Why aren't more people doing benign heme?

[MifflinDunder]

From a first-year fellow's eyes:
It's mostly one medical problem and done.
Zero to minimal pre-charting
Notes can be opened, done, and signed while you're in the room with the patient
Don't need to keep up with the monthly NCCN changes and what abstracts came out last month. Don't have to be a resident studying forever
Better inbox? this is a guess. Probably don't need to go through scans/labs at all hours
Avoid hours of tumor boards every week or keep track of what surgery/rad onc wants
Don't need to answer these at all hours:
The patient is here and I'm staring at them, the platelet is 2, can they get chemo
Hospitalist: this patient has cancer and you saw him last month. Would appreciate recommendations
Palliative: I know we all spoke yesterday about goals of care. The family would like to discuss this again today. When are you free?

The actual (not scheduled) hours of work seem significantly better and you're not living/breathing cancer 24/7, likely also easier to dissociate.

Other than the 300k salaries and I guess the social determinants for the sickle patients, what am I missing?

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[IMres85]

My opinion, you answered your own question for one. Number two in the community it’s just not interesting or intellectually stimulating to see 20 iron deficiency/macrocytosis/microcytosis/anemia of chronic disease, etc.

 

[MD46]

An Adjuvant or Metastatic Colon cancer patient is FOLFOX q2 weeks level 5 for minimum of 6 months, a stable IDA patient with Hb of 13.5 on oral iron is at most q6 month visit at level 3 each. Cant make much from these even if you see 25 a day

 

[ONC2023]

I do find benign hematology kind of interesting (emphasis on kind of), but everytime I was in benign heme clinic at my institution, it felt like primary care clinic … but somehow even worse.

 

[MifflinDunder]

An Adjuvant or Metastatic Colon cancer patient is FOLFOX q2 weeks level 5 for minimum of 6 months, a stable IDA patient with Hb of 13.5 on oral iron is at most q6 month visit at level 3 each. Cant make much from these even if you see 25 a day

q2 weeks FOLFOX also generates everything I mentioned and a significant amount of functional complaints that the nurses can't filter through and ends up in your inbox.

Thank you. Billing is something we don't learn about as fellows. How much do benign heme make in your experience? I know it'll most likely be academic or hybrid if you're lucky.

 

[MifflinDunder]

I do find benign hematology kind of interesting (emphasis on kind of), but everytime I was in benign heme clinic at my institution, it felt like primary care clinic … but somehow even worse.

I also find benign heme interesting, although I find solid onc to be more like primary care since I'm married to the patients. I see them too frequently and patients now send me messages about everything else that's not cancer-related. I can already tell that boundary setting just won't work because it's cancer.

In benign heme, I feel completely off when I sign my last note at 4-5 PM, both physically and mentally. At least for me, even malignant heme is a better on-off than solid tumor.

 

[HemeOncHopeful19]

The reason is $$$

I would recommend something like Endocrinology over Benign Heme personally, same pay but less competitive 2 year fellowship, less medmal risk (no blood clots / bleeding consults) and minimal inpatient consults

 

[Plutarch02]

It comes down to money.
Benign heme isn't going to pay the bills to keep the lights on.

Also to be really good there's only a few centers that offer training in managing hemophilia and other rare bleeding disorders, my fellowship didn't have access to this.

 

[MifflinDunder]

The reason is $$$

I would recommend something like Endocrinology over Benign Heme personally, same pay but less competitive 2 year fellowship, less medmal risk (no blood clots / bleeding consults) and minimal inpatient consults

The salary is more or less the same as academic oncology though, which remains a popular track amongst us fellows.

Would you recommend endocrinology over academic oncology? Salaries are the same when you adjust for no calls and the off-hours work.

 

[gutonc]

The salary is more or less the same as academic oncology though, which remains a popular track amongst us fellows.

Would you recommend endocrinology over academic oncology? Salaries are the same when you adjust for no calls and the off-hours work.

I would recommend doing the thing you like. I do benign heme because I'm a rural generalist and primary care here doesn't know how to workup anemia. If I could never see another benign heme case again in my life I would be a very happy person.

 

[osprey099]

I like seeing a benign heme now and then. I usually try to sandwich a simply IDA between 2 onc patients on active treatment. The benign heme patient serves as a mental break in-between the 2 level 5 onc visits lol

 

[gutonc]

I like seeing a benign heme now and then. I usually try to sandwich a simply IDA between 2 onc patients on active treatment. The benign heme patient serves as a mental break in-between the 2 level 5 onc visits lol

Excellent point. The "boring, easy" stuff does allow you a bit of a reprieve.

 

[bobsmith]

I also find benign heme interesting, although I find solid onc to be more like primary care since I'm married to the patients. I see them too frequently and patients now send me messages about everything else that's not cancer-related. I can already tell that boundary setting just won't work because it's cancer.

I've mentioned this before (probably in response to one of your messages, actually), but I think this is something that can be worked on. One does not have to forego boundaries just because it's cancer, and I do believe we can be good oncologists while also setting appropriate boundaries that allow us to have sustainable careers.

 

[osprey099]

I've mentioned this before (probably in response to one of your messages, actually), but I think this is something that can be worked on. One does not have to forego boundaries just because it's cancer, and I do believe we can be good oncologists while also setting appropriate boundaries that allow us to have sustainable careers.

I think geographical location matters a lot though. If you are rural, you are going to end up doing a lot of PCP stuff because there is a paucity of real PCPs and plenty of mid-levels who are mismanaging/not managing at all. If you're urban/suburban, chances are you have a lot of other specialists available and a good amount of real PCPs in your area.

 

[bobsmith]

I think geographical location matters a lot though. If you are rural, you are going to end up doing a lot of PCP stuff because there is a paucity of real PCPs and plenty of mid-levels who are mismanaging/not managing at all. If you're urban/suburban, chances are you have a lot of other specialists available and a good amount of real PCPs in your area.

Yeah, this is a fair point. Although, I have also inherited some patients from a retiring doc who just chose to do a lot of the PCP work (even though we have excellent PCPs in our area) and so I do think some physicians really do it to themselves.

When "boundary setting" was brought up in the context of 'needing to review scans/labs at all hours', I guess I assumed the issue was more feeling like they needed to answer questions at all times of the day / be accessible to patients 24/7, which I do not think is necessary

 

[IMres85]

I like seeing a benign heme now and then. I usually try to sandwich a simply IDA between 2 onc patients on active treatment. The benign heme patient serves as a mental break in-between the 2 level 5 onc visits lol

On that note regarding new patients, I like to double book a new onc patient and a new IDA. There’s no reason for a benign heme to take a new patient slot

 

[RainerMaria]

IDA is the palate cleanser for the pt with Grade 3-4 tox or progression on scans. Just sayin.

 

[gutonc]

On that note regarding new patients, I like to double book a new onc patient and a new IDA. There’s no reason for a benign heme to take a new patient slot

I have 30 minutes for new heme and 60 for new Onc. I use the extra 20 minutes from the new heme (get some iron, get your colonoscopy, come back in a month) to catch up on the new Onc.

 

[HemeOncHopeful19]

IDA is the palate cleanser for the pt with Grade 3-4 tox or progression on scans. Just sayin.