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."