Clinical Pathology Only Residency

[deleted595450]

I started my AP/CP combined residency in 2013. Unfortunately, I did not perform well in surgical pathology. Misplaced and mishandled a few specimens during surgical pathology rotation. So, my program forced me to resign. I left the program at the end of one year. Obviously, I do not want to be in the same situation again so I want to try something else. Would it be a good idea to apply to clinical pathology only residency programs? Are the too competitive? I know there are only 18-20 programs all over United States. So is it a good idea to apply to those? My previous program director gave me satisfactory evaluation at the end of the year (satisfactory evaluation in all ACGME clinical core competenciers and I scored 65 percentile on the inservice) and I was able to get two fairly good letters of recommendations from my hemepath attendings.

Any suggestions? Or is it that I should just forget about pathology and do something else?

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[Thrombus]

Many competent AP/CP board certified pathologists struggle to find a job in this field. Why would it be different for you? Your resignation in this field may be a blessing in disguise. You have a potential bright future in another field!

 

[mlw03]

It depends on what you want to do. If you see yourself doing hemepath or blood banking, CP only is an option. Many CP (or AP) only people are academic track folks, but not all of us (I'm an AP only forensic person, of which there are some of us).

It comes down to what you want to do for a living. Thinking long term and big picture, not just "what program can I get into?"

 

[gbwillner]

If you want to do blood banking, then yes, apply. If you don't, then forget it- try another specialty.

 

[pathstudent]

If you want to do blood banking, then yes, apply. If you don't, then forget it- try another specialty.

Totally disagree. You can do cp only heme path. You can do cp and then do molecular, micro or chemistry.

At my university the three cp faculty who taught the chemistry residents all made about 300k a year. The head of the fish lab made 475k. The guy who ran molecular made 275k. And these were just the published salaries and didn't include any private compensation they might have from consulting etc.

For the right personalities, CP only is a great way to go.

 

[gbwillner]

Totally disagree. You can do cp only heme path. You can do cp and then do molecular, micro or chemistry.

At my university the three cp faculty who taught the chemistry residents all made about 300k a year. The head of the fish lab made 475k. The guy who ran molecular made 275k. And these were just the published salaries and didn't include any private compensation they might have from consulting etc.

For the right personalities, CP only is a great way to go.

Those are highly atypical academic cp salaries from what I've seen. Cp salaries I've seen are about 60-80% of AP. There are far fewer positions, so you pretty much have to be willing to move. Micro and chemistry are typically run by PhDs who will work for less money and be far more qualified than you. Good luck finding a job only doing molecular for a decent wage. By the way, there you also have to compete with ABMG PhDs who will also work for less.

 

[gbwillner]

I will also add that a vast majority of CP-only residents are MD/PhDs who want a minimal clinical role and be able to maintain an independent research lab. For this purpose CP is great. I've known dozens of CP-only residents. Only two did not have a PhD. All but one who wanted a non-research job did a blood banking fellowship. That other one did heme path, and was lucky to land a job because she couldn't look at lymph nodes.

 

[pathstudent]

Those are highly atypical academic cp salaries from what I've seen. Cp salaries I've seen are about 60-80% of AP. There are far fewer positions, so you pretty much have to be willing to move. Micro and chemistry are typically run by PhDs who will work for less money and be far more qualified than you. Good luck finding a job only doing molecular for a decent wage. By the way, there you also have to compete with ABMG PhDs who will also work for less.

Well I think you are wrong as the median salary for cp faculty is higher than the ap at the large university I trained at. But having said that there are fewer cp faculty. They are older and there aren't any of the "junior faculty" positions making 80k a year like there are in AP.

 

[gbwillner]

Well I think you are wrong as the median salary for cp faculty is higher than the ap at the large university I trained at. But having said that there are fewer cp faculty. They are older and there aren't any of the "junior faculty" positions making 80k a year like there are in AP.

You are free to think whatever you want. I know CP faculty at at least 8 institutions. Starting salary for directors of molecular, chemistry, and micro are often (or usually) under $100k and PhDs. For those with MDs, the range is more like $120-$140k. The highest I have seen for an asst. Prof. Is $250k, and that was at an institution in NYC that paid all faculty the same. Of course, this was in blood banking.

Contrary to what you say, there far more chance of a CP-only starting at instructor, as most are trying to spend as much time as possible in their research labs. And if there are no openings for their field they are stuck. There was a TON of demand for blood bankers a few years back, but this has pretty much dried up recently.

 

[coroner]

You two can't seem to let this one go....lol

Cp salaries are probably 20-30% lower than their AP counterparts in academia. There is also much less opportunity. A vast majority are folks who do primarily research, and need (and get paid for) a minimal clinical responsibility. Outside of TM, they have very few marketable skills. There was certainly a TM shortage as little as a few years ago, but let's not forget that hospitals don't really need more than 1-2 TM faculty. Otherwise, everything else you do can be done by a PhD for a fraction of the cost. Furthermore, you can do TM with an IM background, which gives you much more career flexibility.
Unless you are an MD/PhD who wants to focus on a basic science research career, there is no reason to do cp-only training.

I know it is just one university but to some extent it should be representative. I looked up 16 cp faculty who oversaw immunology chemistry, micro, blood bank, fish/molecular/genetics, aCGH, and flow/hematology coag. Three were 5 PhDs. The average salary was 327k. The lowest was 227k and the highest was 560k. Now you will probably argue that I should take out the heme path people as they can also be considered ap. There were 4 heme path people. Three made less than the mean one made more so I don't think it would be a significant difference. The 560k was not a heme path person.

I find it shocking. There are too many ap people for me to bother counting but it sure looked like the average would be lower by looking up a few.

I say the answer to my question is "yes cp only academics is a darn good kept secret if not the best kept secret".

Cp salaries I've seen for younger faculty have been a fraction of ap. It's hard to really quantify because the numbers of faculty are far fewer. But the range I would say is $80-250K, with most getting in the $140k range.
The pay structure is different- cp are hospital employees and generally do not directly bill for their services. Because they don't really generate RVUs they don't have much leverage with HR for salary. Now, lab directors may be a different story, but there can really be only one for each lab.

Do you have any clue what you are talking about. Every fish, flow, cytogenetics, PCR, aCGH, platelet aggregation study, every chemistry test, every microbial culture, every hla typing, every thing that happens in blood bank has a cpt code associated with it and each one has a -26 modifier. Every inpatient and outpatient is billed for every cp test they have performed. On inpatients Medicare and a few major insurers won't pay anything for it but on outpatient tests they do.
The PhDs are probably so highly reimbursed for having well run lucrative fish lab or molecular micro labs etc that generate tons of revenue for the department.

All I do know is those salaries are real but most of the faculty are seasoned mid career types which also accounts for it being so high. Plus they probably have moxie.

 

[pathstudent]

You two can't seem to let this one go....lol

Yes. This does seem like ground hog day. But I am sticking to my guns on this one. You can make a good living being cp faculty. Flow cytometry, FISH, molecular, outpatient lab work makes money. There are multiple cp PhDs that make more than the ap MDs trained even with similar career spans. And all the salaries are public information published by the state.

 

[BlondeDocteur]

I think the big thing for the OP to decide is what they want to do with their life.