Selecting Your Career Path

Vishal Ranpura, MD
Published: Thursday, Dec 12, 2013
Career Path

After Years and Years, What Are the Options?

Medical education and training is very intense, long, and expensive. When nearing the end of training, it is time to select a career path. In the hematology and oncology fields, there are a variety of paths which fellows can explore depending on their area of interest. To help you narrow down your options, it is important to determine whether you are interested in a clinical or nonclinical position.

Clinical Positions

Clinical practice can be broadly divided into careers that are 1) academic or 2) nonacademic.

Academic careers

Academic careers can be further subdivided into the clinical track, scientist track, or clinical scientist track.
  • Clinical track: Involves mostly patient care and education of fellows and other staff, with zero to minimal research and some administrative tasks.
  • Scientist track: This job consists almost entirely of research, with a very minimal amount of patient care. Research may be laboratory based or clinical trials and involve grant writing, protocol writing, and manuscript preparations as well as presentation of research at conferences at national and international conferences.
  • Translational track:Involves a combination of patient care and research.

Nonacademic careers

Nonacademic clinical practice options include working for a private practice or accepting a position as an employee of a hospital.

Private practice

Once very popular, this model of practice is becoming less lucrative due to health care reform and the buyout of small private practices by larger groups and hospitals. The focus of private practice is to generate revenue through patient evaluation while keeping overhead costs low.

Many private practices have onsite laboratory services, imaging capabilities, and radiation oncology services to keep revenue within the practice. Additionally, most private practices have their own infusion center because infusion service time charges and profits on drugs generate decent revenue. In most private practices, an average of 60% of income is generated through drugs and infusion services, compared with 40% from evaluation and management.

Successful private practice requires business and administration skills. With an increase in the number of developed oral drugs, and the rise in drug prices, most practices now utilize specialty pharmacy rather than the method of buying and billing the insurers because of increased inventory costs. Consequently, this has decreased drug and infusion revenue.

One has to be very careful before joining private practice. If it’s an extremely large group, you may experience abuse by senior partners during the beginning of your career, and you may never become a partner. Another major factor to consider in becom- ing a partner is the high buy-in cost. If joining a solo practitioner, the overhead costs could be intimidating. A group of 3 to 4 physicians is ideal because the chance of abuse is low and overhead costs and calls are shared among all physicians.

No matter what, it is essential to market yourself and network with other physicians to increase the chances of referral during the beginning of your career.

Hospital-employed positions

This model of employment has become increasingly popular. The buyout of small practices by large hospitals or groups and the resultant decrease of referrals to private practice, decrease in revenue from oral and expensive oncology drugs, and increase in overhead costs are a few reasons why.

The starting salary of a hospital-employed position is lucrative and includes attractive bonuses. You work as an employee of the hospital and in most places the salary is guaranteed for a couple of years, after which you are switched to productivity-based payment.

If the referral in the hospital or group is very strict, you will likely keep getting patients because of referral patterns and you probably do not need to aggressively market yourself. In the event that the referral system is not strong, you will want to market yourself aggressively because after your guaranteed salary time period you may lose money.

Some important private/hospital employed practice factors to consider are:


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