Is CP necessary to run or own a private lab?

[dermpath2017]

I'm currently an AP/CP who has a dermpath fellowship lined up. I am considering dropping CP altogether since I have little interest in most of CP.

Upon completing fellowship, I plan on working in private practice and eventually partnering up or possibly owning my own lab. Do I need to be CP boarded to operate a histology lab?

Thanks for your help.

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[LoaLoa]

No. You don't need to be AP-boarded, either. Ask any of the dermatologists who own and operate their own histology operation.

 

[dr.weiner]

If you are set on private practice, it would be unwise to drop CP.

If you join a private path group, no one will make you partner if you don't do CP.

There are no partnership track dermpath only private labs out there that I know of. Basically all have sold/consolidated with Quest/DD and Aurora, etc... There are derm practices that could hire you but most likely not make you partner, and probably replace you with a derm-trained DP who can also see patients eventually. Dermatologists prefer derm-trained dermpaths, for better or worse.

If you are fine with limiting your options and are OK with a good yearly salary with essentially no partnership potential, then definitely drop CP. DP-only is always an option when you are done training. You can't go back and take CP though. Well, I guess you could, but who the hell would want to do that?

Also, good luck opening your own dermpath lab as a pathologist in this era- basically impossible to the newly trained DP. Why would derms send to you?

 

[turtle1966]

If you are set on private practice, it would be unwise to drop CP.

If you join a private path group, no one will make you partner if you don't do CP.

There are no partnership track dermpath only private labs out there that I know of. Basically all have sold/consolidated with Quest/DD and Aurora, etc... There are derm practices that could hire you but most likely not make you partner, and probably replace you with a derm-trained DP who can also see patients eventually. Dermatologists prefer derm-trained dermpaths, for better or worse.

If you are fine with limiting your options and are OK with a good yearly salary with essentially no partnership potential, then definitely drop CP. DP-only is always an option when you are done training. You can't go back and take CP though. Well, I guess you could, but who the hell would want to do that?

Also, good luck opening your own dermpath lab as a pathologist in this era- basically impossible to the newly trained DP. Why would derms send to you?

I agree with ALL of the above.

 

[dermpath2017]

Thank you for all your opinions and wisdom. I will just tough it out.

 

[pathstudent]

Thank you for all your opinions and wisdom. I will just tough it out.

Tough it out!? What are u talking about? The only real rotations in my CP were heme path which was like 9 to 5. Blood bank was 9-3. Chem, micro, molecular and informatics just has a few scheduled hours a week. I swear those latter 4 were like vacation. In fact I knew residents who just didn't show up for a week at a time and got unscheduled unaccounted for vacation. Outta sight outta mind. They might even have been board ineligible. But they are all board certified. Enjoy CP it is the most civilized residency out there.

 

[gbwillner]

Are there positions in private practice that will hire you without CP? Yes. Can you make partner without CP? Yes. Are you putting yourself at a disadvantage for such a position without doing CP? Yes.

As for owning a lab... You don't even need an MD for that.

 

[ipotrader]

I think this is a myth that remains to be busted.

According to CLIA regulations, to be qualified as a Laboratory Director for even a High Complexity lab, "MD, DO with current medical license in state of lab’s location AND certified in anatomic and/or clinical pathology by ABP, AOBP, or equivalent qualifications", i.e., AP only does not limit one's option to be a lab director.

I understand that many practices prefer the AP/CP boarded over the AP only, but I don't know the real reason behind it, maybe just a convention?

 

[2121115]

I think this is a myth that remains to be busted.

According to CLIA regulations, to be qualified as a Laboratory Director for even a High Complexity lab, "MD, DO with current medical license in state of lab’s location AND certified in anatomic and/or clinical pathology by ABP, AOBP, or equivalent qualifications", i.e., AP only does not limit one's option to be a lab director.

I understand that many practices prefer the AP/CP boarded over the AP only, but I don't know the real reason behind it, maybe just a convention?

Being a laboratory director is very different from owning the lab.

 

[univlad]

I think this is a myth that remains to be busted.


I understand that many practices prefer the AP/CP boarded over the AP only, but I don't know the real reason behind it, maybe just a convention?

It may relate to the ability to take call for CP related questions. In a smaller group, it would be cumbersome to have to have two people on call on a given night because one of the partners could not take CP call.

 

[malchik]

Is there a reason why an AP-only cannot take CP call? It would seem odd, according to the CLIA quote above, if an AP only could direct a lab but not take call. If it is just lack of knowledge/training, that could easily be remedied without the "training" one gets in CP residency.

 

[Over9000]

Is there a reason why an AP-only cannot take CP call? It would seem odd, according to the CLIA quote above, if an AP only could direct a lab but not take call. If it is just lack of knowledge/training, that could easily be remedied without the "training" one gets in CP residency.

It is my personal opinion that CP residency training has no place in modern pathology.

Two years or so of AP are woefully inadequate and two years or so of CP are overkill. PhDs can run CP - minus heme - as effectively as any pathologist, at 10% of the cost. Why the med-ed gurus are insistent on continuing CP as a part of training escapes me.

 

[LoaLoa]

Is there a reason why an AP-only cannot take CP call? It would seem odd, according to the CLIA quote above, if an AP only could direct a lab but not take call. If it is just lack of knowledge/training, that could easily be remedied without the "training" one gets in CP residency.

The issue is not that you couldn't take call. Rather, it's that most facilities with which a pathology group would contract won't credential you to do so unless you're CP-boarded. If credentialing is not an issue, CP boards aren't either. For example, there are family practitioners running their own in-office clinical labs all over the country are continuously on what amounts to "CP call".

 

[ipotrader]

The issue is not that you couldn't take call. Rather, it's that most facilities with which a pathology group would contract won't credential you to do so unless you're CP-boarded. If credentialing is not an issue, CP boards aren't either. For example, there are family practitioners running their own in-office clinical labs all over the country are continuously on what amounts to "CP call".

I assume you meant hospital privilege when you said "credentialing"?

I agree that the CP residency is one of the most boring time I ever spent during the training, although civilized, so to speak. And I agree that you don't really need to go through the formal CP training in order to be able to perform the job, self-reading is the major part of the formal CP training anyway.

So the question comes down to this, because the AP only can be the lab director per CLIA regulation, assume that he/she has the knowledge base to perform the job, maybe through self-teaching, why does he/she need to be AP/CP boarded for private practice then? Again, maybe just a convention?

 

[univlad]

So the question comes down to this, because the AP only can be the lab director per CLIA regulation, assume that he/she has the knowledge base to perform the job, maybe through self-teaching, why does he/she need to be AP/CP boarded for private practice then? Again, maybe just a convention?

It may be that you are required to be CP boarded, but many smaller private groups won't consider hiring people who aren't board certified in both. While they may be able to do the job, their hospital credentialing committee may require board certification. As a member in a small 4 person group, I wouldn't take the risk of having the hospital my group is contracted with require us to have a CP boarded person on call at all times--it would mean more a lot more call for me. The hospital board is very strict about having only board certified physicians on staff, and therefore, the credentialing committee here is very strict about the priviledges it gives providers.

If you complete AP/CP training now during your combined residency, it's only 1 more year than AP only. If you get out into market and later decide you want to add CP training after you're already AP certified you have to do an additional three years of CP only. There are only limited numbers of pathology jobs in any given city compared to specialties that need a lot more practioners (FP, IM, etc). It doesn't make sense to limit your opportunities.

 

[LoaLoa]

If you complete AP/CP training now during your combined residency, it's only 1 more year than AP only. If you get out into market and later decide you want to add CP training after you're already AP certified you have to do an additional three years of CP only. There are only limited numbers of pathology jobs in any given city compared to specialties that need a lot more practioners (FP, IM, etc). It doesn't make sense to limit your opportunities.

Despite my assertion above that CP boards aren't required to operate a histology lab (which was the OP's question), I completely agree with Univlad and the other posters above. If you intend to do private practice pathology, you'd probably be making a big mistake if you were to drop CP. As Univlad says, CP is only one extra year, and it makes you far more marketable. When I trained, I also found that the "relaxing" CP rotation months spaced out the more tiring AP rotations nicely.

 

[mlw03]

I write this as an AP-only person. I agree with others. The only people who should be considering AP only are people who plan to do AP specialities in an academic setting for the rest of their career, and forensic folks. Note I said considering. Plenty of them end up doing AP/CP and it's fine.

 

[gbwillner]

Like mlw03 I am also AP-only. I got offers in private practice and industry. I am now a medical director. That being said, depending on the circumstance, not having CP definitely puts you at a disadvantage for the typical private job.

 

[yaah]

CLIA - 88 - certification is acceptable as criteria for being a LMD but not required.

NOTE: Under CLIA-88 regulations, the laboratory director must:


1. Possess a current state license, if required by the state where the laboratory is located

2. Be an M.D. or D.O. licensed to practice in the state where the laboratory is located

3. Be certified in anatomic or clinical pathology, or both, by the American Board of Pathology or American Osteopathic Board of Pathology, or possess qualifications equivalent to those required for certification


OR


1. Be an M.D., D.O. or D.P.M. licensed to practice in the state where the laboratory is located

2. Have at least one year of laboratory training during residency, or at least two years of experience supervising high complexity testing


OR


1. Hold an earned doctoral degree in a chemical, physical, biological or clinical laboratory science from an accredited institution
2. Be certified and continue to be certified by a board approved by HHS


Additional qualifications for grandfathered individuals and for the subspecialty of oral pathology may be found in the CLIA-88 regulations (http://www.phppo.cdc.gov/clia/regs/subpart_m.aspx#493.1443).

 

[Over9000]

I find it very strange that for a medical specialty, non-physicians can weasel their way into leadership roles. Granted, much of CP is just fine for PhDs to do, but when they start heading up AP departments is when things become inadequate.

In a perfect world, CP would be over there in PhD-land and AP would be called something a little less opaque like diagnostic histopathology or something and re-classified as patient examination rather than laboratory testing. Ah, one can dream....

 

[malchik]

1. Hold an earned doctoral degree in a chemical, physical, biological or clinical laboratory science from an accredited institution
2. Be certified and continue to be certified by a board approved by HHS

Additional qualifications for grandfathered individuals and for the subspecialty of oral pathology may be found in the CLIA-88 regulations (http://www.phppo.cdc.gov/clia/regs/subpart_m.aspx#493.1443).

So a PhD in geology is acceptable. Makes sense.