My Experience as an Oncology PA. Is It the Right Specialty for You?

One of the perks of the Physician Assistant profession is being able to work within any medical or surgical specialty. In fact, in speaking with most of my clients (future PAs), they love the idea of being able to change specialties throughout their careers. So how do you choose which specialty is right for you? Personally, I believe it’s that feeling of excitement you get when you think about the subject or how you feel when leaving for the day with a sense of purpose. At least that’s how I fell in love with oncology. But let me be the first to tell you, it certainly was NOT love at first sight. So how on earth did I end up in this specialty for 15 years? And is it the right choice for you?

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How does a PA student get oncology experience?

The amount of hematology/oncology training in PA school is limited, as it only makes up about 5% of the certification exam and there is an overwhelming amount of information to present within the didactic portion of the PA curriculum. When I was a PA student preparing to choose my electives, I selected hematology/oncology first. Prior to PA school I worked in a basic science research lab performing lung cancer research, so naturally I felt this rotation would be a great way to see the clinical side of oncology.

When I arrived on rotation I was excited to see oncology care in action, but by the time I reached my rotation exam, I distinctly remember telling my classmates NOT to do this rotation. It was poorly organized, there was little teaching or preceptorship, and most of the time I felt like an intruder within multiple medical oncology clinics I shadowed. I also found it depressing to mostly deal with patients who had little hope for cure, if any. But don’t let this discourage you—if you have an interest in oncology, make sure you sign up for that rotation.

While you are a student, it is important to focus on your education and rotations as they come. But if you have a passion for oncology and want to increase your exposure, there are some steps you can take to do this. Some PA students find time on their breaks within the didactic year to shadow a PA in oncology. This is a great way to see an oncology PA in action before you head out to rotation. Additionally, it is important to join advanced practitioner societies specializing in oncology. For PAs, the Association of PAs in Oncology (APAO) offers a free membership to students, gives a scholarship yearly, and has a student representative on the board. There is an annual conference and resources to help you not only learn about oncology but network with other PAs in the field.

How can a PA get their first oncology job?

When looking for a position as a PA in oncology, it is important to discuss with the practice how much training or onboarding they will be able to provide, as this can vary greatly. My first position as a PA was in hospitalist medicine, but then I started my first job as a medical oncology PA when I moved to Miami. I worked at a community oncology practice with four physicians who took care of all types of hematology and oncology diagnoses. The learning curve was HUGE, I mean huge. I understood the basics of oncology from PA school and my internal medicine experience, but there was so much more to learn in this unique patient population.

It took me about 6 months to feel confident seeing a patient on my own, and most of that was learning the vocabulary of oncology as well as the complicated pharmacology, including chemotherapy drugs I had never heard of before. But my supervising physicians were integral in my success and making the patient feel comfortable with seeing another provider. They took the time to train me and allowed me to instill confidence in my patients. I was seeing patients in the clinic, consults in the hospital, and taking call on the weekends. I felt comfortable knowing I always had the physicians’ support and guidance, but I also did a lot of self-directed learning.

There are also various oncology-related resources available to advanced practice providers to help overcome the amount of “unknown” and leave you feeling more confident in your knowledge. The American Society for Clinical Oncology (ASCO) in collaboration with APAO and many more have developed an oncology-specific certificate program for advanced practitioners. There are three programs tailored to the educational needs of the provider, from a basic 101 level to one geared towards those working in the field for years. This is a great tool to not only expand your knowledge of oncology that is relevant to clinical practice, but to earn a certificate that will make you more marketable in the future.

What type of work does an oncology PA do?

I have always worked in adult medical oncology, but there are also roles for PAs in surgical and radiation oncology as well as pediatric oncology. In these specialties, the practice type will directly impact your experience, as the role of a PA is different depending on the needs of the practice. For example, at larger academic centers with many residents, fellows, and other trainees, surgical oncology PAs have less opportunity to be in the operating room if at all. They focus more on outpatient clinic, post-op checks, and inpatient rounds. On the other hand, at a private practice, you are more likely to be the first-assist or gain more time in the OR.

Within adult medical oncology, I have worked in community oncology and academia. My role has changed and diversified in each position, allowing me the opportunity to take on supervisory roles and work with administration. I became involved in teaching and professional organizations, and I’ve networked with PAs in other arenas of oncology, including radiation and surgery.

In medical oncology, I have a template of my own where I independently see patients who are receiving treatment, on surveillance, or having restaging imaging. I manage toxicities, provide teaching, respond to infusion emergencies, enter chemotherapy/immunotherapy orders and plans, enroll patients on clinical trials, and much more. The field is always changing with new emerging therapies, so I am never bored, and staying current keeps me constantly learning.

In community practice I saw a broader patient population, including anything from leukemias to anemia to breast cancer, but in academia, the work is much more specialized. There are advantages to both that have helped me throughout my career. I love specializing in lung cancer, but because I have had experience with other types of malignancies, I am able to help my practice see patients with other types of cancer such as colon or head/neck cancer. In the community practice I did more inpatient work and consults, while in my academic positions I have been solely outpatient.

What are the hours, and how much do oncology PAs make?

Working hours depend on the practice type. In my current role, I work a more classic schedule of 8:30 am to 6 pm and fortunately do not take call. Since having my daughter, I have the privilege of working part time, three days a week, and I find it to be the perfect balance. Salary varies by state and practice type, but a general range is $95–148k depending on experience (but can be higher or lower).

Is oncology a difficult specialty to work in?

Although my very first week working in oncology was challenging, I quickly knew this was where I was supposed to be. Just witnessing the physician-patient interaction, the level of trust and empathy exchanged, and the relationships that were created, I knew I had found a home. There is something very unique about the field of oncology that sets it apart from other areas of medicine. It is the amount of faith and trust patients put in the physician, you, the team, and whatever higher being they believe in. It is the moment you are no longer doctor/PA and patient, but human beings who have shared an experience that cannot be put into words. It is the rollercoaster of emotions that oscillate between pure happiness for another person when you can deliver good results, and true grief when the outcome is not as we had hoped.

The first thing people often say when I tell them what I do is “Wow, that must be so depressing,” and I felt the same way at first. But now I realize, yes, taking care of cancer patients can be extremely emotional, overwhelming, and at times, maddening. They will ask questions you cannot answer, they will get angry at you, they will be in denial, they will refuse therapy, they will demand therapy, and they will make you feel you have failed. You will feel a small piece of your heart break when you look at a family trying desperately to help the person they love. You will feel the tears of everyone in the room in the pit of your stomach as you tell them there are no more options. You will, at times, walk away feeling helpless, but there are 10 other patients waiting to be seen, so take a deep breath, put on a smile, and keep moving. But I continue to love this specialty because taking care of these patients can be inspiring, deeply rewarding, and a constant reminder of why the research we do has a purpose.

Because there have been hundreds (maybe thousands) of new drugs that have been developed and approved to treat a multitude of cancers in the last decade alone. 

Because I have a passion to help people feel the best they can during their most difficult days and an inherent desire to connect with the human spirit. 

Because it is a daily reminder to embrace life as it happens, and to cherish every moment and person you have on this earth.

If you are interested in learning more about a career in oncology, contact me at micheleneskey [@] gmail.com.

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Is this the right PA specialty for you? is a series that provides practical advice from PA-Cs for students and individuals looking for their right fit.