Are academic pathologists better diagnosticians?

[coroner]

The thought crossed my mind when speaking with a former alum from my program who's also in private practice. When we were in training, we worked with some brilliant academic pathologists. Now it seems like in private practice there's just a lot of "Joe Public" pathologists out there.

Maybe it's the better part of perception than reality, because we knew nothing about the field coming in as first year residents and the knowledge gap from our attendings was bigger than what it would be now. But, when you look at the renowned figures in our field, the overwhelming majority of them are in academics. They're the ones publishing articles, deemed "experts" in fields, writing books, presenting at conferences worldwide, etc. Numbers play a part as well. The average academic pathologist is going to be in a university hospital with a higher volume of surgical specimens than your typical private. Whether or not they're signing out the same number of cases/yr, the higher volume is going to mean the academics are coming across more zebras, other colleagues are passing around unique cases, interdisciplinary conferences will be held, and their institution may be a major referral center from smaller hospitals across the region/nation. Also, I would think there are more private paths than academics who are in smaller hospitals mainly doing bread & butter type cases i.e. "primary care" pathology; therefore, limiting their scope of diagnostic variance over the long run.

At the same time, there are many a pathologists out there in the private world who trained at some of the best institutions in the country. But, I would like to see how they'd stack up vs those still in the ivory towers. So, I came up of an idea how we could settle this: Create a 64 pathologist bracket March Madness style with 32 of the best from academics and 32 from private as voted by peers (kinda like voting for NBA all stars). Each advances after a head-to-head "scope off" with the most difficult and challenging cases out there and crown a champion at the end. If they put a time limit and televised it like a sports event at the next USCAP conference, this would be a lot more interesting than some of the boring lectures out there…

Anyway, I know saying academics are better than private or vice versa would be a blanket statement, and there's good & bad in both realms. But, if you had to make a broad generalization, what would you say?

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[Pathwrath]

I'm assuming by "academic", you mean subspecialized, because that's what academic pathologists have become or are becoming. A boutique subspecialty pathologist spending all day signing out a limited range of organ tissues can get very good at it, especially at tackling less common tumors. How else does one master esoteric diagnoses, except by being in a position to see more of them? There's nothing surprising here.

But I wouldn't conclude that this makes academic pathologists better diagnosticians. Narrow fields can be a haven for small minds who can't handle the breadth of expertise required of a generalist.

Myself, I reserve the highest respect for the docs who can handle anything put in front of him or her. Where do you find them?

 

[LoaLoa]

In a general sense, absolutely not. However, as PathWrath says, some academics are tightly subspecialized, which makes them expert in a very narrow field.

 

[WEBB PINKERTON]

If you don't sign out a variety of over 10,000 cases a year, then you ain't s*it.

Go home and get your shine box

 

[pathstudent]

Yes and no. I would say westra is probably better and salivary gland pathology than I am. Cibas is probably better at cytology than I am. Burger is probably better at neuropathology than I am.

However At my residency the smartest and hardest working residents in my program all went into private practice.

But some of the least hard working residents also went into private practice or went to work for reference labs like labcorp or gynoptix.