Best Fellowship Combo

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Pathmonster

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Now that it is becoming the expectation to have done 2-3 fellowships in order to be competitive, what would people say are the best fellowship combinations?

For example 4 years AP/CP plus...

1) Surg path, Trans med, micro

2) GI, Surg path

3)GU, GI, Derm

4)Transplant, Surg Path

5) Renal, Trans med

6) Heme, Trans med

7) GU, Heme, Derm

The combos are many. What would make you the most dynamic attractive applicant?
 
Pathmonster said:
Now that it is becoming the expectation to have done 2-3 fellowships in order to be competitive, what would people say are the best fellowship combinations?

For example 4 years AP/CP plus...

1) Surg path, Trans med, micro

2) GI, Surg path

3)GU, GI, Derm

4)Transplant, Surg Path

5) Renal, Trans med

6) Heme, Trans med

7) GU, Heme, Derm

The combos are many. What would make you the most dynamic attractive applicant?
Click to expand...

There is another thread dedicated to this recently. I would say most of your "combos" make no sensewhatsoever so Im gonna assume you are a med student...for example surg path/TM/micro...gibberish, but I did chuckle a bit reading it. :laugh:
 
Pathmonster said:
Now that it is becoming the expectation to have done 2-3 fellowships in order to be competitive...
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I must have missed this memo. How many people are out there with 3 fellowships? I have heard of folks with two, but this was on the 5 year plan with one being a credentialing year. Is it really that necessary to do 3 fellowships?
 
drPLUM said:
I must have missed this memo. How many people are out there with 3 fellowships? I have heard of folks with two, but this was on the 5 year plan with one being a credentialing year. Is it really that necessary to do 3 fellowships?
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I have NEVER heard of anyone doing 3 board certified fellowships in pathology. Only once did I hear about a guy who was IM boarded with a fellowship in GI who then did AP/CP Path + forensics...but the guy who told me that tall tale was stumblin drunk.

The OP could be counting AP and CP as 2 boards, which they arent. Separate out board certified fellowships from crap residents do like:
1.) JOing for a year in a supposed "immunohistochemistry" fellowship, doesnt count
2.) A "research fellowship" likewise is nonsense.
3.) Doing a surg path fellowship as part of being AP boarded also doesnt count, that is a year of AP regardless of the lame a$$ fancy name you want to attach to it.
4.) Mystical things that Pathologists no longer really do like Micro, Chemical Pathology and Radiation Pathology (yes it exists and at one point was even board certified! hahaha, no clue as to what that is) also do not count.

1 fellowship is fine. Sheesh.
 
Is it really becoming the expectation to do 2-3 fellowships? Yikes!! Whose expecations are these, anyway. I mean, crap, I only did one fellowship. How am I going to compete with you young-guns willing to stretch into pgy-10 land by doing some funky derm-blood bank-renal path hybrid training.

I kinda like your odd combinations of subspecialties, btw. Kinda interesting. I am thinking of going back and doing some totally off-the-ball training, just to amuse myself and impress my friends. I am already cyto, so maybe I can add a year of optho path and then a year of chemistry, just to sport that cyto-optho-chem sub-sub-subspecialty. Then, maybe I can fna eyeballs and throw the aspirate in some chemistry analyzer and make some sense of it. Whatdoyouthink?
 
LADoc00 said:
I have NEVER heard of anyone doing 3 board certified fellowships in pathology.
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As an fyi, the ABP will only allow someone to sit for two subspecialty board exams.
 
^You can do three fellowships. Only two can be board certified. You could do Cyto+Derm+GI. That would be a decent combo to land a gig.

I read that topic about fellowships and I only remember people listing the best fellowships in order. I'm talking about best powercombos of fellowships. Residents I talk to say 2 fellowships was unusual a few years ago, but is now what is expected to get hired by big high-paying groups.

I think Derm+GI+GU would be about the ideal fellowship combo.

Cyto+GI+Hemepath would be another good one.

How about Heme+micro+trans med? (All those are boarded, might be a problem)

Is transplantation fellowship of any use at all in private practice?
 
Pathmonster said:
^You can do three fellowships. Only two can be board certified. You could do Cyto+Derm+GI. That would be a decent combo to land a gig.
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Dude, you do realize that is 7 flippin years right??

That is like TWO average residencies.
 
I anticipate that I will not do 3 fellowships. If that makes me "not competitive" so be it.
 
Pathmonster said:
what would people say are the best fellowship combinations?
Click to expand...

None of the above. One shot, one kill.
 
LADoc00 said:
Dude, you do realize that is 7 flippin years right??

That is like TWO average residencies.
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If you are going to hire somebody for a big full service community hospital in a big city, are you going to hire someone who is AP/CP with a GI fellowship, or someone who is boarded in AP/CP and is Derm boarded and has done a GI fellowship.

6-7 years is about how long cardiologists, surgeons, radiologists (who subspecialize), and gastroentrologists train.

I might try to do derm/microbiology/transplant path. I'd be the only one in the country. I would probably command 500K coming out of residency.
 
Pathmonster said:
If you are going to hire somebody for a big full service community hospital in a big city, are you going to hire someone who is AP/CP with a GI fellowship, or someone who is boarded in AP/CP and is Derm boarded and has done a GI fellowship.

6-7 years is about how long cardiologists, surgeons, radiologists (who subspecialize), and gastroentrologists train.

I might try to do derm/microbiology/transplant path. I'd be the only one in the country. I would probably command 500K coming out of residency.
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Just a reality check here:

1. A dermpath trained/certified person generally (every single one I have ever met, btw) exclusively do derm. Give them a GI case and they look at you as if you are asking for a kidney. Also, the whole point in doing derm is signing out large volume derm cases so your group can make money. Why would you want them to do liver and colon biopsies as well?
2. I happened to have done 6 years post-medschool training (one IMed, four AP/CP, one cytopath), so its not real unusual in path, either. If someone wanted to train 6-7 years in path, great. Just don't extrapolate that into meaning that 6-7 years and 3 fellowships is going to be some kind of new standard. That sounds pretty hyperbolic to me, no?
3. 500k out of residency, huh? In lira, maybe. In dollars, no. Won't happen. But, good luck with that.
 
drPLUM said:
I must have missed this memo. How many people are out there with 3 fellowships? I have heard of folks with two, but this was on the 5 year plan with one being a credentialing year. Is it really that necessary to do 3 fellowships?
Click to expand...
I haven't heard of an AP/CP person doing 3 fellowships. Doing more than one fellowship seems, at least at my program, might be more of an issue when you're AP only.
 
Pathmonster said:
I might try to do derm/microbiology/transplant path. I'd be the only one in the country. I would probably command 500K coming out of residency.
Click to expand...

Where exactly are you getting this primo weed you are toking? Seriously, this is completely hair brained!

You wanna know what will happen? You could theoretically do all those, then when you are applying people will laugh their butt off at the fact you spent a year doing micro when CLS's manage the lab section. Then they will take a look at transplant path, dude do you seriously think there is money in that??! Im serious, you are so clueless its insane, specializing in dog path would be a better idea.
 
AngryTesticle said:
I haven't heard of an AP/CP person doing 3 fellowships. Doing more than one fellowship seems, at least at my program, might be more of an issue when you're AP only.
Click to expand...

I have heard of a couple. Sometimes it is because they have a really specialized area in mind. But really, doing MORE fellowships doesn't necessarily increase your marketability.

Maybe someone could do a derm path fellowship, and then the next year do another dermpath fellowship. That way they could make a million dollars a year easy because not only are they going to be twice as competitive as any other dermpath trained person, they also took a spot away from someone else who would be a competitor.

I can see combining fellowships if you do cyto one year and then a surg path area the next. People have done that. Same with heme. But it's still somewhat overkill unless you have a specific reason to do it OTHER than assuming it will make you more money.
 
So dermpath people never go work for a group where they do general also? They typically only do D-Path?
 
I think the more felowships you do, (beyond one) the more skeptical employers will be. They will think - is this dude some kind of loser that can't get a job and spends his entire life training. Or worse someone who is so incompetent and lacking in confidence that they need to stay in training because thay just cannot sign out. With good training a solid pathologist doesn't actually need any fellowship training.
 
Pathmonster said:
So dermpath people never go work for a group where they do general also? They typically only do D-Path?
Click to expand...

These days, it seems like people fresh out of fellowship often tend to go to dermpath only practices. But a lot of people trained in the past are still in their generalist positions. Of course there are people who do dermpath fellowships and then do general surg path (including derm).
 
Humm, zero fellowships didn't seem to hold me back. Granted I am a 5 year resident, but good gosh no one needs 3.
 
GreatPumpkin said:
Humm, zero fellowships didn't seem to hold me back. Granted I am a 5 year resident, but good gosh no one needs 3.
Click to expand...

No you need 3, this med student has declared it so...unfortunately, you are doomed. :laugh:
 
LADoc00 said:
...unfortunately, you are doomed. :laugh:
Click to expand...

Yeah man, better send in your preemptive letter of resignation. When all those guys who are derm boarded with GI fellowships turn up you'll just get fired. Avoid the pain.
 
pathdoc68 said:
I think the more felowships you do, (beyond one) the more skeptical employers will be. They will think - is this dude some kind of loser that can't get a job and spends his entire life training. Or worse someone who is so incompetent and lacking in confidence that they need to stay in training because thay just cannot sign out. With good training a solid pathologist doesn't actually need any fellowship training.
Click to expand...
Recently we had a faculty candidate interview who had surg path,peds path, and heme path plus in reviewing his resume, he had never held a real job in his life (he was in his early 40's), so we were suspicious.
 
i have heard of people doing more than one fellowship, but then one (or both) of these is generally not board-certified, e.g. "surg path" and gi, derm and soft tissue, etc.

i think most people (seriously now, more than 95%) do one, main, board-certified fellowship which they may combine with a general "surg path" fellowship or a second, non-board-certified fellowship if they have developed a second interest.

nobody i know is a gi/derm/gu-pathologist or a cyto/hematopathologist. wouldn't you just dilute your strength? i don't think these "super combos" would fly in academics. you would be seen as scattered and not focused.

i don't know much about private practice, but i would think that, there too, people might think you have been wasting your time (and theirs) with indecisions and maybe you are just too lazy to start a real job...
 
I don't know that much, but I would think that some private practice might not have enough derm or enough GI to hire one guy to only do derm or only do GI. If you could do both, you could be their come to guy for tough cases.

Yeah in university programs people probably don't have two different major areas of interest. But in private practice I think it would give you a step-up advantage.

I kind of thought 2 fellowships was now the minimum and three was even better (heme/cyto/surg), but maybe not for now.
 
pathdoc68 said:
I think the more felowships you do, (beyond one) the more skeptical employers will be. They will think - is this dude some kind of loser that can't get a job and spends his entire life training. Or worse someone who is so incompetent and lacking in confidence that they need to stay in training because thay just cannot sign out. With good training a solid pathologist doesn't actually need any fellowship training.
Click to expand...


this statement totally says it all; well said indeed.

I've also been told that you shouldn't just do a fellowship JUST to do it. YOu better have interest in it (and be good by the end, hopefully). Example, you do surg path fellowship, then hemepath; when you get out, you can probably (emphasis: probably, as the rule doesn't always apply) count on seeing half your stuff being heme.
basic point is that if you do one of the major big 3 (derm, heme, cyto), you can count on seeing around half of your daily cases being from the fellowship you chose vs. all general surg path type signout.
 
pathdoc68 said:
I think the more felowships you do, (beyond one) the more skeptical employers will be. They will think - is this dude some kind of loser that can't get a job and spends his entire life training. Or worse someone who is so incompetent and lacking in confidence that they need to stay in training because thay just cannot sign out. With good training a solid pathologist doesn't actually need any fellowship training.
Click to expand...


this statement totally says it all; well said indeed.

I've also been told that you shouldn't just do a fellowship JUST to do it. YOu better have interest in it (and be good by the end, hopefully). Example, you do surg path fellowship, then hemepath; when you get out, you can probably (emphasis: probably, as the rule doesn't always apply) count on seeing half your stuff being heme.
basic point is that if you do one of the major big 3 (derm, heme, cyto), you can count on seeing around half of your daily cases being from the fellowship you chose vs. all general surg path type signout.
 
Agreed - you should never do anything just to do it, or if the main purpose is to improve your resume. Every now and then, a thread pops up somewhere on these forums about "should I get an MD/PhD to increase my future job opportunities?" BAD idea. Utter silliness.
 
SLUsagar said:
this statement totally says it all; well said indeed.

I've also been told that you shouldn't just do a fellowship JUST to do it. YOu better have interest in it (and be good by the end, hopefully). Example, you do surg path fellowship, then hemepath; when you get out, you can probably (emphasis: probably, as the rule doesn't always apply) count on seeing half your stuff being heme.
basic point is that if you do one of the major big 3 (derm, heme, cyto), you can count on seeing around half of your daily cases being from the fellowship you chose vs. all general surg path type signout.
Click to expand...

Youre at Stanford right? Ask Schwartz how many fellowships (he maxed the subspeciality boarded limit) he has done...I lost track at 4...of course he is the exception to the rule... :laugh:
 
yaah said:
Every now and then, a thread pops up somewhere on these forums about "should I get an MD/PhD to increase my future job opportunities?" BAD idea. Utter silliness.
Click to expand...

I absolutely 100% agree with this.
 
I agree; three fellowships: overkill, is an understatement. On the other hand, I think an average resident, in an average AP/CP program, who does only 4 years training, and takes a demanding (=high paying) job, might have to work hard during the fist few years in practice to rise to the level of performance of his colleagues.

A general surg path year is a good option. If you are interested in a particular job that requires expertise in one of the subspecialties without boards (GI, GU, breast…), you can always focus you efforts in that particular area during the last few months of fellowship and claim in a legitimate way special competence in it. That way you remain eligible for more jobs, and as a plus, you will not have problems in the frozen section room while assessing the proximal margins on an esophagogastrectomy in a patient with diffuse-type gastric ca.
 
While never is a big word, let's just say that it's exceedingly rare that a dermpath would ever look at anything else than derm, so while someone might have done say surg path fellowship to get to dermpath, there would be no sense in spending time in other fellowships.

Personally, I feel that surg path + something else (GI, Breast, Dermpath etc.) gives a strong background. However, three fellowships would be going over the top, methinks. The only possible exception would be molecular path.
 
Seems like the average 'round here is a single year of surgpath, with some people not doing it, and others doing something additional, like cyto, GI, or heme. Three seems completely insane, unless perhaps you're AP only.
 
From an employer's viewpoint, having substantial experience in a subspecialty can turn you into a "high-throughput" pathologist, looking at a substantial number of slides daily. If you would have several subspecs, like e.g. cyto and GI, that would kind of negate the whole idea.

Most likely, you'd be working in one of two primary settings: Small "community" practise, where you'd send off the difficult stuff for consults or academic/specialized practise, where you'd most likely spend the majority of your time looking at a specific type of specimens. I can't see how multiple subspec boardings can be helpful in either setting - but it'll of course look nice up on the wall.
 
I would like to do 4 or 5 fellowsips actually. I have heard it is better to skip residency and just go straight to these fellowships. I think fellowships in GU, GI, Heme, and Neuro would make me more attractive to employers. Do you think this will help me get a derm path spot? Do any of you know anyone who has gotten a derm path spot this way? Thanks.
 
drPLUM said:
I would like to do 4 or 5 fellowsips actually. I have heard it is better to skip residency and just go straight to these fellowships. I think fellowships in GU, GI, Heme, and Neuro would make me more attractive to employers. Do you think this will help me get a derm path spot? Do any of you know anyone who has gotten a derm path spot this way? Thanks.
Click to expand...

:laugh: 👍

I actually am sort of interested in dermpath. I just sat in on signout a few times and thought it was cool. (Actually, I think it was more than these specific people were cool - amazing how that influences my thinking!) I had sort of thought I was interested in heme but don't think so after rotating in it. I just can't stand doing those differential counts. I seriously come home every single day with a headache.
 
beary said:
:laugh: 👍

I actually am sort of interested in dermpath. I just sat in on signout a few times and thought it was cool. (Actually, I think it was more than these specific people were cool - amazing how that influences my thinking!) I had sort of thought I was interested in heme but don't think so after rotating in it. I just can't stand doing those differential counts. I seriously come home every single day with a headache.
Click to expand...

You know, I did a month of dermpath, and I agree with you: the people were just really cool 😎 . I do enjoy heme, though. I guess differential counts are sort of an acquired taste?
 
I was kind of amused at the USCAP - when you turn the corner and are suddenly in the land of dermpath posters things changed. The poster presenters were often more well dressed and tended to be more likely to have those fake smiles and false sense of cheeriness. :laugh: Give me a fellowship! Look at my poster!
 
yaah said:
I was kind of amused at the USCAP - when you turn the corner and are suddenly in the land of dermpath posters things changed. The poster presenters were often more well dressed and tended to be more likely to have those fake smiles and false sense of cheeriness. :laugh: Give me a fellowship! Look at my poster!
Click to expand...

I'm screwed if you have to dress well to get a dermpath fellowship. 😳
 
drPLUM said:
I would like to do 4 or 5 fellowsips actually. I have heard it is better to skip residency and just go straight to these fellowships. I think fellowships in GU, GI, Heme, and Neuro would make me more attractive to employers. Do you think this will help me get a derm path spot? Do any of you know anyone who has gotten a derm path spot this way? Thanks.
Click to expand...

No fellowships without a Residency, my friend. At least not if you want to get boarded.

Thing with Dermpath is, that pathologists are competing with dermatologists for the few fellowships that's out there. And without disrespect for the former, the latter usually have some pretty amazing resumes. Add to that, the fact that a lot of people have experienced the wonderful world of dermpath. So there's A LOT of applicants for the few fellowships out there. On top of that, the Boards are absolutely grueling.

Still, I personally feel that it's well worth the effort to try to get it if you want it. It's a small community, populated by some real characters, and I think it's a nice mix of easy cases and some real challenges -- is that really a melanoma, or perhaps a Spitz nevus? I've seen most of the top dogs in action, and they can frequently be very much in doubt when trying to call the correct diagnosis. Of course, the money that most dermpaths make is also nice, as is the sane, if not downright good, working hours that you can negotiate. But as I've said before: If you're only in it for the money, dump the M.D.-thing, get an MBA and head on down to Wall Street.
 
PathOne said:
No fellowships without a Residency, my friend. At least not if you want to get boarded.
Click to expand...

Curses! This is not encouraging news.

😉
 
beary said:
I had sort of thought I was interested in heme but don't think so after rotating in it. I just can't stand doing those differential counts. I seriously come home every single day with a headache.
Click to expand...
It's the biopsies that get me. I mean, I don't mind doing them as a resident, but certainly not as a fellow, and definitely not as staff.

But it's still on my list because
(1) I STILL haven't done any AP in residency,
(2) It beats blood banking.
 
deschutes said:
It's the biopsies that get me. I mean, I don't mind doing them as a resident, but certainly not as a fellow, and definitely not as staff.

But it's still on my list because
(1) I STILL haven't done any AP in residency,
(2) It beats blood banking.
Click to expand...

i.e., you haven't really started residency yet.

clinical chemistry...puh-leeeease!
 
PathOne said:
Thing with Dermpath is, that pathologists are competing with dermatologists for the few fellowships that's out there. And without disrespect for the former, the latter usually have some pretty amazing resumes.
Click to expand...

Then we should reframe the debate. The former can diagnose an epithelioid hemangioepithelioma on a gnat's ass. The latter dries wet lesions, and wets dry lesions. If we're the 2005 University of Texas football team, they're Brown. Dermpath is our natural right. We should take it.
 
Havarti666 said:
Then we should reframe the debate. The former can diagnose an epithelioid hemangioepithelioma on a gnat's ass. The latter dries wet lesions, and wets dry lesions. If we're the 2005 University of Texas football team, they're Brown. Dermpath is our natural right. We should take it.
Click to expand...

I don't know about this. To tag any kind of specific diagnosis on any non-neoplastic skin lesion, one must have a lot of the clinical facts. Dermpath is so unsatisfying to me because it makes me sound like an idiot. ("The differential diagnosis includes" followed by the entire contents of the lichenoid reaction chapter, for example.) A dermatologist might not know what a hemangioepithelioma is, but the two times in their life that they get one, they can send it out.

However, if a pathology resident can get enough clinical experience in that part of their training to be as good as a derm resident, more power to them.
 
RyMcQ said:
I don't know about this. To tag any kind of specific diagnosis on any non-neoplastic skin lesion, one must have a lot of the clinical facts. Dermpath is so unsatisfying to me because it makes me sound like an idiot. ("The differential diagnosis includes" followed by the entire contents of the lichenoid reaction chapter, for example.) A dermatologist might not know what a hemangioepithelioma is, but the two times in their life that they get one, they can send it out.

However, if a pathology resident can get enough clinical experience in that part of their training to be as good as a derm resident, more power to them.
Click to expand...

Dammit, Jim, I'm trying to get a torch-wielding mob together here, so we can storm the dermpath castle and slay the beast. Please check your reasoning faculties at the coat closet.
 
Havarti666 said:
Then we should reframe the debate. The former can diagnose an epithelioid hemangioepithelioma on a gnat's ass. The latter dries wet lesions, and wets dry lesions. If we're the 2005 University of Texas football team, they're Brown. Dermpath is our natural right. We should take it.
Click to expand...

This is like a CP-only resident doing a hemepath fellowship and then getting a job signing out lymph nodes and bone marrows. This is BAD, but unfortunately it will probably keep happening because CP only=researchers=chairmen fall over themselves to hire them. Correct diagnoses be damned!
 
LADoc00 said:
Youre at Stanford right? Ask Schwartz how many fellowships (he maxed the subspeciality boarded limit) he has done...I lost track at 4...of course he is the exception to the rule... :laugh:
Click to expand...


eric schwartz? cyto attending? didn't realize he did other fellowships...if this is indeed the person you're talking about, i'll stroll over to his office, bang the door open, and holler, heh, this dude LADoc said...........
 
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