What are some of the things I should look for when deciding on ranking heme/onc fellowship programs?

[Grilled_chicken]

Hello everyone,

I would really appreciate some advice on ranking my fellowship programs. At this time of the season, all these fellowship programs are starting to look very similar. On top of that, I am fairly undecided about most things about my career. A few things about me for reference:

1: Quality of clinical training is the primary thing I need some advice about.
2: I am leaning more towards solids onc than malignant heme, although I still find malignant heme interesting (which means I am undecided)
3: Undecided on academics vs community practice. Wouldn't mind either

What should I be looking for when deciding that program X is better than program Y? For the sake of discussion, I have no geographic preference, and I do not care about QOL during fellowship. In case someone here knows about any of my specific programs, here is the list:

Penn state uni, Alleghany health network, Lehigh Valley in PA, Hackensack uni, Orlando Health Florida, Uni of Texas at Austin, LSU Shreveport

Appreciate any insight on this matter

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[gutonc]

These programs are all roughly similar in terms of "prestige", and none of them are academic powerhouses. But they will all likely give you similar, good training in a broad range of hem/onc issues. QOL and geography are probably the only real ways to separate them, so use those even though you pretend you don't care.

 

[Grilled_chicken]

These programs are all roughly similar in terms of "prestige", and none of them are academic powerhouses. But they will all likely give you similar, good training in a broad range of hem/onc issues. QOL and geography are probably the only real ways to separate them, so use those even though you pretend you don't care.

Thank you so much for your insight. As a follow-up question, do you think it matters whether the faculty members are generalists or focus on one or two organ systems? Also, what's a good faculty to fellow ratio or does it not matter that much?

 

[gutonc]

Thank you so much for your insight. As a follow-up question, do you think it matters whether the faculty members are generalists or focus on one or two organ systems? Also, what's a good faculty to fellow ratio or does it not matter that much?

Back in the day, I would have said that you need sub-specialist attendings to get good training. Now, after over a decade as a generalist in community practice, I would say that unless you're planning to be an academic sub-specialist yourself, it probably doesn't matter.

Now, faculty:fellow ratio on the other hand does make a difference. If you've only got 3 or 4 attendings, and that many or more fellows, you're not going to get good teaching and the attendings are probably going to be way overburdened and less focused on education that moving the meat.

 

[ONC2023]

Wanted give the perspective of a fellow at an academic program where attendings are ultra-specialized (they’re not GI attendings, they’re colon or pancreatic or esophageal, etc)

I think it’s very hard to graduate from a program like this and be a generalist because there are simply too many clinics to rotate in. This will limit your job options if you choose to enter the community.

I’ve managed to get 2-3 solid tumor systems under my belt and have found my escape hatch from academics to a high paying job, so it worked out in the end for me, but I would think about this.

Do you want to go out in the community and be able to take any job (and the job market is very favorable right), or are you going to be like me - comfortable with a few solid tumor systems and look for a community job that permits specialization? These jobs absolutely do exist, but they’re definitely less common than the usual generalist who sees everything from benign heme to metastatic colon.

If you’re unsure of what you want, it’s best to keep your options open and go to a place where you can learn general heme onc. It’s easier to go from generalist to specialist than the reverse.

 

[PlyFlower]

You don't care about QoL now, but you will when you're on call every other weekend in a tiny program with only 1 or 2 fellows per class. I say prioritize QoL if you don't have any other specific preferences. Working like a dog for 3 years is difficult, especially when you have an easy out (hospitalist, PCP, or locum). QoL features include fewer or no inpatient rotations, 1 month BMT rotation throughout your 3 years (it's all that is required by ACGME), the greater the number of fellows the better (less call frequency), make sure your elective months are actually electives and not "selectives" (I.E. you get to decide what you want to do, instead of your program director telling you this is what you will do), the more research months the better.

 

[Grilled_chicken]

You don't care about QoL now, but you will when you're on call every other weekend in a tiny program with only 1 or 2 fellows per class. I say prioritize QoL if you don't have any other specific preferences. Working like a dog for 3 years is difficult, especially when you have an easy out (hospitalist, PCP, or locum). QoL features include fewer or no inpatient rotations, 1 month BMT rotation throughout your 3 years (it's all that is required by ACGME), the greater the number of fellows the better (less call frequency), make sure your elective months are actually electives and not "selectives" (I.E. you get to decide what you want to do, instead of your program director telling you this is what you will do), the more research months the better.

I see your point. I think mainly I am going to rank my programs based on the faculty there, number of fellows and how their rotations are structured. I am also couple matching so it makes it a bit challenging but definitely some good things to keep in mind. Thank you!

 

[HemeOncHopeful19]

Wanted give the perspective of a fellow at an academic program where attendings are ultra-specialized (they’re not GI attendings, they’re colon or pancreatic or esophageal, etc)

I think it’s very hard to graduate from a program like this and be a generalist because there are simply too many clinics to rotate in. This will limit your job options if you choose to enter the community.

I’ve managed to get 2-3 solid tumor systems under my belt and have found my escape hatch from academics to a high paying job, so it worked out in the end for me, but I would think about this.

Do you want to go out in the community and be able to take any job (and the job market is very favorable right), or are you going to be like me - comfortable with a few solid tumor systems and look for a community job that permits specialization? These jobs absolutely do exist, but they’re definitely less common than the usual generalist who sees everything from benign heme to metastatic colon.

If you’re unsure of what you want, it’s best to keep your options open and go to a place where you can learn general heme onc. It’s easier to go from generalist to specialist than the reverse.

I’m a few years ahead of you and I’m not sure I fully agree. At the end of the day you can only learn so much in 3 years whether you spend your days in a “GI clinic” or split your days between “Pancreas” and “Colon” clinic. I don’t think anyone can come out of fellowship and feel completely comfortable with all major tumor types.

Now I would avoid a program where if you decide to do Pancreas research then all you do your last 18 months is Pancreas clinic but that’s a bit different IMO

 

[MifflinDunder]

I ranked all research-heavy programs low, regardless of their reputation. I'll be doing community/hybrid practice and wanted as much clinical time as possible.