Why is heme onc not considered a lifestyle speciality?

[geniusindisguise]

You're assuming big pharmas interests align with ours, they would benefi far more if they could dispense onco drugs like other drugs and make the extra cash themselves

No groups will ever perfectly align, but there certainly is some overlap in so far as increased market share from big pharma's standpoint more or less means increased demand for oncologists, especially with the current focus in drug development being moving drugs into neoadjuvant/adjuvant settings, intensifying therapies with upfront combos, and increased downstream imaging/labs/visits, etc. Onco drugs are on another level in terms of toxicity and I don't see any breakthrough drugs with decent efficacy and benign tox profiles being approved any time soon (closest we have is maybe osi), so I don't foresee any major changes in the near future that lead onco therapeutics to be dispensed like other drugs.

---

Members don't see this ad.

 

[osprey099]

Also, you can't just dispense Osimertinib or Capecitabine like you dispense Amlodipine and Metformin. The former requires "special handling", delivered via specialty pharmacies, and require an oncologist overseeing the course of treatment, whereas the latter can be picked up at your local CVS and prescribed/managed by mid-levels.

 

[dozitgetchahi]

I can never do GI or Cards, don't want any of that lifestyle, done with the stupid rat race.
Why do you think rheumatology is better than A/I? Also can a gig like yours be found in the suburbs of a major metro, especially east or west coast metro?

Look, I think A/I is a good bet also. Pay relatively similar, lifestyle very good also. I have heard that the A/I job market isn’t as robust as it was previously, so that would be where I give the edge to rheum.

As far as major metro suburbs…the jobs are absolutely there but the pay will be less, probably $275-300k to start, maybe a cap of $350-400k in most situations paid on RVUs in urban/suburban areas.

 

[dozitgetchahi]

Also, you can't just dispense Osimertinib or Capecitabine like you dispense Amlodipine and Metformin. The former requires "special handling", delivered via specialty pharmacies, and require an oncologist overseeing the course of treatment, whereas the latter can be picked up at your local CVS and prescribed/managed by mid-levels.

Meh. In rheumatology, we use a lot of these “specialty drugs” as well. However, bear in mind that some of the most toxic drugs we use in rheumatology - tacrolimus, azathioprine, cyclosporine, MMF etc can be freely dispensed at any pharmacy in America. Tbh the “specialty pharmacy” thing has a kernel of truth to it (biologics do need refrigeration, it takes a fair amount of capital and logistics to distribute biologics), and a lot of money grubbing BS on the part of the pharmacies (there is no reason Tavneos, Rinvoq and Xeljanz etc couldn’t be supplied through the pharmacy like any other drug, frankly). Some insurance companies let people pick up our injectable biologics at CVS or Walgreens etc

 

[RustBeltOnc]

I will make one last post here re: putative "shortage" of community-based hematologist oncologists.

Allow me to pose some rhetorical questions.

1. Are you seeing many mid- and late-career docs changing jobs, due to the competition for their services? No? It's just the locums market that seems "hot". Interesting.

2. Has there been an expose in the mainstream media about scores of Hodgkin's and Testicular Ca patients that didn't get ABVD or EP due to this "shortage"? No? Also interesting.

3. Are state/federal governments/CMS acting in a forceful way to address this "shortage"? Not really.

 

[Doc mu]

I will make one last post here re: putative "shortage" of community-based hematologist oncologists.

Allow me to pose some rhetorical questions.

1. Are you seeing many mid- and late-career docs changing jobs, due to the competition for their services? No? It's just the locums market that seems "hot". Interesting.

2. Has there been an expose in the mainstream media about scores of Hodgkin's and Testicular Ca patients that didn't get ABVD or EP due to this "shortage"? No? Also interesting.

3. Are state/federal governments/CMS acting in a forceful way to address this "shortage"? Not really.

1. I would assume it is more of a case of someone settling down and getting established in their area/group or aquiring partnership that causes this.

2/3. I don't think these are accurate ways to measure it, you need numbers to be able to make this point

 

[IM_to_ortho_hopeful]

I will make one last post here re: putative "shortage" of community-based hematologist oncologists.

Allow me to pose some rhetorical questions.

1. Are you seeing many mid- and late-career docs changing jobs, due to the competition for their services? No? It's just the locums market that seems "hot". Interesting.

2. Has there been an expose in the mainstream media about scores of Hodgkin's and Testicular Ca patients that didn't get ABVD or EP due to this "shortage"? No? Also interesting.

3. Are state/federal governments/CMS acting in a forceful way to address this "shortage"? Not really.

Is your point that there is a mal distribution of onc in rural areas vs urban?

Isn’t this the case for every specialty? How is this specific to onc?

 

[osprey099]

Mid to late career oncs are not relocating because they played their cards right and made partner. There are no financial incentive to switch jobs at that point

 

[gutonc]

Is your point that there is a mal distribution of onc in rural areas vs urban?

Isn’t this the case for every specialty? How is this specific to onc?

It's not oncology specific. It's just more of a problem in oncology (and other sub-specialties) where the shortage doesn't equate to "not enough" but to "none".

 

[ONC2023]

This has been an illuminating thread. Just my anecdotal experience as a fellow looking for jobs right now is that there is no shortage of overall openings across the country ranging from what would traditionally be considered both desirable and undesirable locations.

A decent proportion of these positions are (a) lower-paying academic positions, including at my home institution which informally offered me a position and (b) challenging mentoring environments where you're joining a small/rebuilding program - for example, I spoke with a hospital I was excited about but found out after discussion that their program has only 1 permanent heme-onc and 2 locums oncologists. They are trying to hire more because they are referring too many patients out to US Oncology. This might be a great place for an experienced doctor, but I think joining this kind of practice as an inexperienced fellow would be incredibly hard.

But even if I remove these positions, I'll honestly say I've been pleasantly surprised in my n = 1 experience at just how many options there appear to be. Maybe I'll end up eating my words.

EDIT: I will also add that I've been surprised how many places outside of the academic ivory tower have disease-specific programs. For example, I spoke with a non-academic cancer center (affiliated with a 600 bed hospital) with ten oncologists in the Midwest in a city of 500,000 people. They told me they are set up with each oncologist doing 1-2 disease sites and are moving more and more towards an academic model in the community hospital setting.

 

[MifflinDunder]

This has been an illuminating thread. Just my anecdotal experience as a fellow looking for jobs right now is that there is no shortage of overall openings across the country ranging from what would traditionally be considered both desirable and undesirable locations.

Thanks for this! Did you find jobs moving towards a 4-day/week? Or is 4.5-5 day/week still the norm

 

[ONC2023]

Thanks for this! Did you find jobs moving towards a 4-day/week? Or is 4.5-5 day/week still the norm

I’ve seen 4.5-5 day work weeks, but my initial impression (I’m still only about a month into this process) is that 4 days is quite common.

My main goals in my search are (a) solid tumor sub specialization, (b) 4 day work week and, (c) pay. I’m getting a bit more optimistic that I will be able to find one that offers all three.

 

[RustBeltOnc]

If someone is planning a 30+year career in community oncology, I don't think any sort of "sub specialization" out the gate is a good idea.
Especially if we are talking about hospital-based employment - then they got you, insofar as you will have less confidence later on in regards to changing jobs.

If you are planning a move to industry after three or four years or winding down to retirement or part time, then it's probably OK.

 

[TexasMed22]

If someone is planning a 30+year career in community oncology, I don't think any sort of "sub specialization" out the gate is a good idea.
Especially if we are talking about hospital-based employment - then they got you, insofar as you will have less confidence later on in regards to changing jobs.

If you are planning a move to industry after three or four years or winding down to retirement or part time, then it's probably OK.

Can you comment on how challenging it is to be a "generalist" in community practice? After speaking to some academic oncologists that treat only a specific tumor type, they seem to think that it would be life consuming to keep up with all of the changing guidelines and developments for each different tumor type. Do you think this is accurate?

 

[ONC2023]

I'm really glad this topic came up because this decision between generalist versus specialist has been the bane of my existence for the past few months. I'm one of those MD/PhDs who realized in the middle of my physician-scientist fellowship what a scam academic medicine is. Awful mentoring, no real support or guidance and then seeing faculty positions starting as low as 235K - forget it.

Because of how my fellowship is set up, becoming a generalist is not easy. I'm having to rotate through all the solid tumor clinics. It would be really difficult to add malignant heme to my schedule and be good at it. Finding community based solid tumor positions is my emergency escape hatch from academia, and I am pleasantly surprised that I think I'll be able to find one. I didn't expect to find site-specific jobs outside of the ivory tower, but they are out there.

I am in total agreement with you RustBeltOnc, though, that general heme-onc would open me up to more positions that I could then tailor to my own interests over time. But if any future MD/PhDs read this while going through their own realization that academic medicine is not for them, you'll be fine - the sooner you realize it, the sooner you can focus on rotating through all the bread and butter clinics.

 

[gutonc]

Can you comment on how challenging it is to be a "generalist" in community practice? After speaking to some academic oncologists that treat only a specific tumor type, they seem to think that it would be life consuming to keep up with all of the changing guidelines and developments for each different tumor type. Do you think this is accurate?

I don't think it's particularly accurate.

Are there academic/academish folks out there who only treat upper GI cancers who are more aware of the data from some Chinese Phase II study of a drug not available outside of China that was recently presented at a European GI meeting? Definitely.

Do I find it all that difficult to keep up-to-date with practice changing studies in the "Big 4" (Breast, Lung, Colorectal, Prostate) and supplement it as needed? Definitely not.

I've posted elsewhere here that I typically spend 5-20 minutes a day reading a few email blasts (ASCO, Medscape, JCO, NEJM, JAMA Oncology) and will typically delve a little deeper (usually the abstract, occasionally the full manuscript) on one or 2 things a day. That and a couple of minutes with NCCN guidelines, UTD or PubMed when needed gets me through the day without trouble.

I'm also fortunate to be a rural generalist with access to academ-ish specialists and tumor boards so when I really get stuck, I can easily go there.

 

[RustBeltOnc]

First: in regards to is hematology oncology a "life style" specialty - no, it's not, not in the least because of the lack of guidance for community practice from our fellowship programs.

Second: I agree with Gutonc's comments. There are scores of MSTP alums who completed fellowship in places that tell you the "fake news" that you cannot keep up with the literature blah blah. And scores of these same MSTP alums are in broad, general community hematology oncology practice. You need to take initiative in fellowship (and as a new attending) to make this work. It's on you.

Third: I'm convinced the "specialization" in community practice is part of this weird faustian bargain the hospital systems make with new grads: you get to live a cool place, you only need to learn these specific tumor types, and you don't need to worry about the business side of things BUT we won't pay you well and you need to do possibly mindless outreach clinic or call coverage.

But ask your self - if there was a "shortage" - then wouldn't it be "all hands on deck" (ie everyone hustling to do it all) to make sure that ABVD, EP, and RCHOP is administered?

 

[Doc mu]

First: in regards to is hematology oncology a "life style" specialty - no, it's not, not in the least because of the lack of guidance for community practice from our fellowship programs.

Second: I agree with Gutonc's comments. There are scores of MSTP alums who completed fellowship in places that tell you the "fake news" that you cannot keep up with the literature blah blah. And scores of these same MSTP alums are in broad, general community hematology oncology practice. You need to take initiative in fellowship (and as a new attending) to make this work. It's on you.

Third: I'm convinced the "specialization" in community practice is part of this weird faustian bargain the hospital systems make with new grads: you get to live a cool place, you only need to learn these specific tumor types, and you don't need to worry about the business side of things BUT we won't pay you well and you need to do possibly mindless outreach clinic or call coverage.

But ask your self - if there was a "shortage" - then wouldn't it be "all hands on deck" (ie everyone hustling to do it all) to make sure that ABVD, EP, and RCHOP is administered?

So is it a lifestyle specialty after you get used to community work? doesnt everyone need to take initiative in fellowship to learn?

I just fail to see how the other specialties have it worse than onco

 

[RainerMaria]

I’ve written elsewhere but think every speciality has its crap to deal with.
Look at the EM forums and tell me if you think they are dealing with high levels of career satisfaction (TL;DR: they served on the front lines of the pandemic, and were rewarded by being wholesale fired by hospital systems when demand was down). Granted work life balance can be better in H/O but a lot of it is self determined. Also being a hematologist oncologist we are probably sought after thinking man’s internists. You can do hospital medicine or concierge primary care if one got tired of the specialty itself. Or go into industry. Lots of things to fall back on. Personally I think doing a mix of things both benign and malignant keeps you balanced. If you chase RVUs you are setting yourself up for career dissatisfaction. There is a number where one makes enough money to be happy and most of us are there already.

 

[MD46]

Well cant speak for all the HOs but I live in DMV in a very nice a robust city

Currently work 4.5 days. 830-430p, 8-12 on half day

Make well over 500k , this is where hospital doesnt pay very well either, here due to family.

If i decide to go more suburban or rural, i could easily double that

Call is 1:5 nights and 1:5 weekends
Rarely get called after midnight
Weekends are not busy

In clinic have MA, Nurse, RN navigator and NP to help.

For me with 2 little kids life style seems decent enough….

 

[Ubba]

So is it a lifestyle specialty after you get used to community work? doesnt everyone need to take initiative in fellowship to learn?

I just fail to see how the other specialties have it worse than onco

Can't personally speak to the first question, as I'm still a fellow.

WRT Q2, yes, everyone needs to take initiative in fellowship, but the fields of cardiology, nephrology, ID, GI, etc. do not change very much on a month-to-month or even year-to-year basis. The pace of change in onc is staggering. This is wonderful for patients! But it makes the job a hell of a lot harder on the attending side, because it means that SOC is constantly changing and you have to do a ton of reading to keep up with it while doctors in basically every other field of medicine get to relax after they finish training (apart from the 1st year of attendingship, which is stressful for everyone due to the new liability one assumes as the attending of record).

And the notes. The **** notes. Even if one is not trying to be an academic and wax poetic and scientific in one's notes, onc notes HAVE to be thorough if one wants to be able to keep track of the patient's oncologic history, lines of treatment, WHY one chose treatment A instead of treatment B, imaging progression, etc. The medical oncologist becomes the "quarterback" for almost all of the patient's care. It doesn't help that unlike in other specialties, the meds we prescribe will, as sure as night follows day, cause significant toxicities.

Take GI and Cards as examples, with their being the other 2 of the "Big 3" IM subspecialties. Most of Cards decisions are driven by EKG, echo, vitals, and physical exam. They are trained to read EKGs within the minute. Echos take time to interpret but that interpretation is reimbursed. Vitals are done by the time they're in the room. And exam takes about 1.5 minutes. I guess subjective symptoms are relevant too, but that discussion is very focused - dyspnea, chest pain, swelling? Notes are short and sweet. In GI, discussions about symptoms may take a bit longer, but most of the work is also rather straightforward, and procedures - while technically very difficult to my perception - are reimbursed well. Again, not very much month-to-month change. These are all things they are trained to do in fellowship.

For context, as I've written before, residency was easy. Inpatient notes took 5 minutes to update for the day.

It's not that this isn't a great field, but Heme/Onc comes with a lot more unpaid overtime work than other subspecialties.

If you've seen footage of WW2 planes taking off from aircraft carriers, you'll notice that many of them don't quite have the speed to get airborne by the end of the platform, so they dip a bit as they gain more speed and ultimately take flight. That's how it feels it's going to be once fellowship is over, and while I'm sure this is true in every field, it seems more intense in Heme/Onc.

Edit: There are many positives to Heme/Onc, of course. For instance, patient connections are off the charts. But to answer the very narrow questions of whether this is a "lifestyle specialty", the answer is very plausibly "no."

 

[RainerMaria]

In my practice we all write very brief notes
It’s not that hard to create an oncology timeline of events and update it . I usually eschew the epic tools and just do it free text.
It takes me 1-2 minutes to write a progress note. As a fellow you are naturally going to perseverate on notes but once you get into a clinic seeing 15-20 patients per day you will get the hang of it.

 

[osprey099]

Only academics will write essays for notes, citing papers and detailing every little thing. When you're in an attending clinic, they expect you to perseverate on their essays/notes.

In community practice, a note would look like this:

S: couple of sentences of any new problems patient report
O: copy/paste of last PE unless something obvious is different. Copy/paste of path/imaging/NGS etc
A: one liner that is copy paste; ex: 70M mcrpc on docetaxel presenting for follow up
P: 1L ADT + abi/pred, 2L docetaxel
- most recent PSA
- AE: G1 neuropathy, on gabapentin
Copy/paste of other chronic problems

 

[MD46]

Can't personally speak to the first question, as I'm still a fellow.

WRT Q2, yes, everyone needs to take initiative in fellowship, but the fields of cardiology, nephrology, ID, GI, etc. do not change very much on a month-to-month or even year-to-year basis. The pace of change in onc is staggering. This is wonderful for patients! But it makes the job a hell of a lot harder on the attending side, because it means that SOC is constantly changing and you have to do a ton of reading to keep up with it while doctors in basically every other field of medicine get to relax after they finish training (apart from the 1st year of attendingship, which is stressful for everyone due to the new liability one assumes as the attending of record).

And the notes. The **** notes. Even if one is not trying to be an academic and wax poetic and scientific in one's notes, onc notes HAVE to be thorough if one wants to be able to keep track of the patient's oncologic history, lines of treatment, WHY one chose treatment A instead of treatment B, imaging progression, etc. The medical oncologist becomes the "quarterback" for almost all of the patient's care. It doesn't help that unlike in other specialties, the meds we prescribe will, as sure as night follows day, cause significant toxicities.

Take GI and Cards as examples, with their being the other 2 of the "Big 3" IM subspecialties. Most of Cards decisions are driven by EKG, echo, vitals, and physical exam. They are trained to read EKGs within the minute. Echos take time to interpret but that interpretation is reimbursed. Vitals are done by the time they're in the room. And exam takes about 1.5 minutes. I guess subjective symptoms are relevant too, but that discussion is very focused - dyspnea, chest pain, swelling? Notes are short and sweet. In GI, discussions about symptoms may take a bit longer, but most of the work is also rather straightforward, and procedures - while technically very difficult to my perception - are reimbursed well. Again, not very much month-to-month change. These are all things they are trained to do in fellowship.

For context, as I've written before, residency was easy. Inpatient notes took 5 minutes to update for the day.

It's not that this isn't a great field, but Heme/Onc comes with a lot more unpaid overtime work than other subspecialties.

If you've seen footage of WW2 planes taking off from aircraft carriers, you'll notice that many of them don't quite have the speed to get airborne by the end of the platform, so they dip a bit as they gain more speed and ultimately take flight. That's how it feels it's going to be once fellowship is over, and while I'm sure this is true in every field, it seems more intense in Heme/Onc.

Edit: There are many positives to Heme/Onc, of course. For instance, patient connections are off the charts. But to answer the very narrow questions of whether this is a "lifestyle specialty", the answer is very plausibly "no."

6 yrs out of fellowship now

Writing a note:

Heme new consult: max 5-10 mins
Heme followup: less than 5 mins

Onc new consult: 10-20mins ( need to spend time on first note as it makes life easier subsequently)
Onc followup on chemo: 5 mins
Onc followup not on chemo: < 5mins

We have macros and templates
Dictation is quick on dragon
20-25 pts per day is easy, finish and go home no documentation pending for following day

Minimize unpaid work, have RNs and NPs answer most inbox messages.

For scans showing progression, no phone call, do a tele visit and bill.

For long Mychart questions from the patient, ask them to make a followup to discuss.

 

[Ubba]

Definitely getting the sense that charting is the big impediment to realization of good work/life balance. Do most attendings wait for labs to return before completing notes? Management often hinges on lab results, which is partly why I can't complete notes in real time. Most of our patients get their labs right before or after the visit, so it takes time for results (days for myeloma labs).

 

[Legend of Link]

Well cant speak for all the HOs but I live in DMV in a very nice a robust city

Currently work 4.5 days. 830-430p, 8-12 on half day

Make well over 500k , this is where hospital doesnt pay very well either, here due to family.

If i decide to go more suburban or rural, i could easily double that

Call is 1:5 nights and 1:5 weekends
Rarely get called after midnight
Weekends are not busy

In clinic have MA, Nurse, RN navigator and NP to help.

For me with 2 little kids life style seems decent enough….

Are you doing solid tumor or inpatient malignant heme?

 

[The kitchen sink]

6 yrs out of fellowship now

Writing a note:

Heme new consult: max 5-10 mins
Heme followup: less than 5 mins

Onc new consult: 10-20mins ( need to spend time on first note as it makes life easier subsequently)
Onc followup on chemo: 5 mins
Onc followup not on chemo: < 5mins

We have macros and templates
Dictation is quick on dragon
20-25 pts per day is easy, finish and go home no documentation pending for following day

Minimize unpaid work, have RNs and NPs answer most inbox messages.

For scans showing progression, no phone call, do a tele visit and bill.

For long Mychart questions from the patient, ask them to make a followup to discuss.

notes done and completed by end of each visit?

 

[MD46]

Are you doing solid tumor or inpatient malignant heme?

Mix of solid tumor and out patient benign and malignant heme. No inpatient malignant heme. We arent very heavy inpatient. Maybe 2-3 followups a day 1-2 new consults if any

 

[MD46]

notes done and completed by end of each visit?

For most followups yes, for new ones i try to open up the note and populate in am before starting clinic while drinking coffee. For example oncology patients, add scans pathology ngs repots pertinent labs etc to the notes already as they are constant, usually have a general idea of a plan. During patient visit i dont type notes, i place orders and instructions for check out. As soon as I go back to my room with fresh info from patient encounter i update not sign and bill. For chemo orders i place at the end of the day just to make sure I am not making mistakes.

 

[gutonc]

In my practice we all write very brief notes
It’s not that hard to create an oncology timeline of events and update it . I usually eschew the epic tools and just do it free text.
It takes me 1-2 minutes to write a progress note. As a fellow you are naturally going to perseverate on notes but once you get into a clinic seeing 15-20 patients per day you will get the hang of it.

This is how I do it too.

My notes are as follows:
CC: Cancer Stuff
H/O History: This is a running bulleted list of diagnostic/therapeutic/surveillance things that have happened. Sometimes it's 2 lines long, sometimes it's 50. I copy this forward and update every time there's something to change
Interval History: What's going on now
Plan: I mean...this should be obvious.
A bunch of autopopulated BS Epic crap to make sure no coder comes after me

The first 2 sections are copied forward each visit. The next 2 are updated each visit, sometimes with a copy forward that is edited. The last one is just smart text.

For the vast majority of patients, the whole thing takes <5 minutes (usually more like 2-3).

 

[osprey099]

Got this today. 10 patients/day 4 days/week for 650k? Sounds like a lifestyle job to me. But you have to be willing to live in Montana...

 

[gutonc]

Definitely getting the sense that charting is the big impediment to realization of good work/life balance. Do most attendings wait for labs to return before completing notes? Management often hinges on lab results, which is partly why I can't complete notes in real time. Most of our patients get their labs right before or after the visit, so it takes time for results (days for myeloma labs).

Ain't nobody got time for that. My notes basically say "labs pending from today, will follow up" and then have if/then statements on what will happen when the results do come in. If the results are dramatically different than I was expecting, I'll addend the note later. This probably happens <5% of the time.

 

[gutonc]

Got this today. 10 patients/day 4 days/week for 650k? Sounds like a lifestyle job to me. But you have to be willing to live in Montana...

I mean, there's Montana, and there's Montana. Certainly some parts I'd love to live in, others...definitely not.

 

[Doc mu]

I mean, there's Montana, and there's Montana. Certainly some parts I'd love to live in, others...definitely not.

You are living proof that onco is a lifestyle specialty, the hours you spend on this forum alone amount to 60 vacations

 

[HemeOncHopeful19]

I mean, there's Montana, and there's Montana. Certainly some parts I'd love to live in, others...definitely not.

Emily would never steer you wrong, bro!

 

[RainerMaria]

This is how I do it too.

My notes are as follows:
CC: Cancer Stuff
H/O History: This is a running bulleted list of diagnostic/therapeutic/surveillance things that have happened. Sometimes it's 2 lines long, sometimes it's 50. I copy this forward and update every time there's something to change
Interval History: What's going on now
Plan: I mean...this should be obvious.
A bunch of autopopulated BS Epic crap to make sure no coder comes after me

The first 2 sections are copied forward each visit. The next 2 are updated each visit, sometimes with a copy forward that is edited. The last one is just smart text.

For the vast majority of patients, the whole thing takes <5 minutes (usually more like 2-3).

I wonder if your autopopulated EPIC bs is the same as mine. For a follow up my only autopopulated stuff is Current Meds & Allergies...

I don't carry PMH, PSH, FH anymore in a progress note, as I only use this on the initial consult note.

Also you mentioned previously how you make yours "medicolegal" proof? Curious what this looks like...

 

[TexasMed22]

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.

Are 3 days a week jobs common in hem/onc? I was under the impression that in medicine, working 3 days per week is basically impossible unless you want to take a gigantic pay cut due to the way overhead and office expenses work (I've heard stories of ophthalmologists making like 150k working 3 days a week due to overhead etc)

3 days a week sounds like a dream tbh

 

[gutonc]

Are 3 days a week jobs common in hem/onc? I was under the impression that in medicine, working 3 days per week is basically impossible unless you want to take a gigantic pay cut due to the way overhead and office expenses work (I've heard stories of ophthalmologists making like 150k working 3 days a week due to overhead etc)

3 days a week sounds like a dream tbh

Possible anywhere but more common/likely in employed scenarios. At my last job (hospital employed, community based academ-ish group with 5 offices and ~15 docs), less than 1/3 of the physicians worked FT. At my office, the busiest of the 5 at the time, not a single one of us worked FT.

Note that regardless of your clinical FTE, everyone shared call equally. Benefits were pro-rated for total FTE (some of us had non-clinical buy-downs for admin, IT, teaching, research). There were always plenty of docs in the office to keep the MAs and RNs busy.