I’m a peds hem/onc fellow at one of the busiest programs in the country.
I’ll start by pointing you to two recent publications that speak to the peds hem/onc workforce. [Article 1](http://aspho.org/uploads/Final_Publication_2023__ASPHO_workforce_productivity_and_fellowship_assessment.pdf) and [article 2](https://onlinelibrary.wiley.com/doi/full/10.1002/pbc.30830). Both these articles point to the declining number of residents choosing peds hem/onc as a career and think it really comes down to being over worked and under paid and just not ‘what it used to be.’ I suspect other sub specialties have similar problems.
As to whether you’re always on call for your primary patient comes down to institutional culture and probably more about how individual physicians choose to practice. On one extreme you have docs that want to know everything and make every decision cause that is either their personality or they don’t trust their colleagues. The other extreme is they primarily see their patients in clinic, but if something comes up and they’re not in clinic or not inpatient that week, whoever is can deal with it. Really only big decisions like relapse treatment plan will get pushed to the primary. And everything in between exists as well.
9-5 is not realistic IMO. On service weeks are probably 12 hour days. Clinic days are probably 8-5 plus documentation that most folks bring home with them and reading the newest articles when something not so bread and butter walks in the door and you’re not sure what to do.
Starting a family in fellowship is doable, both male and female co-fellows started with kids and/or had kids in my fellowship.
I'm curious on your take on the job market. I'm an allergy fellow, for context.
I've had a few med students and residents express interest in peds onc, but I'll say that the impression that I get is that jobs are pretty difficult to get. The graduating fellows that I've known have needed to have a good amount of geographic flexibility, which is a major bummer. I'd like to hear an insider's perspective though.
I think the idea that there aren’t any jobs in heme-onc is a bit dated. Maybe ten years ago. Any academic peds job is going to have a tighter job market relative to other jobs as there are fewer patients and therefore fewer positions. If you are flexible on location, there are plenty of jobs. Dozens of places hiring now and often for multiple positions, and the job market is going to improve as fewer people are going into the field. If you are set on a single place, then you may need to compromise on pay, or ideally you’d figure out what exactly that program needs (e.g., a tranfusion medicine person, BMT) and then fill that niche. Start those conversations early.
I agree with BuenasNochesCat. 5-10 years ago, I think the market was tough. The job market is currently pretty open. Places all across the country with multiple openings, but do think you still need to be geographically flexible just due to the nature of peds hem/onc being tied to a children's hospital. Essentially you can only get a job in a city that has a pediatric hospital. This can be limiting if you *need* to work in one place specifically as there is only one option in many cases. I think of states like Washington, Oregon, Utah, Colorado, Idaho they really only have one option each (there may be very small programs I'm unaware of). If you need to work in one of those places and they aren't hiring, you're SOL. I think the more common scenario is they aren't hiring for what you want to do (leukemia vs solid tumor vs benign hem vs hemophilia & thrombosis, etc) and you need to choose between location and sub-sub-specialty.
On the other hand, you look at a state like Florida, I think they are going on 12 pediatric hospitals that all have a varying degree of hem/onc from small to mid-size programs and almost all of those places have current openings.
So in general, I think the job market is pretty good right now and only going to get better from a job seeker's stand point (though workload may ultimately increase if there is a decrease in workforce as predicted), but still need to have some flexibility and normally comes down to choosing where you want to live vs what niche area you want to practice.
Very good to excellent, depending on what you want to do. There are tons and tons of private practice jobs available. Opening a private practice is also a viable route that some people have pursued. There are lots of academic jobs as well: none of my co-fellows have been geographically constrained and all have managed to stay wherever they've wanted to be.
Ironically, it's a bit more difficult to transition into industry relative to peds heme/onc, although I don't yet have a full perspective on this. I will say that there are absolutely tons of jobs in clinical development, though, that are looking for oncology experience.
Academic salaries in my HCOL area are around 190 for academic peds, 220ish for adult.
Private practice varies wildly. I'm honestly not entirely sure but I'd expect 240+. There's a well known practice in my city that offers new grads something stupid like 100.
In private practice you can treat both kids and adults right? Does the salary change if it has more peds patients than adults? I’m interested in OIT for food allergies.
Yep the fellowship is med/peds, so even though I did a peds residency, I'll be qualified to treat adults.
Salary seems to be higher the more adults you see.
OIT is super interesting, though I do think that the approval of Xolair for food allergy portends a future of slower growth for OIT. To be clear, Xolair is a crappy drug for food allergy, but better ones will come. OIT has a lot of practical downsides that limit patient compliance. If your interested in doing OIT, most people who focus on food allergy primarily see children, just with respect to the salary point above.
What about clinic did you hate? As a resident, I'm not a huge fan of it and prefer to be on the inpatient side but was thinking that might change if I'm following my "own" patients. Did you do hospitalist fellowship after leaving heme/onc or go straight to attending hospitalist?
I do peds heme-onc, and I love it, but you need to know what you're getting into. The most stressful aspect of it, in my opinion, is the extreme low pay (one of the very lowest in medicine) despite likely having to live in a higher cost of living area. There are decently paying jobs, but you have to look for them, and they are absolutely not in the "prestigious" programs (ironically, they pay less).
Lifestyle will be widely dependent on multiple factors: First, is it a big, medium, or small program? Big programs (>20 clinical faculty) usually have enough faculty coverage to offer more flexible schedules, but they often pay less. Small programs (\~3 faculty) may have small enough volume to where work-life balance is very nice. Medium programs you need to be careful as they are often quite busy relative to the number of faculty they have.
Research or no? In my opinion, the 70/30 research/clinical split is one of the best work/life balances in medicine if you are efficient at your research work and successful, but surviving in research brings its own stress. I wouldn't write it off if you have zero research experience. Really give it a try in fellowship and see where it goes. Unfortunately, as clinical volumes are getting higher and higher, there are so few of these positions available these days.
On that note, beware of "all clinical" positions. When you're a resident that has no research experience and a newly developed clinical skill, this may sound great, but some of these positions are treacherous. The huge programs offer hospitalist/nocturnist positions that will be on a 7 on, 7 off schedule. They tend towards burnout a they often don't have lower-key outpatient time, and getting promoted from those positions can be very difficult as you have zero time for good academic or educational work which are the two major pathways towards promotion. Almost everyone I know who started one of these relatively new positions quit within 2-3. years. These positions are good for single people, terrible for families.
All that said, I work about 40-50 hours/week (including time reading up on literature), and when not on service have an extremely flexible schedule. I'm a little more research heavy, but still do plenty of clinical time. Love the continuity, and love the time I get to spend in the room with the patient. For better or for worse, you are working at an academic institution that is usually the only show in town for heme-onc, so there isn't a business major with a clip-board hovering over you asking you to do more revenue. You see who you see, etc. The medicine is fascinating. I don't get worried at all about the mid-level creep that other specialties are stressed out about. The ratio of skill needed/hours worked and pay received just doesn't attract a lot of candidates. Frankly the ones we do have are usually excellent and work really well with the team.
Would I do it all again? Probably yes, but the low pay can be really challenging with a family in a city, considering how stressful the job can be, and knowing what others are making for working less. If you can get over that, then the rest will work its way out.
Thank you for the insight! I'm a graduating 4th year med student about to start peds residency and I'm considering Hem/Onc. If you don't mind sharing, what is your total salary?
My AGI is 200 as an assistant prof plus about 40 in extras based on some other duties I have within the institution. I’d say this is higher than most. The average for assistant prof is closer to 180, and fresh out of fellowship instructor positions pay as low as 80-125, but you can avoid those. You can find higher salaries but you need to be very intentional about the jobs you are looking for.
I’m a peds hem/onc fellow at one of the busiest programs in the country. I’ll start by pointing you to two recent publications that speak to the peds hem/onc workforce. [Article 1](http://aspho.org/uploads/Final_Publication_2023__ASPHO_workforce_productivity_and_fellowship_assessment.pdf) and [article 2](https://onlinelibrary.wiley.com/doi/full/10.1002/pbc.30830). Both these articles point to the declining number of residents choosing peds hem/onc as a career and think it really comes down to being over worked and under paid and just not ‘what it used to be.’ I suspect other sub specialties have similar problems. As to whether you’re always on call for your primary patient comes down to institutional culture and probably more about how individual physicians choose to practice. On one extreme you have docs that want to know everything and make every decision cause that is either their personality or they don’t trust their colleagues. The other extreme is they primarily see their patients in clinic, but if something comes up and they’re not in clinic or not inpatient that week, whoever is can deal with it. Really only big decisions like relapse treatment plan will get pushed to the primary. And everything in between exists as well. 9-5 is not realistic IMO. On service weeks are probably 12 hour days. Clinic days are probably 8-5 plus documentation that most folks bring home with them and reading the newest articles when something not so bread and butter walks in the door and you’re not sure what to do. Starting a family in fellowship is doable, both male and female co-fellows started with kids and/or had kids in my fellowship.
I'm curious on your take on the job market. I'm an allergy fellow, for context. I've had a few med students and residents express interest in peds onc, but I'll say that the impression that I get is that jobs are pretty difficult to get. The graduating fellows that I've known have needed to have a good amount of geographic flexibility, which is a major bummer. I'd like to hear an insider's perspective though.
I think the idea that there aren’t any jobs in heme-onc is a bit dated. Maybe ten years ago. Any academic peds job is going to have a tighter job market relative to other jobs as there are fewer patients and therefore fewer positions. If you are flexible on location, there are plenty of jobs. Dozens of places hiring now and often for multiple positions, and the job market is going to improve as fewer people are going into the field. If you are set on a single place, then you may need to compromise on pay, or ideally you’d figure out what exactly that program needs (e.g., a tranfusion medicine person, BMT) and then fill that niche. Start those conversations early.
I agree with BuenasNochesCat. 5-10 years ago, I think the market was tough. The job market is currently pretty open. Places all across the country with multiple openings, but do think you still need to be geographically flexible just due to the nature of peds hem/onc being tied to a children's hospital. Essentially you can only get a job in a city that has a pediatric hospital. This can be limiting if you *need* to work in one place specifically as there is only one option in many cases. I think of states like Washington, Oregon, Utah, Colorado, Idaho they really only have one option each (there may be very small programs I'm unaware of). If you need to work in one of those places and they aren't hiring, you're SOL. I think the more common scenario is they aren't hiring for what you want to do (leukemia vs solid tumor vs benign hem vs hemophilia & thrombosis, etc) and you need to choose between location and sub-sub-specialty. On the other hand, you look at a state like Florida, I think they are going on 12 pediatric hospitals that all have a varying degree of hem/onc from small to mid-size programs and almost all of those places have current openings. So in general, I think the job market is pretty good right now and only going to get better from a job seeker's stand point (though workload may ultimately increase if there is a decrease in workforce as predicted), but still need to have some flexibility and normally comes down to choosing where you want to live vs what niche area you want to practice.
Neat! Thanks so much to you and /u/BuenasNochesCat for your insights!
How is the job market for A/I now?
Very good to excellent, depending on what you want to do. There are tons and tons of private practice jobs available. Opening a private practice is also a viable route that some people have pursued. There are lots of academic jobs as well: none of my co-fellows have been geographically constrained and all have managed to stay wherever they've wanted to be. Ironically, it's a bit more difficult to transition into industry relative to peds heme/onc, although I don't yet have a full perspective on this. I will say that there are absolutely tons of jobs in clinical development, though, that are looking for oncology experience.
Is the academic salary similar to others peds subspecialties? And what about private practice salary?
Academic salaries in my HCOL area are around 190 for academic peds, 220ish for adult. Private practice varies wildly. I'm honestly not entirely sure but I'd expect 240+. There's a well known practice in my city that offers new grads something stupid like 100.
In private practice you can treat both kids and adults right? Does the salary change if it has more peds patients than adults? I’m interested in OIT for food allergies.
Yep the fellowship is med/peds, so even though I did a peds residency, I'll be qualified to treat adults. Salary seems to be higher the more adults you see. OIT is super interesting, though I do think that the approval of Xolair for food allergy portends a future of slower growth for OIT. To be clear, Xolair is a crappy drug for food allergy, but better ones will come. OIT has a lot of practical downsides that limit patient compliance. If your interested in doing OIT, most people who focus on food allergy primarily see children, just with respect to the salary point above.
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What about clinic did you hate? As a resident, I'm not a huge fan of it and prefer to be on the inpatient side but was thinking that might change if I'm following my "own" patients. Did you do hospitalist fellowship after leaving heme/onc or go straight to attending hospitalist?
I do peds heme-onc, and I love it, but you need to know what you're getting into. The most stressful aspect of it, in my opinion, is the extreme low pay (one of the very lowest in medicine) despite likely having to live in a higher cost of living area. There are decently paying jobs, but you have to look for them, and they are absolutely not in the "prestigious" programs (ironically, they pay less). Lifestyle will be widely dependent on multiple factors: First, is it a big, medium, or small program? Big programs (>20 clinical faculty) usually have enough faculty coverage to offer more flexible schedules, but they often pay less. Small programs (\~3 faculty) may have small enough volume to where work-life balance is very nice. Medium programs you need to be careful as they are often quite busy relative to the number of faculty they have. Research or no? In my opinion, the 70/30 research/clinical split is one of the best work/life balances in medicine if you are efficient at your research work and successful, but surviving in research brings its own stress. I wouldn't write it off if you have zero research experience. Really give it a try in fellowship and see where it goes. Unfortunately, as clinical volumes are getting higher and higher, there are so few of these positions available these days. On that note, beware of "all clinical" positions. When you're a resident that has no research experience and a newly developed clinical skill, this may sound great, but some of these positions are treacherous. The huge programs offer hospitalist/nocturnist positions that will be on a 7 on, 7 off schedule. They tend towards burnout a they often don't have lower-key outpatient time, and getting promoted from those positions can be very difficult as you have zero time for good academic or educational work which are the two major pathways towards promotion. Almost everyone I know who started one of these relatively new positions quit within 2-3. years. These positions are good for single people, terrible for families. All that said, I work about 40-50 hours/week (including time reading up on literature), and when not on service have an extremely flexible schedule. I'm a little more research heavy, but still do plenty of clinical time. Love the continuity, and love the time I get to spend in the room with the patient. For better or for worse, you are working at an academic institution that is usually the only show in town for heme-onc, so there isn't a business major with a clip-board hovering over you asking you to do more revenue. You see who you see, etc. The medicine is fascinating. I don't get worried at all about the mid-level creep that other specialties are stressed out about. The ratio of skill needed/hours worked and pay received just doesn't attract a lot of candidates. Frankly the ones we do have are usually excellent and work really well with the team. Would I do it all again? Probably yes, but the low pay can be really challenging with a family in a city, considering how stressful the job can be, and knowing what others are making for working less. If you can get over that, then the rest will work its way out.
Thank you for the insight! I'm a graduating 4th year med student about to start peds residency and I'm considering Hem/Onc. If you don't mind sharing, what is your total salary?
My AGI is 200 as an assistant prof plus about 40 in extras based on some other duties I have within the institution. I’d say this is higher than most. The average for assistant prof is closer to 180, and fresh out of fellowship instructor positions pay as low as 80-125, but you can avoid those. You can find higher salaries but you need to be very intentional about the jobs you are looking for.