Why aren't more people doing benign heme?

[MifflinDunder]

Advertisement - Members don't see this ad

.

 

[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.

 

[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.

 

[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.