Why is heme onc not considered a lifestyle speciality?

[Legend of Link]

Recently been told by people heme onc is not considered a lifestyle speciality. Was told just cause you see patients in the clinic 4 days a week doesn't mean it's a lifestyle speciality. Was also told heme/onc =/= outpatient cancer visits. For someone who values personal time, lifestyle and like outpatient/clinic more; do you think oncology is not considered a lifestyle speciality?
Just trying to make informed decisions about my future, current Pgy 1

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[gutonc]

Recently been told by people heme onc is not considered a lifestyle speciality. Was told just cause you see patients in the clinic 4 days a week doesn't mean it's a lifestyle speciality. Was also told heme/onc =/= outpatient cancer visits. For someone who values personal time, lifestyle and like outpatient/clinic more; do you think oncology is not considered a lifestyle speciality?
Just trying to make informed decisions about my future, current Pgy 1

Who was telling you these things?

Because I work 3.5 days a week, never take call, only see outpatients and make >50th %ile salary. I have a somewhat atypical job (rural CAH setting but rural like Jackson Hole, WY or Sedona, AZ is rural, not like Dodge City, KS is rural), but my last job in a major metro area at a tertiary care hospital was 3 days a week for only a little bit less money. I took call there though, but it was 2 weeknights a month and 4 weekends a year so not that onerous.

 

[osprey099]

Recently been told by people heme onc is not considered a lifestyle speciality. Was told just cause you see patients in the clinic 4 days a week doesn't mean it's a lifestyle speciality. Was also told heme/onc =/= outpatient cancer visits. For someone who values personal time, lifestyle and like outpatient/clinic more; do you think oncology is not considered a lifestyle speciality?
Just trying to make informed decisions about my future, current Pgy 1

Probably depends on the setup, like all other medical fields.

Academic job? Hell no. You'll be making <25%tile, praying for research grants to prove your "worth" to the hospital, and spend your nights writing papers that'll likely get published in bogus journals unless you're at an ivory tower institution.

Community hospital? It can have good lifestyle. I live in a major east cost metro and I personally know someone who works for a local community hospital, 4 days/wk seeing 12 patients/day, and makes around 450k. Never brings work home. I also know another onc working at a community hospital <10 miles away seeing 20-25/day, 5 days/wk, and oftentimes seeing inpatients at night when on call (you want to see inpatients if you work at community hospital bc it's $$) but he makes around 700k.

Private practice? Mostly poor lifestyle if you want $$$$. The partners at my private practice all make 7 figures but are seeing 20-25/day 5 days a week. If you want a better lifestyle in private practice, you can try finding a practice that offers money+lifestyle (I can only think of one group in my area where docs see 18-20/day 4 days/week still get paid 800-900k) or you can sign a "no partnership track" contract with a private practice but idk why anyone would do that.. EDIT: I will say that private practice is a gamble. Most will have 2-3 year partnership track where you are first an employee paid at a 25%tile rate. Partners are profiting off of your productivity during this time. There are malignant practices out there that will deny partnership when it comes time for you to become partner, but do your research and make sure whatever practice you're joining has a good track record of partnership. Also, private practice is always at risk of potentially being bought out by local hospital systems (see how many gray-hair partners are at the practice) and are most affected by CMS reimbursement cuts given that private practices don't have access to 340b discounted drug pricing that hospitals do.

FDA/Pharma? Very chill. I get a NIH/FDA email every month or so asking if I want to join them as a drug reviewer/officer working 4 days/wk with only 1 in-person day and the rest remote work. But pay is crap (250k or less). The trick is to start at FDA and break into pharma 2-3 years later cause pharma will salivate for someone who knows the ins and outs of drug review/approvals and willing to pay good $$$ for that.

 

[Duke1K]

FDA/Pharma? Very chill. I get a NIH/FDA email every month or so asking if I want to join them as a drug reviewer/officer working 4 days/wk with only 1 in-person day and the rest remote work. But pay is crap (250k or less). The trick is to start at FDA and break into pharma 2-3 years later cause pharma will salivate for someone who knows the ins and outs of drug review/approvals and willing to pay good $$$ for that.

not that I disagree, but lol

 

[HemeOncHopeful19]

I think it really depends on how you define lifestyle specialty.

I’ve interviewed at places where everyone works til 530-6pm and make >750k but I don’t think you HAVE to do that in Heme/Onc.

Call usually isn’t terrible as far as overnight emergencies but our patients do go to the hospital a lot so unlike Rheum or Endocrine who may not even maintain privileges you do have to go see people there

 

[HemeOncHopeful19]

I don't know how much Allergy makes but it might be something to look into if you're after good hours. I'm on it now and my plan for everyone today was to give Zyrtec.

What about dem allergy $hot$

 

[Ubba]

Allergy is the low-key back road that bypasses rush-hour traffic that basically nobody knows about. It represents the one true escape from internal medicine lifestyle and liability. It doesn't tend to pay quite as well as the "top" IM specialties, but pays well enough (around 350-400k/4d week, I gather) and the lifestyle is unbeatable apart from PM&R, Psych, and Rad Onc. It also lets you see young, generally healthy patients most of the time which is probably good for mood and mental health. Not sure about the job market, though.

 

[dozitgetchahi]

Allergy is the low-key back road that bypasses rush-hour traffic that basically nobody knows about. It represents the one true escape from internal medicine lifestyle and liability. It doesn't tend to pay quite as well as the "top" IM specialties, but pays well enough (around 350-400k/4d week, I gather) and the lifestyle is unbeatable apart from PM&R, Psych, and Rad Onc. It also lets you see young, generally healthy patients most of the time which is probably good for mood and mental health. Not sure about the job market, though.

Rheum here.

I work 4.5 days a week, zero call, zero hospital rounds (I don’t even have privileges at the hospital). My patient population skews younger and healthier too (although probably not as extremely as allergy).

I am a partner in a PP and I made $540k last year.

 

[osprey099]

Rheum here.

I work 4.5 days a week, zero call, zero hospital rounds (I don’t even have privileges at the hospital). My patient population skews younger and healthier too (although probably not as extremely as allergy).

I am a partner in a PP and I made $540k last year.

You know better than I do but I feel like you're an outlier in rheum, unless you're seeing a crap-ton of patients per day. Then again, idk how many patients/day is considered a lot in rheum. For example, 25 a day in onc is ALOT, but 25/day in derm is very little compared to norm.

 

[Ubba]

Rheum here.

I work 4.5 days a week, zero call, zero hospital rounds (I don’t even have privileges at the hospital). My patient population skews younger and healthier too (although probably not as extremely as allergy).

I am a partner in a PP and I made $540k last year.

You are rural though, correct?

 

[dozitgetchahi]

You are rural though, correct?

Semi-rural.

I see usually 18-20 a day. Sometimes less, sometimes slightly more.

My partner sees about 30/day and I have no idea how he gives good care (narrator: he doesn’t) or keeps his sanity. He’s not exactly a good physician. Nevertheless, he makes $750k-1M per year. There are Heme/onc docs in our multispecialty group, but he outbills and outearns them.

This kind of income is somewhat uncommon in rheumatology, but not as uncommon as you might think. But you have to be in PP and you have to have the right job, and be willing to work (within reason). You won’t make this money at a hospital system. To get to this job, I first had to go through a crap hospital job where I was underpaid and treated like garbage, and then a PP job that I moved across the country for that basically didn’t exist once I got there, and then another crap PP job nearby that was run by incompetent and fraudulent “super partners” who made it implode about a year after I got there (I was at least paid better than at the hospital job). So it took a lot of digging to find this job, and I walked away from a lot of PP interviews that were rip-off deals. However, if you look at the MGMA numbers for rheum, the median is like $285k but the 75 percentile is something like $575k and the 90 percentile is around $800k. We are out there. It’s all about the ancillaries.

 

[bronx43]

You know better than I do but I feel like you're an outlier in rheum, unless you're seeing a crap-ton of patients per day. Then again, idk how many patients/day is considered a lot in rheum. For example, 25 a day in onc is ALOT, but 25/day in derm is very little compared to norm.

Honestly it’s not that much of an outlier for non-metropolitan rheum. I’m also in semi rural and made similar income last year.

Rheums in big cities make absolutely trash money. You’re legit better off as a pcp in many places. I’ve lamented alot over the years about it but the difference in income is truly stark when you compare jobs in cities vs those in the “boonies.”

 

[osprey099]

Honestly it’s not that much of an outlier for non-metropolitan rheum. I’m also in semi rural and made similar income last year.

Rheums in big cities make absolutely trash money. You’re legit better off as a pcp in many places. I’ve lamented alot over the years about it but the difference in income is truly stark when you compare jobs in cities vs those in the “boonies.”

If we're talking about the boonies, you can make absurd money with many specialties. I get recruiter texts/emails for middle of nowhere places offering 7 figure salaries for heme onc. Only description they have is something like "enjoy weekends in the mountains, serene quiet town life, make over $1m, 2hrs to major airport."

No thanks. I am only interested in living in relatively desirable places to live, which I know can be subjective.

 

[dozitgetchahi]

If we're talking about the boonies, you can make absurd money with many specialties. I get recruiter texts/emails for middle of nowhere places offering 7 figure salaries for heme onc. Only description they have is something like "enjoy weekends in the mountains, serene quiet town life, make over $1m, 2hrs to major airport."

No thanks. I am only interested in living in relatively desirable places to live, which I know can be subjective.

I live in a town of about 40k that is indeed about 2 hours from a major airport. And honestly, my life has never been better. My commute was initially half a mile each way, and sometimes I walked. I just bought a house in a good neighborhood. My commute doubled…to 1 mile each way.

Oh, by the way? I paid about $200k for the house. It’s pretty nice. With the income I’m making now, I plan to have it paid off in less than 5 years with the rest of my student loans. Maybe then I’ll move on to other investment properties, and perhaps even house flipping - which seems to be fairly lucrative around here. At my previous crap PP job in Alabama, I bought an acre of land for $5k. I turned it into an Airbnb site for RVs, with sewer/water/electric hookups etc. I made everything back in 6 months and it’s busy now. My in laws use it on their vacations when nobody else is renting it.

Good luck doing any of this in a big metro area, where I’d be paid less than half of what I make now for a COL that would probably be 4x (or more) bigger. Plus I don’t waste hours of my life sitting in traffic like I did with my first crap hospital job.

I’m glad there are so many docs like you that don’t want these jobs…less competition for me in what’s become my slice of happiness in semi rural America.

 

[The kitchen sink]

Rheum here.

I work 4.5 days a week, zero call, zero hospital rounds (I don’t even have privileges at the hospital). My patient population skews younger and healthier too (although probably not as extremely as allergy).

I am a partner in a PP and I made $540k last year.

Couple of follow up questions for someone who wants to make the transition from employed to private:

How many patients per day? And clinical hours per week? Who takes care of prior auths? Does your private practice own its own infusion suite?

 

[osprey099]

I live in a town of about 40k that is indeed about 2 hours from a major airport. And honestly, my life has never been better. My commute was initially half a mile each way, and sometimes I walked. I just bought a house in a good neighborhood. My commute doubled…to 1 mile each way.

Oh, by the way? I paid about $200k for the house. It’s pretty nice. With the income I’m making now, I plan to have it paid off in less than 5 years with the rest of my student loans. Maybe then I’ll move on to other investment properties, and perhaps even house flipping - which seems to be fairly lucrative around here. At my previous crap PP job in Alabama, I bought an acre of land for $5k. I turned it into an Airbnb site for RVs, with sewer/water/electric hookups etc. I made everything back in 6 months and it’s busy now. My in laws use it on their vacations when nobody else is renting it.

Good luck doing any of this in a big metro area, where I’d be paid less than half of what I make now for a COL that would probably be 4x (or more) bigger. Plus I don’t waste hours of my life sitting in traffic like I did with my first crap hospital job.

I’m glad there are so many docs like you that don’t want these jobs…less competition for me in what’s become my slice of happiness in semi rural America.

To each their own I guess.

I grew up in a VHCOL suburb/county of 300k+ population outside a major northeast metro. I despise city life but love living in large suburbs like the one I grew up in and currently live in. I bought a townhouse that is probably half the size of your home for $700k. Taxes (state, local, property, sales) are also very high here. Don't even get me started on the traffic...

But the pros? My wife and I have access to cuisine from all over the world, from street food to 3 star michelin star restaurants all within 30 min driving distance. I have a plethora of elite/snobby private schools my kids can attend. If I don't have the $$ for that, the public schools in our area are top ranked in the state. Everything is super accessible, population on a whole is very well-off (6 figure median household income/500k+ median home price for entire suburb/county), great healthcare access (at least 4 large tertiary hospital systems I can think of off top of my head), and easy access into the city.

 

[dozitgetchahi]

To each their own I guess.

I grew up in a VHCOL suburb/county of 300k+ population outside a major northeast metro. I despise city life but love living in large suburbs like the one I grew up in and currently live in. I bought a townhouse that is probably half the size of your home for $700k. Taxes (state, local, property, sales) are also very high here. Don't even get me started on the traffic...

But the pros? My wife and I have access to cuisine from all over the world, from street food to 3 star michelin star restaurants all within 30 min driving distance. I have a plethora of elite/snobby private schools my kids can attend. If I don't have the $$ for that, the public schools in our area are top ranked in the state. Everything is super accessible, population on a whole is very well-off (6 figure median household income/500k+ median home price for entire suburb/county), great healthcare access (at least 4 large tertiary hospital systems I can think of off top of my head), and easy access into the city.

I can do all/most of that too. I just have to drive 90 min to do most of it.

Which is OK, because my QOL doesn’t revolve around all of that most of the time. (About the only thing I miss is having the full range of restaurants available…but instead, my wife and I have focused on learning how to cook a wider range of cuisines for ourselves. Which is healthier, and frankly fun too.) Also, when I lived in a high COL area with all that where I got paid a lot less, I frankly didn’t have the money to enjoy it. Now I do, and I can easily afford to drive to go enjoy it (or fly to some other city to enjoy it), and I get to leave the big city BS behind afterwards. Which I am OK with, because IMHO, big city life involves a lot of BS that I don’t want to deal with on a daily basis. Including paying almost a million dollars for a 900 sq ft co-op apartment, as one of my friends in the Bay Area sent me the other day. That **** is for the birds.

 

[dozitgetchahi]

Couple of follow up questions for someone who wants to make the transition from employed to private:

How many patients per day? And clinical hours per week? Who takes care of prior auths? Does your private practice own its own infusion suite?

Patients per day: 18-20, sometimes up to 22 or so if urgent patients need seen. (I covered my partners patients when he was out and saw 23-25/day for a couple months - that was brutal and I will never do that ever again.)
Hours: I work 8-5 M-Th, 8-11:30 Friday.
My practice has an infusion center. The infusion center staff auths the infusions and my own staff auth injectable biologics.

 

[onconc]

(About the only thing I miss is having the full range of restaurants available…but instead, my wife and I have focused on learning how to cook a wider range of cuisines for ourselves. Which is healthier, and frankly fun too.)

+1 on the cooking at home part. Being in HemOnc, and knowing that unhealthy foods have a strong link to cancer, it makes sense to eat as healthy as possible. And the most healthy food is the one cooked at home, freshly prepared from vegetables. Eating vegetables and fruits are the most healthy (well duh). Eating restaurant foods (even the fancy ones) is basically increasing my chances of various diseases (including cancer)

 

[bobsmith]

It's actually supposed to be a well-guarded secret that heme onc is a lifestyle specialty, which is why we are all distracting you with a side conversation about rheumatology

 

[bronx43]

If we're talking about the boonies, you can make absurd money with many specialties. I get recruiter texts/emails for middle of nowhere places offering 7 figure salaries for heme onc. Only description they have is something like "enjoy weekends in the mountains, serene quiet town life, make over $1m, 2hrs to major airport."

No thanks. I am only interested in living in relatively desirable places to live, which I know can be subjective.

I guess “boonies” are kind of relative, but I’m not in THAT type of boonies. In fact, there’s a medium metro 35 min away from me and some of the docs here live there and commute. The school district there is one of the best in the state.

The heme onc guys here don’t make close to 7 figures for what it’s worth.

I’m not here to compare rheum income to heme onc cuz that’s not even close across the board but just wanted to chime in regarding non big city rheum income potential. 500-600k is probably closer to the norm than the outlier.

 

[bronx43]

+1 on the cooking at home part. Being in HemOnc, and knowing that unhealthy foods have a strong link to cancer, it makes sense to eat as healthy as possible. And the most healthy food is the one cooked at home, freshly prepared from vegetables. Eating vegetables and fruits are the most healthy (well duh). Eating restaurant foods (even the fancy ones) is basically increasing my chances of various diseases (including cancer)

Honestly, if one wants truly healthy foods one needs to learn to garden and grow fruits and vegetables. It’s not just processed foods and red meat which are unhealthy, but also the prevalence of pesticides and microplastics (pthalates, BPA, etc)
There’s more and more big studies coming out about the numerous health effects of this crap, such as endocrine disruption, obesity, infertility etc. (not to mention cancer of course)

 

[RainerMaria]

Microplastics are everywhere including in the ground water and in tap water. May be able to filter from tap / fridge , but maybe not. NEJM paper on electron microscopes of coronary a. plaque shows these “specks” waving hi as they are floating on by. Probably pathogenic for CAD and CBVD as well. I think it’s too late unfortunately.

 

[bronx43]

Microplastics are everywhere including in the ground water and in tap water. May be able to filter from tap / fridge , but maybe not. NEJM paper on electron microscopes of coronary a. plaque shows these “specks” waving hi as they are floating on by. Probably pathogenic for CAD and CBVD as well. I think it’s too late unfortunately.

It’s unavoidable for sure, but dosing likely matters too. I suspect a lot of the microplastics we consume is from food processing and packaging. There are studies showing large amounts of microplastic leakage from “paper” cups due to the plastic liner. Similar phenomenon occurs with aluminum cans.

 

[RainerMaria]

Allergy is the low-key back road that bypasses rush-hour traffic that basically nobody knows about. It represents the one true escape from internal medicine lifestyle and liability. It doesn't tend to pay quite as well as the "top" IM specialties, but pays well enough (around 350-400k/4d week, I gather) and the lifestyle is unbeatable apart from PM&R, Psych, and Rad Onc. It also lets you see young, generally healthy patients most of the time which is probably good for mood and mental health. Not sure about the job market, though.

This is why I enjoy my practice that is 60/40 benign heme to Onc. Most of the benign heme patients are MGUS (not even high risk), Iron deficiency (which is satisfying to fix), VTE question hypercoagulable disorder, and other relatively healthy folks to counter balance the solid tumor. Some worried well patients (HFE heterozygotes with elevated ferritin 2/2 NAFLD: "sure, why not donate blood, we are in a shortage, but you don't HAVE to; follow up with your hepatologist and lose some weight").

My colleague who is doing all solid tumor I think is close to burnout as there is nothing to counter balance. That and this doc only sees a single sub specialty for which there is data that this causes higher rates of burnout— this and PP have the highest rates whereas community docs who see a little bit of everything, a good chunk of it heme, have the lowest rates.

Ref:

https://ascopubs.org/doi/10.1200/JCO.2013.51.8480

 

[MifflinDunder]

This is why I enjoy my practice that is 60/40 benign heme to Onc. Most of the benign heme patients are MGUS (not even high risk), Iron deficiency (which is satisfying to fix), VTE question hypercoagulable disorder, and other relatively healthy folks to counter balance the solid tumor. Some worried well patients (HFE heterozygotes with elevated ferritin 2/2 NAFLD: "sure, why not donate blood, we are in a shortage, but you don't HAVE to; follow up with your hepatologist and lose some weight").

My colleague who is doing all solid tumor I think is close to burnout as there is nothing to counter balance. That and this doc only sees a single sub specialty for which there is data that this causes higher rates of burnout— this and PP have the highest rates whereas community docs who see a little bit of everything, a good chunk of it heme, have the lowest rates.

Ref:

https://ascopubs.org/doi/10.1200/JCO.2013.51.8480

Benign heme dominant practices would lead to ~300k salary though right? and not the 450-500k the predominantly solid tumor folks make.

 

[dozitgetchahi]

Honestly, if one wants truly healthy foods one needs to learn to garden and grow fruits and vegetables. It’s not just processed foods and red meat which are unhealthy, but also the prevalence of pesticides and microplastics (pthalates, BPA, etc)
There’s more and more big studies coming out about the numerous health effects of this crap, such as endocrine disruption, obesity, infertility etc. (not to mention cancer of course)

Yeah, absolutely. And we’ve been able to do that also. I finally have enough space to be able to do a significant amount of gardening, and last year I grew a very surprising amount of squash, tomatoes, and onions using just a small strip of land next to my previous rental house. With more space this year, I’m hoping to grow a lot more.

 

[HemeOncHopeful19]

Benign heme dominant practices would lead to ~300k salary though right? and not the 450-500k the predominantly solid tumor folks make.

I think both of your estimates are on the low end but I can't say about purely benign heme. The best if you're going to go the employed route is to get a mix of both (as alluded above) because you can get the higher RVU rate negotiated with the hospital but benign heme patients are typically easier to see quickly and move through your day.

 

[gutonc]

Benign heme dominant practices would lead to ~300k salary though right? and not the 450-500k the predominantly solid tumor folks make.

Depends on how your comp is structured. If you're in a large group (employed, MSG, whatever) that splits things evenly across docs based on productivity, then benign heme can actually be a massive cash cow (for you) since you can see new patients in 20 minutes and follow ups in 10, making seeing 30-40 patients a day pretty easy. If, OTOH, you're in a PP group that is eat what you kill and includes the chemo that you, not the group overall, orders, then yes, 15 chemo patients a day will pay better.

In my former and current groups (both employed), everyone is paid the same base (based on seniority), $/wRVU and has the same benchmarks. People make different amounts based on their productivity.

ETA: Even if you only eat what you yourself kill on the infusion side as a FT benign heme doc, Aranesp, Luspatercept, IVIG and Rituximab bring in a ****ton of cash. You could fund your entire retirement plan with 4 or 5 PNH patients on Ultomiris alone.

 

[osprey099]

Benign heme dominant practices would lead to ~300k salary though right? and not the 450-500k the predominantly solid tumor folks make.

If you're employed and RVU based, seeing benign heme can generate a lot of money. There are ways you can "play the game" and code for level 5s for benign heme patients. Seeing a level 5 new benign heme patient probably takes 1/3 the time and mental capacity as it does seeing a level 5 new onc patient.

If you're in private practice that generates revenue via drug margin, then seeing benign heme gets you pennies. In pp, you want to be wheeling and dealing chemo/IO/dispensary drugs as much as possible.

 

[dozitgetchahi]

Microplastics are everywhere including in the ground water and in tap water. May be able to filter from tap / fridge , but maybe not. NEJM paper on electron microscopes of coronary a. plaque shows these “specks” waving hi as they are floating on by. Probably pathogenic for CAD and CBVD as well. I think it’s too late unfortunately.

You can definitely filter out micro plastics with a countertop RO filter (which I use)…but I’ve also seen studies suggesting that the RO membrane itself can lead to micro plastics being deposited in the water.

I may invest in a countertop distiller at some point that would get around that problem. But for now, I think my RO setup is getting most of the toxic compounds out of our tap water. I want to install a whole house water filter at some point too, which will help get some of the crap out for everywhere else the water is going in the house. Living near farm country means all that pesticide/herbicide/etc runoff is going into the water…

 

[TexasMed22]

You can definitely filter out micro plastics with a countertop RO filter (which I use)…but I’ve also seen studies suggesting that the RO membrane itself can lead to micro plastics being deposited in the water.

I may invest in a countertop distiller at some point that would get around that problem. But for now, I think my RO setup is getting most of the toxic compounds out of our tap water. I want to install a whole house water filter at some point too, which will help get some of the crap out for everywhere else the water is going in the house. Living near farm country means all that pesticide/herbicide/etc runoff is going into the water…

Is there actually data that suggests these things are harmful? I'm aware of the theoretical mechanistic explanations, and I'm sure there's some garbage basic science papers out there on the topic. But is there actually evidence that this is something we should be worried about in humans, in the doses we are exposed to? (this is not a rhetorical question)

Managing exercise, diet, and stress seem much higher ROI moves

 

[Royster33]

Hem/onc is 100% a lifestyle specialty if you want it to be. It also helps that oncologists are VERY in demand right now. Really gives us a lot of negotiating power. I get inundated with recruiter emails daily, here is an example of one: "Heme/Onc Montana, 650K guaranteed for life of contract, average 10 patients per day, 4 day work week, no call." Would be hard to find that kind of work/life/salary balance in any other specialty right now.

 

[sloh]

What are heme onc job packages like in places like NY, SoCal, Bay Area? Kaiser?

 

[whoknows2012]

What are heme onc job packages like in places like NY, SoCal, Bay Area? Kaiser?

Can answer nyc and nyc metro

Academics nyc-250-275k +/- rvu bonus
Academics nyc metro -275-300k likely +/- rvu bonus
Satellite/academic affiliate nyc-275-300k likely with rvu bonus
Satellite/academic affiliate nyc metro-325-350 likely with rvu bonus
Hybrid/community-350-375 especially the further our you get from nyc into the burbs (closer to 300 in nyc)
PP (ie ny blood and cancer) 425-450k + bonus

 

[Duke1K]

What are heme onc job packages like in places like NY, SoCal, Bay Area? Kaiser?

For NorCal, my rough experience over the past few years:

Academics: 250-350K (depending on benign/solid/malignant) + small RVU bonus
VA/Academic Partnerships (clinically light): 200-300K + no/very small RVU bonus
Satellite/academic affiliate/hybrid (clinically heavy): 400-450K at least + good RVU bonus
Kaiser: ~400K fixed (no negotiation) + no RVU bonus
PP: highly variable, ~400-650K reasonable + good RVU bonus
PP further out (~1h driving from closest international airport): 500K-1M + good RVU bonus

 

[sloh]

For NorCal, my rough experience over the past few years:

Academics: 250-350K (depending on benign/solid/malignant) + small RVU bonus
VA/Academic Partnerships (clinically light): 200-300K + no/very small RVU bonus
Satellite/academic affiliate/hybrid (clinically heavy): 400-450K at least + good RVU bonus
Kaiser: ~400K fixed (no negotiation) + no RVU bonus
PP: highly variable, ~400-650K reasonable + good RVU bonus
PP further out (~1h driving from closest international airport): 500K-1M + good RVU bonus

Wow for Kaiser it’s only 400k even after partnership?

The spread of these incomes in this thread is nuts. 250k to 7 figures depending on setup and location

 

[Duke1K]

Wow for Kaiser it’s only 400k even after partnership?

No, these are starting numbers; it takes I think ~5? or so years to buy into partnership, and there's a fixed salary scale each year

 

[osprey099]

Hem/onc is 100% a lifestyle specialty if you want it to be. It also helps that oncologists are VERY in demand right now. Really gives us a lot of negotiating power. I get inundated with recruiter emails daily, here is an example of one: "Heme/Onc Montana, 650K guaranteed for life of contract, average 10 patients per day, 4 day work week, no call." Would be hard to find that kind of work/life/salary balance in any other specialty right now.

But you would have to live in Montana...

 

[onconc]

No, these are starting numbers; it takes I think ~5? or so years to buy into partnership, and there's a fixed salary scale each year

How much are the > 5 year numbers once partnership kicks in ?

 

[onconc]

What are heme onc job packages like in places like NY, SoCal, Bay Area? Kaiser?

desirable metros in CA will have the middle thick part of bell curve between 450k to 700k for employed W2.
At the tail end of the bell curve, it can go well into 7 figures.

 

[Duke1K]

How much are the > 5 year numbers once partnership kicks in ?

I'm no Kaiser expert by any stretch, but I vaguely remember people in the 600K+ range before retiring when pension-eligible. The value of being partner is variable like a stock, but they have impressive returns on investment in the multiple 100s% range. Also keep in mind that all Kaiser medical groups operate independently, so how TPMG (The Permanente Medical Group based in Norcal) is managed would be different than the groups in SoCal, Northwest, Southeast, mid-Atlantic, Hawaii, etc.

 

[Legend of Link]

I guess “boonies” are kind of relative, but I’m not in THAT type of boonies. In fact, there’s a medium metro 35 min away from me and some of the docs here live there and commute. The school district there is one of the best in the state.

The heme onc guys here don’t make close to 7 figures for what it’s worth.

I’m not here to compare rheum income to heme onc cuz that’s not even close across the board but just wanted to chime in regarding non big city rheum income potential. 500-600k is probably closer to the norm than the outlier.

How much are you currently making in total comp? How's the workload? What part of the country?

 

[bronx43]

How much are you currently making in total comp? How's the workload? What part of the country?

Mid 500s with 4.5 days and 20-21 pts on average daily. Midwest.

 

[Legend of Link]

Mid 500s with 4.5 days and 20-21 pts on average daily. Midwest.

that's beautiful. how come MGMA average is so low for rheumatology? Wonder why rehuma is not more competitive

 

[MifflinDunder]

that's beautiful. how come MGMA average is so low for rheumatology? Wonder why rehuma is not more competitive

You knew the answer! Everyone's trying to make the best financial decision and searching for the best return on investment. As soon as the MGMA shows median rheum salaries of $500k, you'll see everyone on Twitter talking about lupus, not colorectal cancer awareness.

 

[Doc mu]

I think it really depends on how you define lifestyle specialty.

I’ve interviewed at places where everyone works til 530-6pm and make >750k but I don’t think you HAVE to do that in Heme/Onc.

Call usually isn’t terrible as far as overnight emergencies but our patients do go to the hospital a lot so unlike Rheum or Endocrine who may not even maintain privileges you do have to go see people there

Pts go to the hospital a lot? even if you dont do heme and only do solid onc?

 

[osprey099]

Pts go to the hospital a lot? even if you dont do heme and only do solid onc?

It's the solid onc patients who are going to the hospital a lot. Malignant heme patients do too. But your IDA patient is not going to the hospital. Even if they do, you're not the one who's gonna need to see them.

 

[bronx43]

that's beautiful. how come MGMA average is so low for rheumatology? Wonder why rehuma is not more competitive

I suspect a large part is due to the fact that most rheum are in a metropolitan area where the income is actually <300k. I used to be academics in major metro and I was making <200k. I don’t have data for this, but I would bet that rheum is one of the specialties with the highest gap (as a %) between rural and metro income. For comparison, the GI guys here pull 700-800k, but the GI in major metro areas in my state make 500-600k. The onc guys here make 600-700, but the ones in major metro make 450-500k.
This is why I said before I would NOT do rheum again. Doing this specialty basically forces you to work in rural/semi rural. There are good things about living here but it’s never a good thing to limit your geographic flexibility.

Out of all the fellows around the time I trained, none are working in rural/semi rural.
You also have to add in the fact that a lot of rheum out there are on mommy-track or have a high earning spouse and don’t really care to hustle for $.

 

[Doc mu]

I suspect a large part is due to the fact that most rheum are in a metropolitan area where the income is actually <300k. I used to be academics in major metro and I was making <200k. I don’t have data for this, but I would bet that rheum is one of the specialties with the highest gap (as a %) between rural and metro income. For comparison, the GI guys here pull 700-800k, but the GI in major metro areas in my state make 500-600k. The onc guys here make 600-700, but the ones in major metro make 450-500k.
This is why I said before I would NOT do rheum again. Doing this specialty basically forces you to work in rural/semi rural. There are good things about living here but it’s never a good thing to limit your geographic flexibility.

Out of all the fellows around the time I trained, none are working in rural/semi rural.
You also have to add in the fact that a lot of rheum out there are on mommy-track or have a high earning spouse and don’t really care to hustle for $.

What specialty would you do if you could go back and why?