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thinking about oncology...

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I have spent the last 7 years in endocrinology and am ready for a career change. I am considering a position in hem/onc but am a bit hesitant due to the complexity of these patients and the learning curve. As our practice only managed non-diabetic endocrine patients I saw mostly healthy, non acute patients. I'm also a new mom so I have to factor that into my career change as well. Any thoughts are appreciated.

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Heme Onc requires an intense one year learning curve before you even think of being comfortable going to work.  After that it is gravy and incredibly rewarding. 

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Thank you for your thoughts rpackelly! I have accepted the position planteater but the credentialing process has yet to take place so it will likely be another 2-3 months before I would start. Any thoughts/insight still appreciated!

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Congratulations on the job and the baby! Hem/Onc is a big learning curve-I'm pretty new myself. Does your new practice have a certain focus or will you be seeing all types of heme/onc patients? Depending on the way your practice operates, you might see a lot of benign heme, chronic malignancies like CLL, and yearly follow ups of relatively healthy cancer survivors. For patients that are in active treatment, I think it is a good idea to focus on one or two types of cancer at a time until you are comfortable and then add on additional types. The ability to do this will definitely depend on how your practice is set up. Have they given you an idea your length of training/orientation and how many patients you will be expected to see in the beginning?

 

NCCN is a great site (.org) with lots of great information.

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So I've been working in hem/onc for about 3 months now and it has been completely overwhelming. I've even had a lot of time to read at work and have not had a very heavy patient load (which is good and bad). nccn has been a great resource but learning a wide variety of conditions, their treatments, side effects of treatments, and addressing primary care concerns that come up has been stressful. I'm also learning a new emr/health system which complicates things too. I'm just not sure when I will start to feel more comfortable! I have had the opportunity to work with a great attending but learning this stuff (especially the heme) has been a struggle. Maybe just continuing to see it will help? Any insight is appreciated. The PAs/NPs here have a LOT of autonomy (I feel like I have too much even though I have 7 years experience as a PA I feel like I'm starting from scratch).

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I started in outpatient heme/once for about 4 months (with basically no mentoring), then transitioned to bone marrow transplant/heme malignancy and have been doing that for about 9 months and I can say I am just starting to feel somewhat comfortable (except for super sick patients- they still make me nervous). For me, repetition has been the key (and wonderful support from my fellow providers). I am fortunate in my setting- we see a lot of the same issues over and over because they are common transplant issues. And I see the same patient for multiple days in a row because we are a day hospital. One thing you could do at work, if there is room for them to be flexible with your schedule, is to ask to focus on certain types of patients for a block of time. For example, maybe you could see benign and malignant heme only for a few weeks, breast and gyn onc patients for a few weeks, or prostate and male gu for a few weeks. It should help your comfort level to be able to focus that way if it is a possibility. I hope you start feeling more comfortable soon- it is such a great patient population (usually )! I'm glad you have a great attending too- it makes a huge difference !

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I think you hit the magic point in about a year. That takes a lot of reading though. Much of it depends on the quality and cooperation of your oncology trained nurses, hopefully you work with some good ones. In the beginning you need their help more than they need yours but if you can establish a collaborative relationship taking care of their needs (which after all are the patients needs) they will take care of you. If you are interested in and invested in how well the patients do, you will do fine. The trick in oncology is that it is frequently about the journey and not the cure.

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thank you for your advice planteater and rpackelly! i will just try and be patient with myself. i may come back to this post for advice as more questions come up!

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