A Fellows Choice

[AnnieSim]

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Hi! I am Annie, newbie to the board. I am in private practice, have been for 4 years. I am applying for fellowships, and was wondering your opinions... given a choice, would you choose
1. Dermatopathology anywhere
2. GYN Path at Brigham and Women's (Harvard)

also, I have read that the positions at COckerell and Associates (Ackerman, Texas, Dermpath fellowship) only pay $25,000 a year. Is this true, and if so can you take out student loans to eat?????

Thanks! I look forward to chatting.

 

[106174]

Hmmm... Very disparate fellowship choices. I do not want to question your intentions but based solely on this disparity, I am guessing you have motives other than genuine interest in these fields.

My opinion is for you to do whatever it is that you truly love the most.

The word out there is that we are producing WAY TOO MANY dermatopathologists that a few years from now, the market will become too saturated and dermatopathologists may actually have a hard time looking for jobs.

 

[Patrick O]

God, I hope the market doesn't get oversaturated. I have been interested in going into Dermpath since I was a 3rd year medical student, and I am now a 3rd year resident. I'm sure that they're are those out there that go into Dermpath, not for the love of dermpath, but are drawn to its high salaries. I only hope that the majority of those in the field are not into it for this reason. I can absolutely say that if dermpath wasn't as lucrative I would still want to pursue it because I think its a great subspecialty in many ways.

As to Dr. Cockerell's program, the salary is $25k a year, but you could always allocate money from now until the start of fellowship and save money to "eat". Since you have been in private practice for the last 4 years you should easily be able to add the additional cash to support yourself (depending on your personal/family situation). There is always personal loans out there, if one wanted to go that route.

 

[Nilf]

God, I hope the market doesn't get oversaturated. I have been interested in going into Dermpath since I was a 3rd year medical student, and I am now a 3rd year resident. I'm sure that they're are those out there that go into Dermpath, not for the love of dermpath, but are drawn to its high salaries. I only hope that the majority of those in the field are not into it for this reason. I can absolutely say that if dermpath wasn't as lucrative I would still want to pursue it because I think its a great subspecialty in many ways.

Hasn't Ladoc already debunked the 'dermpath = mad bank' myth?

 

[106174]

As it is, there are already way too many dermatopathologists and yet, the ACGME continues to accredit more programs. This year only, they accredited five more - Sloan Kettering, SLU, Dartmouth, Thomas Jefferson, and Penn State. If somebody does not look into this and does something about it, there will be an oversupply of dermatopathologists.

The same has to be done with Pathology. Somebody has to seriously look into the Pathology workforce and assess objectively how many we really need to graduate each year. The number of residency slots has to be cut down.

 

[AnnieSim]

I am not going to defend my choices, but I would be very discouraged if there were only one area of pathology that I loved.

My primary motivation is not monetary, but a nice salary is important to me. When you have a $1200 a month student loan payment and a mortgage, it tends to come into consideration 🙂
I had not thought about oversaturation in derm, but I appreciate you guys bringing that up.
And as far as the salary at Cockerell, just checking- it is so different from other programs I wanted to make sure it was not a misprint. It will be quite an adjustment, but it will be temporary.
Thanks for the input!

 

[paleman]

umm you guys have to be kidding? private practice jobs are EVERYWHERE for dermatopathologists. the market is far from saturated.. mainly bc most derm trained dermpaths don't take private path lab jobs and sign out in their own/group practices. if i were you i'd go into dermpath whereever you can.. (from personal experience (i have been out a few years now)) it will open a whole new avenue of opportunity for you.. fellowships are hard to get but it'll be worth it believe me unless you have a genuine academic aspiration (in which case gyn with partners sounds like a winner)

 

[106174]

yes, the salary at dr. cockerell's is $25,000 for that one year. derm-trained fellows usually moonlight at any of the many derm clinics in the DFW area to augment their income. path-trained fellows live off of credit cards for that one year and pay them off after they get out.

 

[Unty]

I know everyone has been talking about how dermpath makes "mad bank" and all, but a friend of mine is looking for a PP position and he told me he was offered a starting pay similar to what has been stated on this site. Now, I am not in the workforce yet, so I was wondering if someone can answer a few questions for me.

My friend doesn't seem satisfied with the offer he's receiving. I would think dermpath would make "mad bank" only if you own the practice (the senior guys), where I can see you making big bucks. But if you are a new graduate...you will be signing out cases and get paid much less than the amount you are making for the group. I mean if I was in his position, or any pathologist, I could make mad bank if I had clinicians sending me their biopsies, etc to MY practice...but if you don't own a practice, like most ppl, you would have to work under someone and they would profit from your work.

I guess this is where "parnership" comes in. Can someone educate me about this "partnership in x years" clause that is in contracts? If someone was a senior in the group, why would he/she make someone partner so that he/she could take a share of the profits? I understand new graduates in dermpath make ~250K starting. However, I don't understand why someone would pay you substantially more in a few years as a partner, when they can hire someone else for 250K down the road? Is it because the supply of dermpaths is low? I guess I don't understand the concept of "partnership." Is it because senior members of a group will offer you a partnership if they like you and you have been there for a few years?

Sorry for all the rambling...im just clueless about the whole process...

 

[malchik]

As it is, there are already way too many dermatopathologists and yet, the ACGME continues to accredit more programs. This year only, they accredited five more - Sloan Kettering, SLU, Dartmouth, Thomas Jefferson, and Penn State. If somebody does not look into this and does something about it, there will be an oversupply of dermatopathologists.

The same has to be done with Pathology. Somebody has to seriously look into the Pathology workforce and assess objectively how many we really need to graduate each year. The number of residency slots has to be cut down.

Sounds like someone's trying to create a rumor to keep his subspecialty of interest in short supply and high demand.

 

[yaah]

Seems to me as though a lot of dermpath jobs are being bought up by large mega labs, so your job options if you want to do primarily dermpath are to go into academics or to work for dermpath diagnostics or ameripath. I may be wrong about that, but a lot of info out there seems to suggest that. That $25000 statistic is pretty weak. Talk about squeezing money out of every available orifice. That would be reason enough for me to not do dermpath right there.

As for dermpath being oversaturated, I wouldn't worry so much about that just yet. Seems like almost every academic program is looking for a dermpath, and a lot of private places are too. It just may get harder to find a job outside of mega labs or academics where you do ONLY dermpath. But even that would be unlikely in the near future. Skin cancer isn't decreasing any.

In regards to the OP, I would be fairly surprised, if not stunned, if BWH took someone who was already in private practice into a gyn path fellowship. Unless there is a compelling reason, of course. But I have been surprised before! I am also curious as to why someone would leave private practice to go back into a fellowship. Having four years in the real world is almost better than a fellowship in the eyes of many who do the hiring.

 

[106174]

Sounds like someone's trying to create a rumor to keep his subspecialty of interest in short supply and high demand.

As a medical student, you obviously have not been around enough to know what is going on out there, so if I were you, I would make sure I knew what I was talking about before I made any accusations such as the one you made above.

The American Board of Dermatology certifies ONLY 390 dermatologists every year. Contrast that to the close to 100 Dermatopathologists the American Boards of Dermatology and Pathology certify each year. So roughly, there is 1 Dermatopathologist for every 4 Dermatologists. Not every patient seen by a Dermatologist is biopsied. In fact, if you have done a Derm rotation at all, you would know that of the 15 patients seen in one morning, maybe only 1 or 2 would get a biopsy. Sometimes, none of the patients get biopsied at all. Do the math.

Yes, there are jobs available out there right now but if the current trend continues, there will be an oversupply of Dermatopathologists. Like I said, this is the same problem we are facing in Pathology. We certify more than 700 Pathologists each year. Do we really need that many? Unfortunately, there are no data out there that address this issue.

Dermatology, on the other hand, is the way it is (very good job security) because they are very protective of their specialty. Alexa Boer Kimball in Boston heads a group nationwide that specifically looks into the Dermatology workforce. She has several papers published that have looked into how many Dermatologists really are needed to support the demand.

There is absolutely NOTHING wrong with protecting your specialty. Yes, I am very protective of Dermatopathology but I will NEVER spread rumors to do that.

I stand by what I said earlier - the job market for Dermatopathology might not be like what it is today years from now, so do it only if you truly love it. Because if you are in it for the wrong reasons, if and when the financial compensation falls, you will be miserable.

 

[paleman]

I know everyone has been talking about how dermpath makes "mad bank" and all, but a friend of mine is looking for a PP position and he told me he was offered a starting pay similar to what has been stated on this site. Now, I am not in the workforce yet, so I was wondering if someone can answer a few questions for me.

My friend doesn't seem satisfied with the offer he's receiving. I would think dermpath would make "mad bank" only if you own the practice (the senior guys), where I can see you making big bucks. But if you are a new graduate...you will be signing out cases and get paid much less than the amount you are making for the group. I mean if I was in his position, or any pathologist, I could make mad bank if I had clinicians sending me their biopsies, etc to MY practice...but if you don't own a practice, like most ppl, you would have to work under someone and they would profit from your work.

I guess this is where "parnership" comes in. Can someone educate me about this "partnership in x years" clause that is in contracts? If someone was a senior in the group, why would he/she make someone partner so that he/she could take a share of the profits? I understand new graduates in dermpath make ~250K starting. However, I don't understand why someone would pay you substantially more in a few years as a partner, when they can hire someone else for 250K down the road? Is it because the supply of dermpaths is low? I guess I don't understand the concept of "partnership." Is it because senior members of a group will offer you a partnership if they like you and you have been there for a few years?

Sorry for all the rambling...im just clueless about the whole process...

i have 2 suggestions re private practice
(i) MBA
(ii) read the radiology blog, those guys know that stuff inside out

 

[malchik]

Yes, there are jobs available out there right now but if the current trend continues, there will be an oversupply of Dermatopathologists. Like I said, this is the same problem we are facing in Pathology. We certify more than 700 Pathologists each year. Do we really need that many? Unfortunately, there are no data out there that address this issue.

Fair enough, BigD. You're correct that I don't know much about the dermpath market. But your post asserting that there are already far too many dermatopathologists didn't exactly make a convincing case, nor does this one. The problem, as you say, is bolded above. Do you have data supporting your oversupply assertion? 1 dermatopathologist for 4 dermatologists is not a meaningful statistic without specimen numbers. Thanks for the reference to the derm people who keep track of the market dynamics of their specialty, I'm curious to see how they gauge that.

 

[paleman]

59 people sat the DP exam last year. 85% passed. around a 1/3 are dermatologists who will not set foot in a private path lab. so around 35 actually join market every year. mmm not even 1 per state per year!

 

[xanthines]

People aren't like dogs. They live a long time! A fresh 35 dermpathies every year adds up. Especially since dermpath is pretty specialized.

Just sayin'...

-X

59 people sat the DP exam last year. 85% passed. around a 1/3 are dermatologists who will not set foot in a private path lab. so around 35 actually join market every year. mmm not even 1 per state per year!

 

[LADoc00]

Hi! I am Annie, newbie to the board. I am in private practice, have been for 4 years. I am applying for fellowships, and was wondering your opinions... given a choice, would you choose
1. Dermatopathology anywhere
2. GYN Path at Brigham and Women's (Harvard)

also, I have read that the positions at COckerell and Associates (Ackerman, Texas, Dermpath fellowship) only pay $25,000 a year. Is this true, and if so can you take out student loans to eat?????

Thanks! I look forward to chatting.

4 years out in practice and you are going to do a fellowship now?
Sounds like a disaster in the making IMO.

First off, no clue with what you are thinking with GYN at BWH. What will Crum and company teach you that you already dont know during your daily sign out?? If you cant sign out a borderline serous ovarian tumor or a uterine MMMT by now what the heck are you doing??

My point: GYN path will be no value added unless you are going to research. It isnt that marketable anymore. No one cares.

My advice if you are REALLY interested in GYN path go to a conference, read a book ffs, DONT do a fellowship in it.

Your post sounds like "My job/life sucks, I want change, I cant find another job easily enough so Im going to a fellowship" I would guess you are single maybe hoping to get back into a university social scene to meet potential spouses..no, thats what match.com is for.

The derm thing is a wash. Might help you, might not.

Once again your original post seems a bit random without also stating what your goals are...

 

[AnnieSim]

LADoc00
You sound like a real jerk. My life is great, lovely and wonderful thank you very much, I am interested in becoming better, more specialized, and furthering my education. I happen to enjoy most aspects of pathology.
But thanks for your input.
So much for collegial interaction.

 

[LADoc00]

LADoc00
You sound like a real jerk. My life is great, lovely and wonderful thank you very much, I am interested in becoming better, more specialized, and furthering my education. I happen to enjoy most aspects of pathology.
But thanks for your input.
So much for collegial interaction.

go take an art class at the community college if you are interested in "furthering your education". Doing more residency training isnt the answer. Im trying to be as candid as possible. If I was running a pathology fellowship and got someone applying for gyn years after training I would ask alot of questions....ALOT. Its very atypical.

Seriously..seriously, you are going to go to Brigham of all places and say you are a practicing pathologist (for quite a long time too) and are just now interested in a fellowship to become "better"?! They would laugh their butts off at you.

Im just trying to save you the embarassment.

Here is my advice: take a month off of your job, which you supposedly love... and sit with a derm or gyn person at the scope. Private prac people do that all the time.

 

[djmd]

Here is my advice: take a month off of your job, which you supposedly love... and sit with a derm or gyn person at the scope. Private prac people do that all the time.

I have seen private practice people do this before... It seems like an interesting approach... good if you don't like courses ( but I would guess there is no way to get CME from it...)

 

[pathdoc68]

I have met a few practicing pathologists who did fellowships after years out. Miostly to accomodate another physician spouses career. Seem to work out all right, no big deal.

 

[djmd]

I have met a few practicing pathologists who did fellowships after years out. Miostly to accomodate another physician spouses career. Seem to work out all right, no big deal.

I guess I have seen that, not with pathologists...

 

[LADoc00]

I have met a few practicing pathologists who did fellowships after years out. Miostly to accomodate another physician spouses career. Seem to work out all right, no big deal.

thats a different story, when forced to relocate by a spouse you might need to do job retraining in any field. This is very common with dual-MD families especially where a spouse is at a different time in their training cycle.

And that is NOT the case the OP is presenting.

When someone is supposedly happy with their life and job, they dont for no good reason uproot their life, risk their job and leave on a 1 year hiatus.

 

[AnnieSim]

Actually, I did not give my reasons for quitting the job I have right now to pursue a fellowship, because I am not looking for opinions as to whether or not I SHOULD do a fellowship at this point in my career. I have made that decision and am quite comfortable with it, and excited about beginning my fellowship.
My question was only "which would you prefer" between the two options I presented. But thank you, LAdoc, for analyzing my life and career based on a couple of sentences. It is quite interesting.

 

[LADoc00]

Actually, I did not give my reasons for quitting the job I have right now to pursue a fellowship, because I am not looking for opinions as to whether or not I SHOULD do a fellowship at this point in my career. I have made that decision and am quite comfortable with it, and excited about beginning my fellowship.
My question was only "which would you prefer" between the two options I presented. But thank you, LAdoc, for analyzing my life and career based on a couple of sentences. It is quite interesting.

I actually take a small bit of pride in posting advice here and when someone says which is better Gyn at BWH or DP with Cockrell, what type of answer are you looking for exactly??

Re-read your original post....please.

then you go on to state Cockrell only pays 25K a year..that theoretically should be nothing to someone who has worked for 4 years and banked what should have been several hundred grand away...

Im going to be blunt now: your question is IDIOTIC. The 2 fellowships are totally different, this isnt Chinese food vs. Burgers for dinner..People "prefer" training that fits their own personalized goal set.

You seem very flippant in this decision and what Ive seen so far I think it is going to be a mistake for you.

 

[djmd]

Actually, I did not give my reasons for quitting the job I have right now to pursue a fellowship, because I am not looking for opinions as to whether or not I SHOULD do a fellowship at this point in my career. I have made that decision and am quite comfortable with it, and excited about beginning my fellowship.
My question was only "which would you prefer" between the two options I presented. But thank you, LAdoc, for analyzing my life and career based on a couple of sentences. It is quite interesting.

Well I would have to point out that your behavior is odd in the sense that it is outside of the norm of most pathologists. You don't give a reason for this aberration, so it is only natural for people to speculate...

And as you said you are new to the board, I will let you know that this is norm behavior for LADoc.

If you want advice, given the limited information you gave us. Choose which ever interests you more. (unless money is the reason for this, then choose Derm ( until the billing rules for derm change)...

 

[HCE]

Well I would have to point out that your behavior is odd in the sense that it is outside of the norm of most pathologists. You don't give a reason for this aberration, so it is only natural for people to speculate...

And as you said you are new to the board, I will let you know that this is norm behavior for LADoc.

If you want advice, given the limited information you gave us. Choose which ever interests you more. (unless money is the reason for this, then choose Derm ( until the billing rules for derm change)...

LADoc can be painfully direct. That being said, you can usually bank on advice from him or Yaah....the two wisemen, with slightly different styles...

 

[yaah]

Annie, I think you would be advised to not take things too personally. While LADoc is being blunt, I sincerely doubt he means personal offense. Internet forums are well known for people taking offense, and I think instead of focusing on the personal you should focus more on what he is saying apart from that. Although, I will add (for everyone) - keeping things away from being personal is always advised here, and some of the stuff that was posted was unnecessarily inflammatory. So I would ask people to refrain from anything approaching a personal attack. But, of course, bluntness is not always a personal attack.

But the fact remains is that the criticisms that were posted are extremely valid. LADoc's points were similar to mine, kind of an "I can't imagine what you are thinking" kind of response. I'm sure we all agree that you are the one to make your own career decisions and you have probably thought this out well and have come to your decision, and that's fine. You don't have to justify it to us if you don't want to. But the thing is, when you come here and post a question like that you are going to have to expect a reasonable amount of incredulity. As an attending, you can take a leave of absence and go and spend a month with an expert in the field and get more out of it than you would with a fellowship, because your learning would be directed and focused towards what YOU need.

If you have thought out the fact (with reasonable certainty) that you are going to leave an established job not for another job but to go back to being a low-paid trainee for at least one year, it stands to reason that the next question would not be, "should I do derm or Gyn path?" You have probably answered the "why" for yourself. But for two disparate fields like derm and gyn path, you should already have decided.

An established pathologist does not normally decide that they are going back to do a low paid fellowship and ONLY THEN decide which fellowship to pursue. You would decide that you really wanted a lot more cytopath training, and one route to this is to go back and do a cytopath fellowship, and the pursue that and only that.

Now perhaps financial considerations are not an issue. If that's true, why bother with the hassle of a fellowship? Do some visiting rotations and some extended study time, you will learn just as much as a fellow.

To get back to your original question though, the answer I would give would come from how you would answer the question, "What are your specific goals?" As stated (or implied) above, it sounds as though your goals are ill-defined and not well thought out. But if that is incorrect, and you have disregarded everything I have posted above as being irrelevant or inappropriate, then what is your goal? To become better at either of these two specialties? Or just one of them? Or does the specialty itself not matter? It's confusing. Any career choice that one makes has to be made with the consideration of just what your goals are and how this specific change will help you get there. I can't figure that part out.

 

[b&ierstiefel]

I just saw this thread and I must admit that I too am a bit baffled as to your motivations given that you've been in practice for several years...but every situation is different and I respect that and it's not my position to judge you. I don't know much about your background but am curious wonder as to your future aspirations and if you are interested in academic GYN pathology?

As a GYN fellow under Crum, I have really enjoyed my fellowship so far. I have no reservations. Crum has been a great mentor and teacher and he's a blast to work with. Comparing it to dermpath...well I can't really comment. Skin pathology was not really an interest to me as much as GYN pathology was. I'm glad to have done a GYN path fellowship and especially to have done it here at BWH.

Now, regardless of whatever career interests you may have from now on, I will say that Crum is more interested in training academicians. This also falls in line with the fact that the demand for GYN pathologists is relatively low in the private sector. Personally, I was fine with that when I made my decision and it wasn't incongruent with my decision to not to a postdoc. Many of those who train under Crum do go into academics with a few exceptions...and as an academician himself, he does like to see his trainees follow in his footsteps.

Anyways, feel free to ask me any questions about the GYN fellowship here at BWH.

I don't know if you have already applied to the GYN fellowship here but I have heard through the grapevine that there is currently a strong applicant who has quite a bit of practice experience. Do you happen to be a friend of a certain someone who has recently relocated to San Diego from our department? You don't have to answer that 🙂

 

[pathstudent]

^It seems to me that GYN path is very prevalent and would be very practical at any hospital. Are you sure that Gyn is in low demand?

I think a Gyn fellowship would get a lot of play in academics and community practice. If you doubled it up with a surgical pathology fellowship, Cyto or breast, you would be off to the races.

 

[b&ierstiefel]

^It seems to me that GYN path is very prevalent and would be very practical at any hospital. Are you sure that Gyn is in low demand?

I've been looking at job postings quite recently. Many of the academic jobs are probably not posted but the private jobs seem to want folks who have specialty training in Derm, GI...and of course joint AP/CP training 🙂

I think a Gyn fellowship would get a lot of play in academics and community practice. If you doubled it up with a surgical pathology fellowship, Cyto or breast, you would be off to the races.

I don't plan to do a surg path fellowship but am following GYN with another fellowship...let's see where it gets me.

 

[Matte Kudesai]

I don't plan to do a surg path fellowship but am following GYN with another fellowship...let's see where it gets me.

Cyto with Cibas would be sweet. 🙂

 

[LADoc00]

Actually had a spark of insight: My guess, just guess is that Annie was less looking for help with her decision than congratulations/personal validation she got into 2 somewhat competitive fellowships.

In that sense, us as readers, failed and proceeded to do the exact opposite which was to mock the conundrum she was proposing.

Probably was a very rude awakening for her.

 

[Patrick O]

She didn't say she got any spots.

 

[b&ierstiefel]

Cyto with Cibas would be sweet. 🙂

Word.

 

[CameronFrye]

I just saw this thread and I must admit that I too am a bit baffled as to your motivations given that you've been in practice for several years...but every situation is different and I respect that and it's not my position to judge you. I don't know much about your background but am curious wonder as to your future aspirations and if you are interested in academic GYN pathology?

As a GYN fellow under Crum, I have really enjoyed my fellowship so far. I have no reservations. Crum has been a great mentor and teacher and he's a blast to work with. Comparing it to dermpath...well I can't really comment. Skin pathology was not really an interest to me as much as GYN pathology was. I'm glad to have done a GYN path fellowship and especially to have done it here at BWH.

Now, regardless of whatever career interests you may have from now on, I will say that Crum is more interested in training academicians. This also falls in line with the fact that the demand for GYN pathologists is relatively low in the private sector. Personally, I was fine with that when I made my decision and it wasn't incongruent with my decision to not to a postdoc. Many of those who train under Crum do go into academics with a few exceptions...and as an academician himself, he does like to see his trainees follow in his footsteps.

Anyways, feel free to ask me any questions about the GYN fellowship here at BWH.

I don't know if you have already applied to the GYN fellowship here but I have heard through the grapevine that there is currently a strong applicant who has quite a bit of practice experience. Do you happen to be a friend of a certain someone who has recently relocated to San Diego from our department? You don't have to answer that 🙂

Your post sums up my original thoughts when first reading this thread. Crum is awesome (and one of my favorite interviewers when I was applying), but to paraphrase a conversation I had with him, he is very ambitious and never had an interest in just being a slide monkey. He always wanted to make his mark on the world (and he's certainly done that with his work on HPV and now with serous tumorigenesis). He looks for similarly ambitious trainees. I can't see him being very interested in someone that is coming from private practice and will just return to private practice afterwards.