Career after MD / DNB - Pediatric Hematology & Oncology

One of the smart decisions in our lives is to pick a medical sub-specialty that can keep us happy the entire life. But it is not as simple as said.

The hardest decisions in a doctor's career start right after completing MBBS when you have to choose a particular broad specialty for training.

This gets even worse after post-graduation (or better !). The second milestone is choosing further subspecialty training after completing your MD/DNB in medical branches. You are again at crossroads, in fact, I feel deciding a broad specialty in medicine is much easier as compared to choosing a sub-specialty, on the other hand.

In pediatrics itself, there are more than 10 subspecialties including Cardiology, Gastroenterology, Neurology, Hematology & Oncology, Intensive care, Neonatology, etc. 

Not all, but many of us struggle to decide which super-specialty branch is suitable for us. Some decide based on their passion, some decide, based on their previous exposure to patients. Unfortunately for some, it is not what they initially thought after entering a particular specialty due to limited exposure during pediatric residency and lack of guidance.

It was great catching up with a friend and colleague, Chintan, on Sunday afternoon in a nearby cafe at Great Ormond Street. Chintan is a Hemat-oncologist pursuing further training at Imperial College health Care, St Mary’s Hospital, in London.

The cafe is deserted, so I can bomb him with some FAQ. Thanks to the Covid-19 situation here.

Hi Chintan, what made you choose pediatric Hematology-oncology for specialty training after your DNB in Pediatrics? what was your thought process?

Hi, I loved hemato-oncology since the period I started working as a post MBBS resident in one of Delhi Hospital back in 2010. 

Sometimes, you do not need months or years to strike on your passion, These 3 months of time I spend with kids in hemat-oncology made me choose this branch for the lifetime. 

In India, back in 2010, the Pediatric Heamat-oncology as a subspecialty was only a decade old. It is a branch of new millennia and there is always much more to do. 

All these things helped me to strengthen the idea to become a Hemat-oncologist and of course I liked the subject from the beginning.

No doubt Haem-Onc is one of the top 10 most demanding medical courses after MD or DNB. But I heard few chaps saying hemat-oncology is depressing? what is your take on this?

I think it is just a myth, every branch has its own stigma, isn't it ?. Previously the outcomes were thought to be poor but there comes a hope that we can challenge the equilibrium and defy all hopelessness. 

Lots of my seniors and teachers who had been trained nationally and internationally are a part of state of art haem/onc and BMT centers in Major, metro cities delivering outcomes comparable to the developed world. The world has now moved to a complete cure of most common malignancy like Acute Lymphoblastic leukemia with very minimal chemo toxicity. 

I have seen outcomes of pediatric malignancy like ALL, Wilms tumor, Medulloblastoma, Hodgkin lymphoma, NHL reaching up to 90%. Not only this, but the outcomes for diseases like thalassemia and sickle cell anemia which are prevalent in our country have improved a lot. 

Even BMT outcomes are way better than what it was 10 years ago all over the world including India. I think there is sufficient positivity to take a deep dive in the field of Hematology and oncology, to give a new future to these deserving kids.

What is your timeline and experience in the field of hemat-oncology. What sort of skill set one can develop in this branch?

Well, I finished my pediatric residency in 2013, its when I started searching for all the possible pathways to start my training in dedicated Pediatrics heam-onc. I completed FNB (fellowship of NBE) after which I opted for international fellowships. 

For the last 3 years, I am in BMT and trying to gain experience in all kinds of BMTs. It's more complex than plain oncology but amazingly fascinating. The world is moving to the era of transplant and cellular therapies now and I am looking forward to starting my future as a transplant physician. I also learned fascinating immunodeficiencies and their transplants. 

I am currently working in exclusive RBC disorder transplants and bone marrow failure syndromes. So overall pediatric hematology/oncology in itself is a broader term and includes pediatric hematology, oncology, immunodeficiency, transplant, and cellular therapies. 

One can always choose to practice specifically in one of these sub-specialties or work in a broad specialty, both options are open.

Wow ! that sounds amazing to have so many opportunities, are you happy being a hemat-oncologist? what is your overall satisfaction score including stability, salary?

Well, scoring is difficult but let me try. I am 100% satisfied with what I have chosen. Salary satisfaction in India, I would give 70-80% which is not bad. isn’t it?. Placement/Job offers score depends on your area of practice. Almost 50% of jobs for consultants are still vacant in major cities, but above and all that is important is, that you need 100% hard work and dedication in this branch for achieving good outcomes in your practice.

So, tell us what all training options and fellowships available in India to specialize in hematology/oncology.

The super-specialty programs are offered by the National Board of Examination (NBE), Delhi, and the Indian Association of Pediatrics (IAP). While IAP fellowship is interview-based, for FNB in Haem-onc you need to appear for the competitive entrance exam which is MCQ based. Then there are 3 year DM programs. 

There are excellent institutes in India for the training. Few names are Rajiv Gandhi Institute and Sir Ganga Ram Hospital in New Delhi, in Mumbai Wadia Hospital for children and SRCC. Chennai Apollo and Narayana in Banglore offer good training in the southern area. 

DM seats are available in Hematology and oncology at PGI Chandigarh, AIIMS Delhi, RCC Kerala, Kidwai Bangalore, and TMH in Mumbai.

What further you can do after basic training Haemat-oncology, what are the post fellowship career pathways and training available internationally and nationally?

Well, it depends on your further interest. During training, you will get an idea about the advanced training in subspecialties of Hematology as well as Oncology. 

One can go ahead with Transplant fellowship and cellular therapies which are available internationally. These may take anywhere from 1 to 2 years. You can work clinically or you can participate in the research project or you may choose to work in both. 

To mention a few good places, In the UK in London, Newcastle, Bristol, Manchester, Birmingham, Leeds have good institutes which offer such training. National UNI Hospital at Singapore is a good place, in Australia Westmed- Sydney, Melbourne children’s hospital are good places. Sick kids Toronto, Vancouver- British Colombia in Canada are excellent places. 

Even in Indian places like Rajiv Gandhi Institute, New Delhi, Narayana hospital at Bangalore, Wadia, and Kokilaben in Mumbai, Apollo in Chennai, CMC Vellore offer further Sub-specialty training which is of international standards.

What do you think the international training added to your skill sets?

The international training familiarizes you with different approaches these hospitals offers for their patients, besides there are few things which we don’t do much in India like cellular therapies for example. It definitely adds to your profile. 

Your training seems like a more filtered one but you have done basic training in India. Will you recommend basic training in India first before moving onto a more filtered kind of sub-specialty training in BMT or immunology?

Absolutely, This is a very strong suggestion from my side. As far as possible, basic training in India is a must for at least 2 or more years and then you should opt for further training internationally. There is always a possibility that you may get to learn advanced therapies without basic knowledge and hands-on experience, if not done so.

Continuing with the discussion over the same topic, do you think further training is a must or optional? what will you recommend?

Well, that's an individual choice, but In my view, training in transplant is a MUST. In the coming 5 years, there is a chance of inflation in plain oncology as it is for every other broad specialty. So 1 to 2 years of BMT training is definitely what I will recommend. 

This will make your training a bit longer, 4-5 years maybe! (haem/onc 2 years, BMT 2 years) but it comes with its own perks. It is needed to excel in such a high-end branch and the international posts are sufficiently paid for.

Well let me tell you, I am always confused about this! Are hematologists also oncologists? Can you practice them both?

Yes, of-course. Hematologists are oncologists too. The training includes both branches.

What are the career choices for a pediatric hemat-oncologist in India, I am referring to the job profiles offered after your training?

You can kick start as a consultant after 2-3 years of Haematology / Oncology training. But to start as a BMT physician you must have some BMT fellowship (Abroad or in India). 

In the smaller metro cities, you can start your own unit or head a unit even from the beginning. Many government institutions are coming up with state of art facilities that require trained doctors in the subspecialty. 

Even the medical colleges are coming up with major training courses and will need educators in near future. It is super for those who have a passion to teach. The current govt sector's options are limited. 

But corporate set up always want to develop cancer center and BMT center and the opportunities for pediatric hemeto-oncologist in India are increasing day by day. Even if you start as a junior consultant, it won't take much time to scale up to senior consultant.

Thanks, Chintan. That's all folks, hope this guides you in your decision on what to do after your MD or DNB training, However, the views expressed here are solely ours. Finally, Choose for yourself, not others, Do what you good at or enjoy yourself doing. There is no need to follow the herd mentality. 

Whatever the branch you choose for the super-specialty training, there is always a room at the top ( with a sofa!). If you have further questions leave them in the comment box below.

1. Zweidler‐McKay, P.A., Hogan, M.‐J.S., Navigating your career path in pediatric hematology/oncology: On and off the beaten track. Pediatr Blood Cancer, 63: 1723-1730. https://doi.org/10.1002/pbc.26094
2. A Career in PediatricHematology-Oncology? The American Society of Pediatric Hematology/oncology.

Author

Chintan Vyas | DNB (Pediatrics), FNB (Paediatric Haematology-Oncology), Fellowship in Paediatric BMT

Chintan is a pediatric Hemat-oncologist currently working as clinical fellow in BMT at Imperial College Healthcare NHS, London