When Should I Start Looking for a Hematology Oncology Job?

Wow.  Brings back memories.  Thank God I got through it.

Medical oncology is one of the most emotionally challenging fellowships in existence. Period. By the time you start your third-year, not only are you still developing your clinical acumen, but also starting to realize the challenge of preparing for your board examination, and ultimately finding a job.  A lot of factors going to your decision for finding work. 

I will review a few of these factors here: 

Geographic constraints
Desired salary
Employment models
Academic or private practice
Work-life balance

Geographic Constraints.

If you are willing to look beyond a popular city like San Francisco, New York, Boston or Los Angeles (if you consider Los Angeles popular) then your chances of finding a job grow exponentially.  Your salary as well.  There are several advantages to working in 
 non-cosmopolitan settings as well as disadvantages.  We will cover those in another post.  The salary differential could be anywhere between 50 – 100%. Be careful when comparing a city job with a rural job, as you are comparing apples and oranges across numerous parameters.

Desired salary.  

For nonacademic positions, the general starting salary for a new graduate, will be on the order of $275-$325,000 a year. Do not perseverate on this number. Numerous factors contribute to this. What is the call schedule like? How are evening and weekend consults handled? How is hospital rounding split up?  Are you going to be covering every 3 weekends or every 8 weekends?  Do you need to make your own time to round in the hospital before 8 AM or after 5 PM? Is the hospital census 2 patients or 20 patients?  Are you expected to meet your salary requirements with RVUs? Does seniority drive referral patterns? Each of these is a topic in and of itself.

Employment models.
There are variety of employment models out there.  There are completely vertically integrated healthcare system such as Kaiser Permanente, that are consolidated insurance company, physician group, and hospital system in one.  Everything is in-network.  Entities like this, are well lubed machines, and you are simply a cog in a wheel.  This statement cannot be exaggerated. Less things are dynamic in this model. There is also the private practice model, but you are at the mercy of the owner(s) of the group.  These group models can tend to be more bottom line driven, but again there is a lot of variability depending on the group. Being bottom-line driven is not necessarily a malicious thing. Compared to a large hospital system, you may be privy to the information. 

Academic versus private practice
This will be the biggest fork in the road for the majority of hematology oncology fellows.  Unless somebody has worked in private practice, they have little to no idea what the experience is like.  Most fellows are training in a tertiary care center, and are likely exposed to very challenging cases, and less so bread and butter.  They both have their pros and the cons.  For example, the typical medical oncologist, will spend more of their time dealing with iron deficiency anemia, non-ITP thrombocytopenia, and breast cancer in its early stage rather than relapsed AML and angioimmunoblastic T-cell lymphoma.  Intellectual conversations are few and far between.  Grand rounds are relatively nonexistent.  While there are some hybrid models, this is not the norm.  What somebody desires in their day-to-day experience, should drive their decision for a job.  If you want to work 2 days a week and do research 3 days out of the week and expect to make $400,000 a year as a new graduate, may the force be with you.

Worklife balance
Hopefully by the time you are a fellow, you would have understood what this is.  You will develop the wisdom to know when to hit the accelerator and went to slam on the brakes.  Also knowing when to pull over the car relax for a couple of hours.  This becomes truer once you become an attending.  The level of detail you can delve into never ends.

More posts to come on the job search front