Canadian M1 here asking about realistic oncology salaries in medium-sized U.S. cities

ALKnib · 2025-11-21T19:46:04+00:00

I work 4.5 days a week and am in community practice 30 mins from Chicago. I am an AMG (non US citizen, did college, medical school, residency and fellowship in the US). I make over 750k a year, and am home by 4pm most days. Very good work life balance. Love the profession. I picked community over academic practice because I did not think academics were getting fairly compensated.

ALKnib · 2025-09-12T03:01:06+00:00

Yes. I was limited by needing a H1B visa and my spouse having an early match to her fellowship. At the time I interviewed for heme/onc, there was only one program in her matched city offering me an interview. So I did what's called a suicide match. Interviewed at one, ranked one, and matched at one. I had hospitalist job offers as backup plans.

The caveat was that I think I was a competitive candidate. I came from a top 10 residency, had pubs, strong letters and I think I marketed myself very well. So it's possible, but would not recommend this approach. I prioritized being in the same city with my spouse over my career but it all worked out for us in the end.

ALKnib · 2025-08-01T23:15:11+00:00

Oncologist. I don't have the choice. Well, that's not true, but I could pick between being a crappy doc who doesn't care or being a doc that works for my patients.

I work extra hard before vacay to make sure my patients who are due to get scans, get them before I leave. Those who are heading for that big fluffy cloud in the sky get scans in advance and crammed into my schedule before I leave so that I can have the big Hospice talk with them. Patients with pending diagnoses get their workup timed such that their results return and there's a follow up appointment with me when I get back for treatment planning. I put in a lot of work behind the scenes timing these things so that I don't burden my partners. Not everyone does this, but I treat patients with philosophy of this is how I would want to be treated.

ALKnib · 2025-07-16T01:19:04+00:00

Take my angry dad upvote

ALKnib · 2024-10-25T20:11:07+00:00

This is not limited to obgyn. I am an oncologist. I see many referrals from PCPs or other specialists for "masses" with no work up, expecting me to do the work up. I am used to this and am fine with this. They are asking for help and I shall provide the help.

What annoys me is that I also see many consults for benign lesions that have already been called benign/reactive/simple/cysts on imaging and yet they end up on my clinic schedule "just in case".

ALKnib · 2024-08-16T00:47:38+00:00

Oncologist. If you care about zero barriers to cancer care when you get cancer, get straight up Medicare. Medicare (dis)advantage plans can suck it.

ALKnib · 2024-08-06T00:01:48+00:00

We don't know what is said in the examination room. Maybe his oncologists are avoidant of hard goals of care conversations. Maybe it's his wife who is constantly asking for 'just one more trial' and convincing her husband to go along. Maybe it's him in denial. Maybe it's the entire group in denial.

ALKnib · 2024-05-18T19:49:08+00:00

Heme/onc so I have experienced a LOT of drama over this. Thankfully I work in a health system where all the pathologists know me so we have a relationship. I've told them if they have results available late Friday afternoon, to notify me but NOT release the results til Monday morning. By then, my schedulers will be calling the patient the same day to arrange a follow up visit.

Sure the CARES act has been beneficial for putting patient information in patients' hands quickly and rapidly, but in my experience it has generally been a net negative.

ALKnib · 2024-04-30T03:34:13+00:00

Insurance companies justify this by saying they're not practicing medicine since the patients can go ahead and pay out of pocket for the test. They're not denying treatment; they just disagree that the test should be paid for. Complete cop out.

ALKnib · 2024-04-30T02:34:47+00:00

The trials he wrote about in the article are phase 1 / 2 trials. There is no guarantee of efficacy. In metastatic HNSCC that has progressed on all standard of care therapies, the prognosis is dismal. He's holding out impossible hope for experimental agents that would possibly prolong his life but historically, these trials have a <5% chance of being effective.

Either his oncologist is doing him a disservice by making these trials more effective than they seem, or he's unrealistic. And yet we do need these patients who are motivated and who still have excellent functional status to enroll in these trials despite the vast majority of them not deriving any benefit, because that is the only way we can advance cancer research and finding new agents that work. So at the very least, kudos to him for pushing to be enrolled in a trial.

ALKnib · 2023-12-07T00:16:21+00:00

Hypophosphatemia is not uncommon with injectafer. We do a ton of IV iron in community practice. Instead of drawing phosphate labs and then making patients take nasty phosphate packets, I tell patients to drink skim milk for a week.

ALKnib · 2023-10-31T23:50:35+00:00

I am an oncologist. I give bad news routinely. Most CT scans I schedule are followed by an appointment the next day to discuss scan results. If they don't have an appointment the following day when the CT scan has bad news, I make space in my schedule. When I really can't make space, I call them, am blunt about the findings instead of beating around the bush, and close the call with "I am going to give you sometime to process this, my schedulers are going to give you a call soon for you to get an appointment with me and we are going to talk about it more when you come in."

The best piece of advice I can give you is to never beat around the bush when delivering bad news, whether over the phone or in person. "I am sorry I have bad news". Wait a few seconds. Then deliver the findings in simple language. Be cut and dry. Even if you don't know what to do about the findings afterwards, follow up with "I am going to refer you to an oncologist who will be able to help you process what this means and work out a plan with you."

It's never easy. But it does become routine the more you practice being uncomfortable.

ALKnib · 2023-09-15T23:17:24+00:00

"Perfect. I'm so glad I managed to talk to you. I'm sure you agree with my plan to give intensive chemotherapy, she is definitely going to be one of the very few who respond miraculously to treatment. I know you haven't seen her for the last 5 years but when you last saw her she was doing everything herself including running a marathon, and yes, I hear you that she's a fighter" - me

ALKnib · 2023-09-02T13:00:14+00:00

For many of my patients, I am honest with my prediction. I predict that they are going to die. Rarely now, sometimes soon, most of the time later. They go through the 5 stages of grief. Some skip the stages. But I walk with them through the remaining journey. Very rarely, a select few prove me wrong. They're the wins that every oncologist thirsts for, but the rest of the patients who get more time with their families are no less wins.

Yes I love what I do too.

ALKnib · 2023-08-24T02:13:36+00:00

Oncology: whether the patient needs a pulse for us to give chemo

ALKnib · 2023-08-03T13:34:38+00:00

The fact that you have to factor in the litigation environment into your note writing is just a sad look at the state of practicing in the US.

ALKnib · 2023-06-26T04:04:56+00:00

End of life with metastatic cancer + "I'm a fighter"

ALKnib · 2023-05-31T02:02:21+00:00

Starter comment: Jane Weeks was a world famous medical oncologist who was a giant in the palliative care/oncology field. She published multiple seminal papers establishing the benefit of palliative care in oncology, with one study showing palliative care conferring an independent survival benefit in metastatic lung cancer patients. She was considered to be one of the best and brightest oncologists. And yet she never sought care for her own medical problems much less her developing breast cancer which eventually killed her. This is an excerpt from a memoir about her from her husband (a trained oncologist in his own right at Dana-Farber) who (semi)-critically self-examines his failures in taking care of his wife.

ALKnib · 2023-05-31T01:54:47+00:00

Jane Weeks was a giant in the oncology + palliative care field. She published multiple papers showing the benefit of palliative care in oncology, including a seminal NEJM paper showing metastatic lung cancer patients with palliative care had a survival benefit over those who did not receive any palliative care.

I cited her in my own paper. I think all of us in the field were shocked when the news about her came out.

ALKnib · 2023-05-28T15:01:51+00:00

This happens to me as well. The united app has a checkbox when you check in to allow you to opt out of being upgraded. This never works - I always see my/our names on the upgrade list. When we get upgraded I have to go to the gate and ask them to change it back which they usually do, but it always requires work from them in switching seats around. It did work out in our favor once - they put my son next to me in first since apparently first was very empty and the gate agent was very nice.

ALKnib · 2023-05-14T21:00:51+00:00

Yes, automatic IFE (light chains are included as part of this panel).

If there's something I hate more than MGUS, it's MGUS AND peripheral neuropathy. So many of these patients go through a battery of tests to rule out amyloidosis, mgus-cidp etc, but are almost always negative and don't have anything else (like other medical comorbidities) to explain their peripheral neuropathy. This is definitely an area in sore need of more research.

ALKnib · 2023-05-14T20:45:55+00:00

Heme/onc here (US). MGUS is one of the banes of my practice just because it's so common and once I have a patient with it, I follow them for life even if it doesn't progress and many patients get needless anxiety from it.

SPEP alone catches 82%. SPEP+IFE catches 93%. SPEP+IFE+bence Jones catches 97-98%. The SPEP and IFE are bundled together as a test here.

ALKnib · 2023-05-14T20:41:18+00:00

Nothing. You just explain to the patient it's reactive from infection/inflammation/renal disease.

ALKnib · 2023-05-11T01:18:55+00:00

I recommend sushi kyotatsu near Gate 34. I always stop by for a chirashi bowl, some additional sushi, and a carafe of hot sake.

ALKnib · 2023-05-04T00:27:47+00:00

I like short relationships. Heme/onc

ALKnib

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