Role of the heme/onc PA?

[cbrsmurf]

Have a possible job opportunity in a heme/onc position and I know it varies, but can someone give me an idea of what is expected of a PA in this role? I had a 3 wk rotation with a heme/onc MD and have worked in an onc lab for a few years prior, but I don't really know how they use midlevels in this specialty.

 

All I have seen personally is midlevels taking care of issues in the infusion room and some hospital rounds. I haven't seen any midlevels do any initial evals or initiate chemotherapy.

[SocialMedicine]

if someone longs for autonomy and decision making I would imagine heme onc is the farthest specialty from that. real interesting medicine though and I feel as though NP and PA's will have expanding roles. but the role is fairly limited now as far as I know.

[bananapeppers]

Have a possible job opportunity in a heme/onc position and I know it varies, but can someone give me an idea of what is expected of a PA in this role? I had a 3 wk rotation with a heme/onc MD and have worked in an onc lab for a few years prior, but I don't really know how they use midlevels in this specialty.

 

All I have seen personally is midlevels taking care of issues in the infusion room and some hospital rounds. I haven't seen any midlevels do any initial evals or initiate chemotherapy.

 

I got a job offer recently (as a new grad) in socal for a heme/onc position. Getting into it is pretty difficult as most positions require 2-3 years of experience. My role as a PA in that practice would have been both outpatient (90%) and inpatient. It wasn't exactly what I had suspected -- as a PA, I would see the pts referred to the heme (pts with abnormal lab RBC/WBC levels) and all different types of cancer (lung, breast, prostate). You manage these patients all through chemotherapy - so as a PA, you'd be selecting the best type of therapy for these patients. You also have to have the right mindset in heme/onc becuase you are only prolonging the patient's quality of life, not treating, so be sure you'd be okay with that. It's a rewarding career as a heme/onc PA, but the most you'd be doing would be selecting and administering chemotherapy, analyzing lab values, etc.

[gleannfia]

Have a possible job opportunity in a heme/onc position and I know it varies, but can someone give me an idea of what is expected of a PA in this role? I had a 3 wk rotation with a heme/onc MD and have worked in an onc lab for a few years prior, but I don't really know how they use midlevels in this specialty.

 

All I have seen personally is midlevels taking care of issues in the infusion room and some hospital rounds. I haven't seen any midlevels do any initial evals or initiate chemotherapy.

It all depends on the setting and your supervising physician. I had a position in the VA. They trained me. I functioned completely autonomously, with limited attending supervision. I did initial evaluations, ordered chemo, even signed off on fellows' orders. Wonderful, supportive attendings. It was without a doubt the best job I ever had. Unfortunately, I foolishly left due to some internal politics. Worst mistake of my career. Since then, I have tried 2 other heme/onc positions and have totally soured on it. Both

of these positions were replete with insecure, egocentric supervising physicians who micromanaged my every move. I was not allowed to see new patients but was sent to the hospital to do consults on patients who were there for their umpteenth admission, so the doc could collect a hefty consult fee. Two docs attempted to throw me under the bus for mistakes that they made (sound familiar?) In short: Heme/Onc is tremendously rewarding in terms of challenge, new developments, and patient care. If you are really interested, make sure you have them enumerate in writing exactly what your duties will be, level of supervision, and eventual autonomy, if that is what you seek. Make sure your supervising doc is someone with whom you believe you will develop a rapport. Good luck! Let us know how it works out.

[Gordon, PA-C]

Heme/onc would suck to me. Its is almost completely protocol-based. When someone comes in with a new diagnosis, you assign them to a research protocol and the protocol dictates what chemo they get. A computer could easily replace a heme/onc doctor in terms of planning chemotherapy. There's no real thinking behind it or creativity in terms of chemo.

 

The more interesting side would be procedural (bone marrows, lumbar punctures, etc) but even that is very limited.

[FBIDoc]

The more interesting side would be procedural (bone marrows, lumbar punctures, etc) but even that is very limited.

 

Not limited for us Interventional Radiology guys =P

[Evan]

I did heme/onc right out of school and it was a good experience but I have to agree that you need to have a good relationship with your SP. Make sure up front (in your contract) what your role will be. I spent waaay too much time babysitting the infusion room and not enough time seeing patients.

 

It is rewarding in its way. Despite what some would have you believe there are cancers out there that can be "cured". For the stage 4 folks with poor prognoses quality of life is a BIG deal and a good oncology team can make a HUGE difference.

 

In many cases cancer is becoming a set of chronic diseases, much like DM2 or COPD. (In a few cases, DM has a worse prognosis.) So, in our setting, we became the patients' primary care provider. With the addition of chemo and new comorbidities to the patients' (often long) problem list, it just made sense in a lot of cases. It did make us quite busy and sucked every bit of extra time out of the day (would have gone better if they'd have cut me loose on some of this stuff).

 

Good Luck!

 

Evan

[gleannfia]

Heme/onc would suck to me. Its is almost completely protocol-based. When someone comes in with a new diagnosis, you assign them to a research protocol and the protocol dictates what chemo they get. A computer could easily replace a heme/onc doctor in terms of planning chemotherapy. There's no real thinking behind it or creativity in terms of chemo.

 

The more interesting side would be procedural (bone marrows, lumbar punctures, etc) but even that is very limited.

 

I have to say that Gordon is correct. Some physicians I have worked with lack common sense and adhere too strictly to NCCN guidelines, to the detriment of the patient. The forget that they are just that, *guidelines.* I have seen physicians give toxic chemo for CLL to 88 year-olds who had no concept as to why they were going through all this hassle. Again, I cannot emphasize enough how important it is to be simpatico with your supervising physician(s).

[TaliaCat]

I've been in primary care for 4.5 years, and have been thinking more and more that I want to go in to heme/onc, so this has been very informative. My reasoning is that I have a huge interest in the medicine behind treatment and cure. I probably wouldn't even deal with that. So I'm likely delusional that this would be a good choice for me. . . As it is, I have almost complete autonomy right now, and a huge patient load of my own. But I'm sick of poison ivy, runny noses and UTIs.

[HopefulPA]

Sorry I disagree with some of the negative or judgemental statements above. Yes Oncologist follow protochols based on EVIDENCE BASED MEDICINE, as do just about every other area of medicine. No one is dolling out tpa, anaesthisa or IV antibotics willie nillie are they? Probably not.

 

I worked for several years in IM and made the move to Bone Marrow Transplant about 1.5 years ago and I am still learning everyday. I also take call for Heme/Onc patients and have had to deal with lots of banal things like pain mgt as well as major codes. The Hem/Onc midlevels at my hospital either do clinic only or both 70% inpt. Like most services the midlevel is doing all the "work" and the docs see the pt on rounds.

 

No midlivel is going to choose the chemotherapy reigimen anywhere just as no midlevel is going to perform major surgery solo either. Chemo is chosen based on several factors not just "protochol" and are altered too. But doctors should be the ones chosing the chemo afterall this is some powerful sh*t. It is a bit different than choosing a CCB over an ACE or Bactrim over Cipro for a uti. But do you have automony the answer is yes!

 

The other issue to raise in Heme/Onc is patients die at a higher rate than any other area of medicine. In Heme/Onc you really get to know the pts and their family members. Quite a bit different that the few days you treat pts on other inpt services. In BMT my pt are admitted for 3-5 weeks depending on auto/allo and then seen in clinic 1-3 times a week for 3-12+ months again depending on type of transplant and complications. Most likely with readmissions for complications or relapse. So you need to be able to deal with the emotional side of this. i am not sure how often heme/onc pts are seen but since chemo involve multiple cycles I imagine it is more than one would see in most other areas of medicine.

 

I hope this helps.

[Planteater]

Thank you hopefulpa. I am very interested in oncology and I am seriously considering heme/onc (though I won't decide until after my elective rotations). Anyway, I've had limited experience so I didn't want to speak up, but I find the idea that oncology is brainless, protocol driven work to be misguided at best. The psych aspect alone should keep it interesting (not to mention the emergencies, genetics, survivorship issues, etc).

[gleannfia]

Sorry I disagree with some of the negative or judgemental statements above. Yes Oncologist follow protochols based on EVIDENCE BASED MEDICINE, as do just about every other area of medicine. No one is dolling out tpa, anaesthisa or IV antibotics willie nillie are they? Probably not.

 

I worked for several years in IM and made the move to Bone Marrow Transplant about 1.5 years ago and I am still learning everyday. I also take call for Heme/Onc patients and have had to deal with lots of banal things like pain mgt as well as major codes. The Hem/Onc midlevels at my hospital either do clinic only or both 70% inpt. Like most services the midlevel is doing all the "work" and the docs see the pt on rounds.

 

No midlivel is going to choose the chemotherapy reigimen anywhere just as no midlevel is going to perform major surgery solo either. Chemo is chosen based on several factors not just "protochol" and are altered too. But doctors should be the ones chosing the chemo afterall this is some powerful sh*t. It is a bit different than choosing a CCB over an ACE or Bactrim over Cipro for a uti. But do you have automony the answer is yes!

 

The other issue to raise in Heme/Onc is patients die at a higher rate than any other area of medicine. In Heme/Onc you really get to know the pts and their family members. Quite a bit different that the few days you treat pts on other inpt services. In BMT my pt are admitted for 3-5 weeks depending on auto/allo and then seen in clinic 1-3 times a week for 3-12+ months again depending on type of transplant and complications. Most likely with readmissions for complications or relapse. So you need to be able to deal with the emotional side of this. i am not sure how often heme/onc pts are seen but since chemo involve multiple cycles I imagine it is more than one would see in most other areas of medicine.

 

I hope this helps.

With all due respect:

Actually, at my job at the VA I DID choose the chemo regimen for patients. As long as it was supported by NCCN guidelines or the literature, it was never questioned. No one here was suggesting that administering chemo was a random, haphazard practice. What a leap! I did not say that all heme/onc practices are bad. I merely cautioned the OP to thoroughly research the position and to make sure that his supervising doc is someone with whom he believed he could have a good working relationship. That is paramount, in fact in any PA position, not just heme/onc. And I certainly did not imply that it is a boring specialty. Quite the contrary. However, in terms of being used as a scut monkey or scribe, that is a very real situation in some practices. As well as doing 80% of the work with 20% of the ancillary support.

And for the record, I have a bit more than 1.5 years experience in heme/onc.

[HopefulPA]

Glen , good thing you set the record straight with your 1.5 + years. But Gordon's and your statements were negative. 'Replaced by computuer" If that was the case many of my BMT patients would be dead now.

[gleannfia]

Glen , good thing you set the record straight with your 1.5 + years. But Gordon's and your statements were negative. 'Replaced by computuer" If that was the case many of my BMT patients would be dead now.

I apologize for my snark. I did not mean to belittle your work. I am sure your patients are very grateful for the excellent care you provide. Let me just rephrase what I wanted to say without the negativity: The OP should thoroughly investigate the job and make sure he gets everything in writing. Heme/onc is a great specialty, and I wish you and the OP well in your careers.

[cbrsmurf]

Thanks for the info y'all. It seems likely they will give me an offer, but I'm going to go in to shadow for half-day to see what's what.

[gleannfia]

Thanks for the info y'all. It seems likely they will give me an offer, but I'm going to go in to shadow for half-day to see what's what.

 

Shadowing is a great idea! Let us know how it goes. Good luck!