Would you go into hem onc if you were a med student?

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If you are a 'clean' (no substantive adverse history) friendly competent medonc, you can easily find the job I'm referencing. And several others in that ballpark.
 
In Metro Detroit, I've asked. Nobody makes the money that is mentioned here. 7 digits is not happening for anyone except a few owners and a few busy employed people. They are starting in 250-300 range for pre partner salary and working very hard. I'm friends with one, as the wives get along, and we know that he hardly is home to see them. This is anecdote, of course, but he is part of the 4 docs in our town that I work in and they all work very hard. Partners do well, but no one is earning million round these parts. They still have waaaaaay more flexibility than us. I'm begging my hospital to get someone part time for that range mentioned above and still can't get anyone, medoncs seem to hate employment, but unlike us, they have choices.
 
THe med oncs I know doing big numbers are the ones that are owners in a big group, have their own facilities/pharmacy and a gazillions NP's. Maybe they own some imaging or have a piece of an imaging center as well. They work hard but also tend to take more vacation weeks off.

Employed ones in metro areas do fine but always seem more upset with admin. Getting things like scribes or getting staff to do more chart prep is a constant issue. Their inpatient service is no joke though - they don't admit but they are seeing lots of patients, long weekend rounds, etc. Anything even resembling a new cancer diagnosis it seems gets an auto-consult from the hospitalist.

Rural employed can make much more money.
 
Mandelin Rain said:
I'm not rural, but I know it costs >>>$1.3 million per year to get a locums med onc here.
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The market dynamics in medonc are so different than radonc. They are just totally different phenomenon.

Medonc is a much bigger field with almost 40% IMGs filling spots. There is national high demand.

Radonc is a much smaller field with (as of 2021) about 4% IMGs filling spots. Very low national demand.

IMGs are in general discriminated against in the fellowship selection and job selection process. They are more likely to be in community oncology programs and to be the reasonable candidates available for rural jobs.

There is no comparable population in radonc. I have been contacted about a job from persons with undergraduate IVY league degrees and Top 3 residency positions.

The locums market, relative intensity of medical oncology work and global cultural changes have also markedly changed the market for rural medical oncology.

I am now seeing good IMG candidates who are choosing to keep their families or move their families back to their home country. They do the locum gig or negotiate remarkably flexible schedule, make bank and find a way to spend roughly 3-4 months a year abroad. It is remarkable, and a function of many things, including improved global wealth and a perception that the US may not offer the brightest future for their children.

But unlike @sirspamalot they are flying in a much bigger plane!
 
sirspamalot said:
Medoncs: Rural outpatient job paying north of 1.3m+ no inpatient call 4 day reasonable load work week and plenty of jobs available. But it's horrible.

Radoncs: Sorry, you were saying what again?
Click to expand...

I realize that there's a bit of levity in this post for the sake of the comparison, but it should be made clear to lurkers who are curious about the respective fields that this position is as real as a unicorn.

If there is a job that is paying 1.3m in H/O, it comes with the burden of seeing about 30 pts per day with plenty of night and weekend call and full 5-day weeks.

I was fast in residency. F/u progress notes took about 5 minutes apiece (Epic). Learned how to artfully (in my mind, at least) perform H&P concurrently. Etc. H/O pts are totally different. Imagine having to look up for your follow-up in 2-3 different EMRs (because you will have pts who use different hospitals and it's also dangerous to assume that they didn't stumble into Hospital C's ER for an acute complaint 2 weeks ago) all ER visits, doctor visits, labs, PET results, CT results, and the Doppler US they got 2 weeks ago for leg swelling. Now you have to refer back to an NCCN guideline chart to restage the patient because there's an indeterminate mass in some node whose N classification you can't remember because there are about 50 different staging schemas per NCCN. Now you have to look up the guidelines for recurrent [cancer] for said stage. Consider the toxicities of the Category 1 regimens and think about how to choose the least bad regimen. Then go in to talk to the patient about results, plans, and expected toxicities for the anticipated regimen. Refer back to NCCN guidelines for monitoring recommendations.

Multiply this process give or take by 20 and assume the rest are heme patients, which are frequently more complex than onc patients and very often have more social issues. Early mornings and late evenings are spent writing notes from the day's encounters. That's what a 1.3m/year medical oncologist (there are maybe several hundreds of these in the entire country) is doing to earn that money - being a 16-hour-a-day, >5-day-a-week doctor.

Don't get me wrong. I like medical oncology. But this is not a lifestyle specialty. It will consume your life and alter your personality.
 
Ubba said:
I realize that there's a bit of levity in this post for the sake of the comparison, but it should be made clear to lurkers who are curious about the respective fields that this position is as real as a unicorn.

If there is a job that is paying 1.3m in H/O, it comes with the burden of seeing about 30 pts per day with plenty of night and weekend call and full 5-day weeks.

I was fast in residency. F/u progress notes took about 5 minutes apiece (Epic). Learned how to artfully (in my mind, at least) perform H&P concurrently. Etc. H/O pts are totally different. Imagine having to look up for your follow-up in 2-3 different EMRs (because you will have pts who use different hospitals and it's also dangerous to assume that they didn't stumble into Hospital C's ER for an acute complaint 2 weeks ago) all ER visits, doctor visits, labs, PET results, CT results, and the Doppler US they got 2 weeks ago for leg swelling. Now you have to refer back to an NCCN guideline chart to restage the patient because there's an indeterminate mass in some node whose N classification you can't remember because there are about 50 different staging schemas per NCCN. Now you have to look up the guidelines for recurrent [cancer] for said stage. Consider the toxicities of the Category 1 regimens and think about how to choose the least bad regimen. Then go in to talk to the patient about results, plans, and expected toxicities for the anticipated regimen. Refer back to NCCN guidelines for monitoring recommendations.

Multiply this process give or take by 20 and assume the rest are heme patients, which are frequently more complex than onc patients and very often have more social issues. Early mornings and late evenings are spent writing notes from the day's encounters. That's what a 1.3m/year medical oncologist (there are maybe several hundreds of these in the entire country) is doing to earn that money - being a 16-hour-a-day, >5-day-a-week doctor.

Don't get me wrong. I like medical oncology. But this is not a lifestyle specialty. It will consume your life and alter your personality.
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I work with some very busy medoncs (no idea how much they are paid, but the key is having an excellent support-pa/np). I know several medoncs who went for the rural 1 mill type of arrangement and arent getting killed. One even refuses to do heme and has some kind of telehealth for pts. After 5 yrs, a good general medonc is really on top of nccn guidelines, toxicities, pathways, drugs for common cancers and probably this part of the job is a lot less formidable. Radoncs do enter practice much more skilled in what they need to do than medoncs.
 
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Ubba said:
I realize that there's a bit of levity in this post for the sake of the comparison, but it should be made clear to lurkers who are curious about the respective fields that this position is as real as a unicorn.

If there is a job that is paying 1.3m in H/O, it comes with the burden of seeing about 30 pts per day with plenty of night and weekend call and full 5-day weeks.

I was fast in residency. F/u progress notes took about 5 minutes apiece (Epic). Learned how to artfully (in my mind, at least) perform H&P concurrently. Etc. H/O pts are totally different. Imagine having to look up for your follow-up in 2-3 different EMRs (because you will have pts who use different hospitals and it's also dangerous to assume that they didn't stumble into Hospital C's ER for an acute complaint 2 weeks ago) all ER visits, doctor visits, labs, PET results, CT results, and the Doppler US they got 2 weeks ago for leg swelling. Now you have to refer back to an NCCN guideline chart to restage the patient because there's an indeterminate mass in some node whose N classification you can't remember because there are about 50 different staging schemas per NCCN. Now you have to look up the guidelines for recurrent [cancer] for said stage. Consider the toxicities of the Category 1 regimens and think about how to choose the least bad regimen. Then go in to talk to the patient about results, plans, and expected toxicities for the anticipated regimen. Refer back to NCCN guidelines for monitoring recommendations.

Multiply this process give or take by 20 and assume the rest are heme patients, which are frequently more complex than onc patients and very often have more social issues. Early mornings and late evenings are spent writing notes from the day's encounters. That's what a 1.3m/year medical oncologist (there are maybe several hundreds of these in the entire country) is doing to earn that money - being a 16-hour-a-day, >5-day-a-week doctor.

Don't get me wrong. I like medical oncology. But this is not a lifestyle specialty. It will consume your life and alter your personality.
Click to expand...
Cool post. But wrong. Rural smart medoncs are crushing it. Believe whatever you want...
 
sirspamalot said:
Cool post. But wrong. Rural smart medoncs are crushing it. Believe whatever you want...
Click to expand...

Why is rural Heme onc being held up as an example of how good Heme/onc is?
 
grenz said:
Why is rural Heme onc being held up as an example of how good Heme/onc is?
Click to expand...
the larger point is that medoncs have good paying jobs in almost any local and a very bright future. Most importantly they are highly valued by hospitals and hard to replace.
 
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Ubba said:
I realize that there's a bit of levity in this post for the sake of the comparison, but it should be made clear to lurkers who are curious about the respective fields that this position is as real as a unicorn.

If there is a job that is paying 1.3m in H/O, it comes with the burden of seeing about 30 pts per day with plenty of night and weekend call and full 5-day weeks.

I was fast in residency. F/u progress notes took about 5 minutes apiece (Epic). Learned how to artfully (in my mind, at least) perform H&P concurrently. Etc. H/O pts are totally different. Imagine having to look up for your follow-up in 2-3 different EMRs (because you will have pts who use different hospitals and it's also dangerous to assume that they didn't stumble into Hospital C's ER for an acute complaint 2 weeks ago) all ER visits, doctor visits, labs, PET results, CT results, and the Doppler US they got 2 weeks ago for leg swelling. Now you have to refer back to an NCCN guideline chart to restage the patient because there's an indeterminate mass in some node whose N classification you can't remember because there are about 50 different staging schemas per NCCN. Now you have to look up the guidelines for recurrent [cancer] for said stage. Consider the toxicities of the Category 1 regimens and think about how to choose the least bad regimen. Then go in to talk to the patient about results, plans, and expected toxicities for the anticipated regimen. Refer back to NCCN guidelines for monitoring recommendations.

Multiply this process give or take by 20 and assume the rest are heme patients, which are frequently more complex than onc patients and very often have more social issues. Early mornings and late evenings are spent writing notes from the day's encounters. That's what a 1.3m/year medical oncologist (there are maybe several hundreds of these in the entire country) is doing to earn that money - being a 16-hour-a-day, >5-day-a-week doctor.

Don't get me wrong. I like medical oncology. But this is not a lifestyle specialty. It will consume your life and alter your personality.
Click to expand...
Great post. My medonc colleagues work hard. (I'm rural but not remote. Not a place where radoncs fly in).

Serious question/concern: I was surprised by the shear amount of follow-up (and now active treatment) patients filling hemonc schedules. They may have 18-20+ patients per day, but a relatively small fraction of these are new consults. In the setting of targeted therapies and IO of sometimes indefinite duration, these visits are the killer, not the new patient volume, which though substantial, is manageable.

Any recommendations for determining (in a somewhat evidence based way if possible) frequency of f/u or on treatment visits and optimal use of mid-levels regarding such visits.

Feels like community hemonc is drowning in contd. management type visits (often not the highest value if you ask me).
 
I'm telling you that you and anyone else who tells me that 1.3M+ 'easy' jobs for medoncs in rural areas don't exist are abso-f'n-lutely W.R.O.N.G.

I said that before, I'm saying it now, and I'll say it tomorrow.

Get It Chuck Norris GIF by Sony Pictures Television
 
communitydoc13 said:
Great post. My medonc colleagues work hard. (I'm rural but not remote. Not a place where radoncs fly in).

Serious question/concern: I was surprised by the shear amount of follow-up (and now active treatment) patients filling hemonc schedules. They may have 18-20+ patients per day, but a relatively small fraction of these are new consults. In the setting of targeted therapies and IO of sometimes indefinite duration, these visits are the killer, not the new patient volume, which though substantial, is manageable.

Any recommendations for determining (in a somewhat evidence based way if possible) frequency of f/u or on treatment visits and optimal use of mid-levels regarding such visits.

Feels like community hemonc is drowning in contd. management type visits (often not the highest value if you ask me).
Click to expand...

Every medonc I know has at least 1 dedicated midlevel during every day of their clinic time, if not multiple mid levels per doctor.

This is (relatively) rare to see in Radiation Oncology.
 
evilbooyaa said:
Every medonc I know has at least 1 dedicated midlevel during every day of their clinic time, if not multiple mid levels per doctor.

This is (relatively) rare to see in Radiation Oncology.
Click to expand...
My observation is in the context of serious mid-level support. The docs are still seeing a ton of on treatment and f/u patients.

(Think of the radical change in adjuvant treatment for so many solid tumors as well as increase in OS for stage IV solids over the past 5-10 years). Just eating up medonc appointments.
 
Ours who want to be busy do just fine. 1-2 NPs, scribes, etc, etc. Our busiest hasn't dictated a note himself in clinic in years, and his notes even with a scribe are like haikus. No one cares.
 
OTN said:
Ours who want to be busy do just fine. 1-2 NPs, scribes, etc, etc. Our busiest hasn't dictated a note himself in clinic in years, and his notes even with a scribe are like haikus. No one cares.
Click to expand...
No one cares about any of our notes that's for damn sure...
 
communitydoc13 said:
My observation is in the context of serious mid-level support. The docs are still seeing a ton of on treatment and f/u patients.

(Think of the radical change in adjuvant treatment for so many solid tumors as well as increase in OS for stage IV solids over the past 5-10 years). Just eating up medonc appointments.
Click to expand...
Medoncs in my system work 8-5 and see pts 4 days/wk and inpts every 6-8 weeks. all have excellent midlevels who perform all the documentation. Seem to put in 8-9 hrs per day of solid work. earn more than the radoncs here and seem to have a ton of paid speaking opportunities. desirable location and hospitals always seem desperate for more of them. There is a striking difference between their interactions with senior admin and my own.
 
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For those of you who’ve been out in practice for a few years, are you doing anything different now than what you were doing 5 years or so ago? I am doing less things of things (less postop N2 lung, less whole brain, less breast fractions, etc.). That’s different, and all I can think of right now.

Wonder what a med onc would say. Genuinely curious.

To the rad oncs: referring more people for immunotherapy is not an answer I’m going for here 🙂
 
TheWallnerus said:
For those of you who’ve been out in practice for a few years, are you doing anything different now than what you were doing 5 years or so ago? I am doing less things of things (less postop N2 lung, less whole brain, less breast fractions, etc.). That’s different, and all I can think of right now.

Wonder what a med onc would say. Genuinely curious.

To the rad oncs: referring more people for immunotherapy is not an answer I’m going for here 🙂
Click to expand...

APBI. SBRT in metastatic patients. Arthritis and plantar fasciitis.

But 5 years ago I was an angry end-of-residency resident seeing prostate follow ups... 🙂

I want to tell you all about my systems med oncs but I think you will just get jealous. The other day I walked in to their clinic and a scribe was feeing the guy grapes while he signed chemotherapy orders. He winked at me and said "you should've picked hem/onc".

I wanted to ask him follow up questions but it was already 1PM and way past quitting time for me, so I had to leave.
 
Ubba said:
I realize that there's a bit of levity in this post for the sake of the comparison, but it should be made clear to lurkers who are curious about the respective fields that this position is as real as a unicorn.

If there is a job that is paying 1.3m in H/O, it comes with the burden of seeing about 30 pts per day with plenty of night and weekend call and full 5-day weeks.

I was fast in residency. F/u progress notes took about 5 minutes apiece (Epic). Learned how to artfully (in my mind, at least) perform H&P concurrently. Etc. H/O pts are totally different. Imagine having to look up for your follow-up in 2-3 different EMRs (because you will have pts who use different hospitals and it's also dangerous to assume that they didn't stumble into Hospital C's ER for an acute complaint 2 weeks ago) all ER visits, doctor visits, labs, PET results, CT results, and the Doppler US they got 2 weeks ago for leg swelling. Now you have to refer back to an NCCN guideline chart to restage the patient because there's an indeterminate mass in some node whose N classification you can't remember because there are about 50 different staging schemas per NCCN. Now you have to look up the guidelines for recurrent [cancer] for said stage. Consider the toxicities of the Category 1 regimens and think about how to choose the least bad regimen. Then go in to talk to the patient about results, plans, and expected toxicities for the anticipated regimen. Refer back to NCCN guidelines for monitoring recommendations.

Multiply this process give or take by 20 and assume the rest are heme patients, which are frequently more complex than onc patients and very often have more social issues. Early mornings and late evenings are spent writing notes from the day's encounters. That's what a 1.3m/year medical oncologist (there are maybe several hundreds of these in the entire country) is doing to earn that money - being a 16-hour-a-day, >5-day-a-week doctor.

Don't get me wrong. I like medical oncology. But this is not a lifestyle specialty. It will consume your life and alter your personality.
Click to expand...
I agree that Medonc follow ups seem like they could or should be complex. Yet I work with some that see 50 follow ups a day! Granted with a mid level or 2
 
NotMattSpraker said:
APBI. SBRT in metastatic patients. Arthritis and plantar fasciitis.

But 5 years ago I was an angry end-of-residency resident seeing prostate follow ups... 🙂

I want to tell you all about my systems med oncs but I think you will just get jealous. The other day I walked in to their clinic and a scribe was feeing the guy grapes while he signed chemotherapy orders. He winked at me and said "you should've picked hem/onc".

I wanted to ask him follow up questions but it was already 1PM and way past quitting time for me, so I had to leave.
Click to expand...
Ours stay past one, but admins around here would absolutely supply them with a scribe to feed them grapes. Would probably draw the line at a piss boy, but who knows, i am sure one will try their luck.
 
Ubba said:
Imagine having to look up for your follow-up in 2-3 different EMRs (because you will have pts who use different hospitals and it's also dangerous to assume that they didn't stumble into Hospital C's ER for an acute complaint 2 weeks ago) all ER visits, doctor visits, labs, PET results, CT results, and the Doppler US they got 2 weeks ago for leg swelling. Now you have to refer back to an NCCN guideline chart to restage the patient because there's an indeterminate mass in some node whose N classification you can't remember because there are about 50 different staging schemas per NCCN. Now you have to look up the guidelines for recurrent [cancer] for said stage. Consider the toxicities of the Category 1 regimens and think about how to choose the least bad regimen. Then go in to talk to the patient about results, plans, and expected toxicities for the anticipated regimen. Refer back to NCCN guidelines for monitoring recommendations.
Click to expand...
This is literally my job.

Except I have 4 EMRs. I have 3 different email addresses, not including my personal email addresses (so, technically 5).

I'm so happy to see this post, actually. Because this illustrates a point I try to make constantly:

There's more variety to physician jobs than people realize.

I know my job is unusual. It became this way because in a rural area, the hospitals my patients go to are either independent (they still exist) or in different networks. My hospital was mismanaged into the ground by the prior administration. I adore the current administration but it's hard for us to undo 20 years of stupidity quickly or safely. My MedOnc colleague (singular) is mediocre on a good day, in terms of skill - and does the work of two doctors. So you can imagine how that goes.

In short: everything that gets missed, I have to catch and fix - because there's no one else.

While I'm technically academic, I get paid like a community doc. It's not the same level of classic private practice/professional services agreement, but it's certainly better than the academic satellite gigs I hear about.

Based on what I've seen and heard from my friends, I'm certain there are RadOncs working harder than me for less money, and MedOncs working less than me for more money.

But I don't know why anyone is on here expressing disbelief about MedOncs making more than a million a year, or assuming that all RadOncs have a "lifestyle" job.

After residency, for the rest of your life, it's just an absolute free-for-all and no actual rules.
 
elementaryschooleconomics said:
This is literally my job.

Except I have 4 EMRs. I have 3 different email addresses, not including my personal email addresses (so, technically 5).

I'm so happy to see this post, actually. Because this illustrates a point I try to make constantly:

There's more variety to physician jobs than people realize.

I know my job is unusual. It became this way because in a rural area, the hospitals my patients go to are either independent (they still exist) or in different networks. My hospital was mismanaged into the ground by the prior administration. I adore the current administration but it's hard for us to undo 20 years of stupidity quickly or safely. My MedOnc colleague (singular) is mediocre on a good day, in terms of skill - and does the work of two doctors. So you can imagine how that goes.

In short: everything that gets missed, I have to catch and fix - because there's no one else.

While I'm technically academic, I get paid like a community doc. It's not the same level of classic private practice/professional services agreement, but it's certainly better than the academic satellite gigs I hear about.

Based on what I've seen and heard from my friends, I'm certain there are RadOncs working harder than me for less money, and MedOncs working less than me for more money.

But I don't know why anyone is on here expressing disbelief about MedOncs making more than a million a year, or assuming that all RadOncs have a "lifestyle" job.

After residency, for the rest of your life, it's just an absolute free-for-all and no actual rules.
Click to expand...
What I envoy abt your situation is the value you bring to the hospital and the fact that they probably think you would be hard to replace. Can’t complain abt my salary, but hospitals I have worked at have absolutely seen me as replaceable and let me know it. You basically experience what is like to be a medonc.
 
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elementaryschooleconomics said:
This is literally my job.

Except I have 4 EMRs. I have 3 different email addresses, not including my personal email addresses (so, technically 5).

I'm so happy to see this post, actually. Because this illustrates a point I try to make constantly:

There's more variety to physician jobs than people realize.

I know my job is unusual. It became this way because in a rural area, the hospitals my patients go to are either independent (they still exist) or in different networks. My hospital was mismanaged into the ground by the prior administration. I adore the current administration but it's hard for us to undo 20 years of stupidity quickly or safely. My MedOnc colleague (singular) is mediocre on a good day, in terms of skill - and does the work of two doctors. So you can imagine how that goes.

In short: everything that gets missed, I have to catch and fix - because there's no one else.

While I'm technically academic, I get paid like a community doc. It's not the same level of classic private practice/professional services agreement, but it's certainly better than the academic satellite gigs I hear about.

Based on what I've seen and heard from my friends, I'm certain there are RadOncs working harder than me for less money, and MedOncs working less than me for more money.

But I don't know why anyone is on here expressing disbelief about MedOncs making more than a million a year, or assuming that all RadOncs have a "lifestyle" job.

After residency, for the rest of your life, it's just an absolute free-for-all and no actual rules.
Click to expand...

Yea but I bet your grape guy is awesome though, right?
 
RickyScott said:
What I envoy abt your situation is the value you bring to the hospital and the fact that they probably think you would be hard to replace. Can’t complain abt my salary, but hospitals I have worked at have absolutely seen me as replaceable and let me know it. You basically experience what is like to be a medonc.
Click to expand...
I might be the only RadOnc in America able to successfully negotiate a raise <1 year into a gig with the phrase: "I don't know who you're going to find that's both willing and able to do this job".

NotMattSpraker said:
Yea but I bet your grape guy is awesome though, right?
Click to expand...
I had one of the executive secretaries follow me down the hallway yesterday to give me lunch, but there were no grapes.

Obviously, I threw it against the wall and yelled "UNACCEPTABLE, TRY AGAIN".

I think she's still onboarding, which is why I was so kind about it.
 
If heme onc is making seven figures are people just FATfire after like 5 years? What are you folks seeing?
 
NotMattSpraker said:
APBI. SBRT in metastatic patients. Arthritis and plantar fasciitis.

But 5 years ago I was an angry end-of-residency resident seeing prostate follow ups... 🙂

I want to tell you all about my systems med oncs but I think you will just get jealous. The other day I walked in to their clinic and a scribe was feeing the guy grapes while he signed chemotherapy orders. He winked at me and said "you should've picked hem/onc".

I wanted to ask him follow up questions but it was already 1PM and way past quitting time for me, so I had to leave.
Click to expand...
I was doing APBI ~6-8y ago at least. Been doing the SBRT for mets since... ~2010? I don't count PF and OA 😉
 
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