin/research duties so these are definitely more stressful weeks. Hours are probably 45-50 vs 60 outpatient vs when on service. Usually on service you work one or both wknds but those wknd days are not fully spent in house (can round early and be done by noon). Service duties per year vary heavily by specialty but on average ~2 months ”
