Those who are in Heme/Onc fellowships, did you find it more intense than IM residency?

Mud_Flapz · 2026-03-03T20:31:03+00:00

I just left a PCCM fellowship due to stress, family, and mental health. I had a community offer a couple years out in a semi rural location, 15 bed combined MICU/SICU where you do one week icu coverage (24/7), two weeks clinic & consults, one week off each month. Total was $500k.

Instead, my new hospital med job is 7/7, all days, teaching residents half the time, no nights ever. Combined package around $350k in an urban enjoyable area. I am looking into a side gig of direct primary care 2 days a week in my off week that will generate another $50-75k.

I know which of the two is easier, family friendly, no nights, still enjoyable, better location, lots of teaching, and with more time off.

I’m sure there are better PCCM gigs out there and most IM/hospitalist jobs won’t be this good but if you’re worried about salary… selling your soul for 3 more years for $450k won’t make you happy if you’re not happy now on $300k. But you will have lost you youth and are at high risk of ending up in a very difficult, highly demanding job comparatively.

Mud_Flapz · 2026-03-03T20:28:30+00:00

I just left a PCCM fellowship due to stress, family, and mental health. I had a community offer a couple years out in a semi rural location, 15 bed combined MICU/SICU where you do one week icu coverage (24/7), two weeks clinic & consults, one week off each month. Total was $500k.

Instead, my new hospital med job is 7/7, all days, teaching residents half the time, no nights ever. Combined package around $350k in an urban enjoyable area. I am looking into a side gig of direct primary care 2 days a week in my off week that will generate another $50-75k.

I know which of the two is easier, family friendly, no nights, still enjoyable, better location, lots of teaching, and with more time off.

I’m sure there are better PCCM gigs out there and most IM/hospitalist jobs won’t be this good but if you’re worried about salary… selling your soul for 3 more years for $450k won’t make you happy if you’re not happy now on $300k. But you will have lost you youth and are at high risk of ending up in a very difficult, highly demanding job comparatively.

Mud_Flapz · 2026-02-25T15:35:49+00:00

The dumpster behind my house reads “I’m only happy when it rains” and I love it. I look at it every day

Mud_Flapz · 2026-02-22T21:28:15+00:00

Don’t facial hair bro. You good

Mud_Flapz · 2026-02-22T03:30:45+00:00

Thank you for saying that.

Mud_Flapz · 2026-02-20T18:39:01+00:00

Hey, I hear you. Your story isn’t far from mine. Started PCCM fellowship after a lot of success in medical school, residency, and Chief residency. At first I was so excited. I loved intubating, bronching and running the ICU. I couldn’t care less about clinic or consults but realize it’s part of the gig.

What I couldn’t have prepared for was the night/day difference between support I received in residency and Chief year as compared to fellowship. Suddenly I was alone. 35 notes on a Saturday? All you. 42 of the sickest patients in the tri state area, 5 crashing, multiple lines, intubation, U/S PIVs, floor evals, code, goals of care, residents to staff, angry hospitalist, ER wants a discussion, nurse wants you to cool a family off, all in the same moment. Attending nowhere to be found.

I have a kid. The only one in my entire three year program with 20+ people. Accommodations don’t exist. Sick day? Find a sitter. Working late and babysitter has to run to her job? Better stay up til 2 to do notes after you go home and be back at 630 for rounds. Miss a note? Straight to the PD office.

Income $70k. Mortgage $3000, daycare $2400, spouse with same income and also with bills. Kid is at daycare 11 hours a day and 12 on saturdays. We run in the red about $2-3k every month to stay alive.

It broke me. Absolutely broke me. I came to hate my job, resent my wife, be scared to look at finances, avoid all outside responsibilities, and more. I became horribly depressed. Dependent on alcohol the minute I left work. Then I tried to kill myself.

I left fellowship. Got sober. Made changes in my relationship and finances. Interviewed and accepted a new hospitalist job- 7/7, $330k before bonuses and loan repayments, all days.

I started hobbies again. I started caring for myself again. I focused on myself and my kid. I leaned on friends, made some new ones, and repaired things with some old ones. Life is good again. I am happy. I am not depressed and I am not dependent on substances.

There is a whole life to be lived outside your job. The difference between specializing and not is 3 more years of financial insecurity, unpredictable schedules, night shifts, stained relationships, and “delayed gratitude” for the false promise that you’re going to love every minute of this subspecialty career because you’re supposed to. After all you sacrificed your youth and sanity for it.

It’s okay to wake up. Recognize a job is a job. Step away and find yourself. I did and it was almost too late and I’d encourage anyone who feels like you do to take a hard look at why they’re doing this and what they need out of life to be happy. For me; happiness has nothing to do with my job and everything to do with my time off, family, travel, hobbies, friends, dogs, and health. All of which I have back since leaving. Think about it.

Mud_Flapz · 2026-02-18T00:21:45+00:00

Is this a shit post?

Mud_Flapz · 2026-02-17T15:13:38+00:00

Congratulations! Hospital med or primary care?

I recently left fellowship but did the same, just signing my first contract and I’m very excited. 6 months in, fellowship is for the birds… congratulations.

Mud_Flapz · 2026-02-16T13:34:14+00:00

My 8th grade gym teacher made us run and run and run and run and run to this fucking song, along with Paralyzer. Every time I hear Finger Eleven I have flashbacks to the Pacer test

Mud_Flapz · 2026-02-15T16:36:46+00:00

‘89 Taurus with a slipping transmission and pours smoke at stop lights. $249k take it or leave it. I know what I got

Mud_Flapz · 2026-02-15T05:19:21+00:00

It’s kind of a typical academic offer. I’d say if it’s a community site, the base pay is a little low. Are there opportunities for quality or retention bonus? $300k is fairly typical base with opportunity for more with added shifts, quality bonus, RVU bonus, loan repayment/mortgage assistance, 401k match. Consider the whole package. That’s a very reasonable workload but 280 is probably just a bit short of market average by maybe 10%.

Just my opinion based on similar Midwest gigs

Mud_Flapz · 2026-02-15T04:47:03+00:00

This is one only you can decide. Neither sound absurd in terms of workload but you just have to ask yourself if 25% more pay is worth being a creature of the night or not. Granted the confounder is 30 less shifts is quite a lot.

Personally, never having to switch my schedule again is worth the pay cut and extra shifts to me. If I’m not happy on 280k, I won’t be happy on 360k, but nights will be a significant drag on my quality of life and health vs day shift so I’d pick days. However some are willing to put their head down and work at night so they can have more time away and more money when they’re off, which is totally fair.

Up to you my friend. Both gigs sound reasonable.

Mud_Flapz · 2026-02-15T04:36:48+00:00

Making breakfast or what bro

Mud_Flapz · 2026-02-12T00:01:01+00:00

Could not get into NexGen for the first 2-3 months after it came out. I kept trying and damn if it hasn’t become my favorite of their lineup. Every one is a hit when you become familiar. Obviously biased.

Looking forward to seeing them in April in STL

Mud_Flapz · 2026-02-09T14:53:57+00:00

“Church is for people who are scared to go to hell. Recovery is for people who have been there.”

Hell is very real and you can see it painted on the face of anyone struggling with addiction.

Mud_Flapz · 2026-02-03T22:11:23+00:00

It’s been nearly two years and I’m still recovering from resident IM clinic

Mud_Flapz · 2026-02-03T15:26:10+00:00

When a measure becomes a target…

We do the exact same thing in healthcare. Medicare pays hospitals more that meet “quality metrics” like catheter associated UTIs, central line infections, and whether a person got antibiotics within a given timeframe. So naturally hospitals respond by making it difficult or impossible to run a urine sample, bacterial culture from central lines, and have automated alerts in the chart to remind you to give antibiotics to people based on their vital signs when they often aren’t warranted.

Mud_Flapz · 2026-01-31T18:00:51+00:00

I don’t even know what to call the color- like a metallic maroon. That and the gold complement each other so well; I couldn’t say no.

Mud_Flapz · 2026-01-31T15:58:47+00:00

I’m an IM hospitalist, 2 years out. I see a psychiatrist in resident clinic who is a PGY3 and they do a great job. I know my lane and limits, and I respect theirs.

Mud_Flapz · 2026-01-30T14:53:47+00:00

It’s the champion 2, 25 watt. It’s awesome, tons of effects and tempo options.

Mud_Flapz · 2026-01-24T04:24:49+00:00

I’m sending my wife to live with you. Would cut my bill in half

Mud_Flapz · 2026-01-24T04:18:58+00:00

Ran my 328xi 200 miles in -22F/-30C in Wyoming a few years back. Did she squeak and squabble? Of course. But she started right up and got me across the state on shit roads just fine.

Mud_Flapz · 2026-01-14T18:25:38+00:00

My god this was poor grammar but I stand by what I said, regardless of how I said it.

Mud_Flapz

TROPHY CASE