Surgical Oncology Job Market

[bboynation]

I have searched but really haven't found a good recent discussion on the surgical oncology job market.

My interest is in HPB, complex GI oncology/HIPEC. I know there are certain training programs that are better suited for this. Everyone always discusses the limited number jobs that are geared towards this type of practice but most of that is old and a lot of hearsay. Wondering if anyone who has recently graduated can comment.

I would consider myself moderately competitive; good research, good LOR, midsized academic program with support from my local surgical oncologist, but poor ABSITE scores. Would love to train at MSK, MDA but for this discussion, let's assume you don't train at these programs, what is the job market like for fellowship trained surgical oncologist interested in HPB/complex GI oncology?

My BIGGEST fear is completing all this training, and fellowship, and not being able to find a job doing what I love. Being forced to do something like melanoma/sarcoma or breast. Looking through the SSO Job Search there are TONS of breast positions advertised, but not much in the way of hepatobilliary or pancreatic 😵.

Thanks!

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[vhawk]

There are other recent threads on this topic, but I think I can probably give some insight. I finished fellowship last year and have been working at an academic surg onc job that is primarily HPB/foregut as well as some sarcoma stuff. I can say that in general the job market is not particularly great, but there are jobs, depending on what exactly you want. MDA/MSK grads are not having a hard time finding good academic jobs, and next-tier SSO grads are not, I dont think, having a hard time finding next-tier academic jobs. In general though, outside of the busiest programs, it isnt that easy to find jobs that are ENTIRELY HPB. If you want to do HIPEC that can be a useful skill but who is doing 50 HIPEC cases a year? Not many. Its a minor add-on to keep yourself a little extra busy, but it is hard to make that a huge part of your practice at most places.

Contrast that with private practice, in which the job market is actually quite good. Tons of multi-specialty groups are looking for SSO trained people who are able to do a wide range of surgical oncology, and tons of practices are looking for ANYONE who is willing to do general surgery and also take the big awful cases that no one else in their group has the desire or confidence to do. The "job market" is always sort of a weird thing in that there are multiple levels of job: the truly desirable, top academic jobs that dont ever really get "advertised" in the sense that you would see them on a job board, the less desirable academic jobs that, nonetheless, receive many applicants and are still competitive, the lower-tier jobs that are less competitive, the private practice jobs....there isnt really any one "job market." It depends on what you are looking for.

 

[bboynation]

There are other recent threads on this topic, but I think I can probably give some insight. I finished fellowship last year and have been working at an academic surg onc job that is primarily HPB/foregut as well as some sarcoma stuff. I can say that in general the job market is not particularly great, but there are jobs, depending on what exactly you want. MDA/MSK grads are not having a hard time finding good academic jobs, and next-tier SSO grads are not, I dont think, having a hard time finding next-tier academic jobs. In general though, outside of the busiest programs, it isnt that easy to find jobs that are ENTIRELY HPB. If you want to do HIPEC that can be a useful skill but who is doing 50 HIPEC cases a year? Not many. Its a minor add-on to keep yourself a little extra busy, but it is hard to make that a huge part of your practice at most places.

Contrast that with private practice, in which the job market is actually quite good. Tons of multi-specialty groups are looking for SSO trained people who are able to do a wide range of surgical oncology, and tons of practices are looking for ANYONE who is willing to do general surgery and also take the big awful cases that no one else in their group has the desire or confidence to do. The "job market" is always sort of a weird thing in that there are multiple levels of job: the truly desirable, top academic jobs that dont ever really get "advertised" in the sense that you would see them on a job board, the less desirable academic jobs that, nonetheless, receive many applicants and are still competitive, the lower-tier jobs that are less competitive, the private practice jobs....there isnt really any one "job market." It depends on what you are looking for.

vhawk, thank you for the responce. I have been a long time reader and it is people like you (and others like southern surgeon, winged scaupula, sluser, etc. ) that routinely respond and really add value to this forum. Thank you for your response and candor. I can tell you that I have informally discussed this topic with my staff and mentors and have not yet received such an honest answer. I am usually told, "don't worry about that stuff, you'll be fine" - which isn't really helpful.

I'd be open to doing a variety of case mixes including gen surg and slowly building up surg onc referrals but sounds like it might be difficult to find an academic position. Is there much competition between surg onc and transplant at most places?

 

[boogaaloo]

There are other recent threads on this topic, but I think I can probably give some insight. I finished fellowship last year and have been working at an academic surg onc job that is primarily HPB/foregut as well as some sarcoma stuff. I can say that in general the job market is not particularly great, but there are jobs, depending on what exactly you want. MDA/MSK grads are not having a hard time finding good academic jobs, and next-tier SSO grads are not, I dont think, having a hard time finding next-tier academic jobs. In general though, outside of the busiest programs, it isnt that easy to find jobs that are ENTIRELY HPB. If you want to do HIPEC that can be a useful skill but who is doing 50 HIPEC cases a year? Not many. Its a minor add-on to keep yourself a little extra busy, but it is hard to make that a huge part of your practice at most places.

Contrast that with private practice, in which the job market is actually quite good. Tons of multi-specialty groups are looking for SSO trained people who are able to do a wide range of surgical oncology, and tons of practices are looking for ANYONE who is willing to do general surgery and also take the big awful cases that no one else in their group has the desire or confidence to do. The "job market" is always sort of a weird thing in that there are multiple levels of job: the truly desirable, top academic jobs that dont ever really get "advertised" in the sense that you would see them on a job board, the less desirable academic jobs that, nonetheless, receive many applicants and are still competitive, the lower-tier jobs that are less competitive, the private practice jobs....there isnt really any one "job market." It depends on what you are looking for.

Exactly. Private practice is the way to go here.

 

[Winged Scapula]

Totally agree with @vhawk in regards to private practice/"priva-demics".

Large oncology groups are falling all over themselves to hire or collaborate with surgeons: built in referral base if you will. While traditionally they've focused on breast and urology due to the prevalent need for rad and med onc in those specialties, there certainly is interest in general surg onc as well.

 

[droliver]

The idea that anyone is going to do much liver and pancreas case outside of tertiary referral centers now or in the future would be incorrect as I see it. There's just not the volume around to support that, and people doing occasional Whipple's and liver resections usually have no business doing them. Those are two index types of cases where the data strongly supports referral to high volume centers, which are almost all University affiliated teaching hospitals at this point.

Out of the 7 hospitals I have privledges at with about 50 surgeons on staff, there are exactly 2 guys that do pretty regular pancreas cases. One a MSK trained surg onc who left academics 15+ years ago and does mostly general surgery, and one HPB fellowship trained guy (who was a fellow when I was a resident at Louisville) who does a TON of ERCP work and carved out a niche in all things pancreas with the robot. All other liver and pancrease referrals in the state usually go to the two University affiliated cancer centers . I don't know of a single other general surgeon who wants anything to do with those cases anymore.

To me, if you want a heavy HPB practice outside a University setting, you have to go all in on ERCP to develop the cases and referrals.

 

[Gastrapathy]

Surgeons doing ERCP is very atypical. I know I know they kinda learn it at Louisville but they don’t do EUS or other therapeutics. That’s not a recipe for good decisions. Anyone coming from an advanced endoscopy fellowship nowadays does both. Having both skills is more relevant to onc patients than any other group. I’ve only ever seen one of the Louisville trained surgeons do an ERCP, so it may not be fair to generalize but he was an excellent surgeon and a poor ERCPist. It’s not going to be common that ERCP will be a ticket to a complex surgical practice. If anything, I suspect my colleagues would prefer to refer to someone who wasn’t a threat to their procedure volumes and whom they felt was incompletely trained.

We refer to 2 nonacademic surgeons who do these cases for our very large multi specialty group. I think one did surg onc and the other hbp. They occasionally pass on a case and refer onward but we send them ~20 Whipples a year.

 

[vhawk]

I trained in residency in a program where we covered a private group and one of the surgeons there was a Louisville trained ercp guy. He had a modestly busy panc practice, probably around 15 whipples a year and I'd guess about same number of distals/other. He didn't do any liver. They have a pretty strong foothold in the region with a strong referral base and the academic center isn't exactly a thriving HPB program so that may have had something to do with it. That being said this guy still does a large amount of general surgery and also ercp.

 

[droliver]

Surgeons doing ERCP is very atypical. I know I know they kinda learn it at Louisville but they don’t do EUS or other therapeutics. That’s not a recipe for good decisions. Anyone coming from an advanced endoscopy fellowship nowadays does both. Having both skills is more relevant to onc patients than any other group. I’ve only ever seen one of the Louisville trained surgeons do an ERCP, so it may not be fair to generalize but he was an excellent surgeon and a poor ERCPist. It’s not going to be common that ERCP will be a ticket to a complex surgical practice. If anything,

While a general surgeon doing ERCP is rare, you’d be mistaken about the guys coming out of fellowship in this. The fellows from that program at UofL (which is like 35 years old now) do extensive therapeutic work, it’s actually most of what they do. They do surgery as well, but it’s an extroidinary high volume of therapeutic ERCP they spend most of their time doing and it’s a good multidisciplinary setup with GI there. A modern HEpatobilliary surgeon treats a majority of benign disease rather then a guy like John Cameron used to do, with just did whipples and liver resections that were referred in. It’s a lot of chronic pancreatitis + CBD stones, structures, and injuries that inevitably make up the majority of that kind of practice. If you don’t do that, you’re going to be as obsolete as a vascular surgeon or cardiac who does no endovascular work, particularly outside a super tertiary university setting. UofL was the first fellowship like that, with most HPB fellowships now incorporating that idea into their curriculum as they know if they don’t they’ll be left behind.

In practice, there’s really not much of a competition from GI as these patients are largely not ones they’re clamoring for. When you make it known that you treat these difficult things, people are glad to ship them.

 

[Gastrapathy]

That just isn't the model in the vast majority of places. I think we've argued about this before. And again, they don't do EUS so they are incompletely trained for managing these patients endoscopically. It doesn't matter what's in the curriculum, it matters what they do in practice