Academic Heme

[Smitty]

Do most academic heme faculty also sign out surg path? Our heme people do, but I'm curious if that's the case at other institutions?

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[cytoborg]

Well here at UCSF, our heme people are in the Lab Medicine (aka CP) department, so they don't sign out surgicals. There is one AP attending with a heme background who does lymph nodes & consults as well as general surgicals, but he's the only one I can think of. Oh, at one of our affiliated hospitals, an attending who does surgicals & cytology also signs out the bone marrows. So I guess it's idiosyncratic here. But I would think it would largely depend on whether the institution considers heme part of AP or CP.

 

[LADoc00]

Back in the day, there was a Stanford dermpath attending (who was quite well known in dermpath) who had to sign out bone marrows because there were so few attendings that could...scary huh?

What does Tressler do? Only nodes? I dont really consider that "hemepath"

 

[cytoborg]

Back in the day, there was a Stanford dermpath attending (who was quite well known in dermpath) who had to sign out bone marrows because there were so few attendings that could...scary huh?

That's crazy! I wonder why so few people sign out bone marrows...

 

[CameronFrye]

Do most academic heme faculty also sign out surg path? Our heme people do, but I'm curious if that's the case at other institutions?

Here, the heme people just do heme, but a few of the surg path attendings will sign out lymph nodes.

 

[Smitty]

a dermpath signing out BMs? that is scary. i like heme but it would be nice if i could do heme only without surg path, although I wonder how easy it would be to find heme only positions

it seems odd to me that heme people would also sign out surg path when by and large derm people seem to do only derm. not sure if it's just a matter of volume or b/c so many derpath people are dermatology trained

any thoughts?

 

[SLUsagar]

Back in the day, there was a Stanford dermpath attending (who was quite well known in dermpath) who had to sign out bone marrows because there were so few attendings that could...scary huh?

What does Tressler do? Only nodes? I dont really consider that "hemepath"

emphasis is on BACK IN THE DAY. We've got a surplus of heme attendings now actually, having to turn down hemepath fellow graduates for staying on (at least for now).
Heme folks here don't do surgicals. Several derm attendings do double dip and do a few months of surgpath. But def. no BM's.

 

[b&ierstiefel]

A lot of our heme folks sign out only heme. We do have a few that also sign out heme and general surgicals.

 

[LADoc00]

My own personal take, never get yourself into a job where you do one thing repeatedly. Really only a few subspecs like derm can pull that off and even derm I think its good to keep up your surgpath skills.

I sign out marrows, cytology, surg path, supervise CP and plot to take over the world in my spare time.

Be the jack-of-all-trades and the master of all.

My residency advisor:

 

[CameronFrye]

My own personal take, never get yourself into a job where you do one thing repeatedly. Really only a few subspecs like derm can pull that off and even derm I think its good to keep up your surgpath skills.

I sign out marrows, cytology, surg path, supervise CP and plot to take over the world in my spare time.

Be the jack-of-all-trades and the master of all.

My residency advisor:

How exactly does the workflow operate at your practice? Do you spend a week doing just surgicals or cyto or heme, or do you do everything everyday? I've never seen a description of how workflow, turnaround time, and division of cases works out in a private practice.

 

[LADoc00]

How exactly does the workflow operate at your practice? Do you spend a week doing just surgicals or cyto or heme, or do you do everything everyday? I've never seen a description of how workflow, turnaround time, and division of cases works out in a private practice.

I do everything everyday. Most of rapid TATs for stuff like derm, breast and GI biopsies get signed out by 10am the day after they are submitted. Immunos prolong it a bit. TATs for marrows are longer due to outsourcing flow and cytogenetics.

 

[dermpathlover]

My plan is to be a rockstar of a dermpathologist who can kick some ass in Heme and general surg path. Or Dermpath + Cyto + General Surg Path.

I don't see how it isn't possible.

 

[CameronFrye]

My plan is to be a rockstar of a dermpathologist who can kick some ass in Heme and general surg path. Or Dermpath + Cyto + General Surg Path.

I don't see how it isn't possible.

What happened to your GI fellowship?

 

[Hector]

If you are at an academic place and are heme trained, you'll probably do almost all heme. In private practice, mostly surgpath with some heme.

I trained at Stanford, seems that Roger Warnke has been doing nodes for a long time (before there was a heme fellowship). Before him was Ron Dorfman. I haven't heard of anybody who does dermpath and heme there.

At Stanford, heme people only do heme. Derm people do mostly derm with some surgpath. Cyto people do surgpath and cyto.

 

[Gut Shot]

What happened to your GI fellowship?

Dude, when you have D-path you don't need GI to maintain your powercombo fellowship status. That would make it, like, a super double bonus combo (with happy ending).

 

[djmd]

What happened to your GI fellowship?

That is the nature of his star system. He has to pick One Three, and one Two.

Or One three and two ones. Or he can just get the combo special.
No substitutions

 

[LADoc00]

If you are at an academic place and are heme trained, you'll probably do almost all heme. In private practice, mostly surgpath with some heme.

I trained at Stanford, seems that Roger Warnke has been doing nodes for a long time (before there was a heme fellowship). Before him was Ron Dorfman. I haven't heard of anybody who does dermpath and heme there.

At Stanford, heme people only do heme. Derm people do mostly derm with some surgpath. Cyto people do surgpath and cyto.

As I said, hemepath does not =doing nodes. Nodes are surgical pathology specimens. Hematology is marrows, flow, hemoglobin electrophoresis, automated hematology, cytogenetics/molecular diagnostics and some other crap.

Currently "at Stanford, heme people only do heme" BUT Im telling you a board certified dermatopathologist who had NEVER done a hemepath fellowship signed out heme there. He is no longer there, probably due to having to sign out hemepath, no idea. There was a point where there were almost no board certified CP Pathologists at Stanford, but yes it seems that has changed.

And Professor Warnke is not a board certified hematopathologist, to further drive home the point of (just) nodes not =hemepath.
check here:
http://www.abms.org

 

[dermpathlover]

As I said, hemepath does not =doing nodes. Nodes are surgical pathology specimens. Hematology is marrows, flow, hemoglobin electrophoresis, automated hematology, cytogenetics/molecular diagnostics and some other crap.

Currently "at Stanford, heme people only do heme" BUT Im telling you a board certified dermatopathologist who had NEVER done a hemepath fellowship signed out heme there. He is no longer there, probably due to having to sign out hemepath, no idea. There was a point where there were almost no board certified CP Pathologists at Stanford, but yes it seems that has changed.

And Professor Warnke is not a board certified hematopathologist, to further drive home the point of (just) nodes not =hemepath.
check here:
http://www.abms.org

If you are strong in nodes, you are probably pretty good in marrows too. Can one get away with no fellowship and doing nodes and marrows in private practice or academics?

 

[dermpathlover]

What happened to your GI fellowship?

I am limiting my second choice to board-certified specialties. It is sexier, though GU+derm GI+derm would probably make you a bigger money maker.

 

[LADoc00]

If you are strong in nodes, you are probably pretty good in marrows too. Can one get away with no fellowship and doing nodes and marrows in private practice or academics?

No....no DPL. Often nodes and marrows arent even in the same department. Sometimes marrows arent even in PATHOLOGY at all. They are 2 totally unrelated skill sets, marrows are far more dependent on cytomorphology and less on architecture. You dont do 200-cell counts for nodes. You dont zoom to oil on nodes. The spectrum of disease for nodes and marrow is TOTALLY different. MDS does not occur in nodes. Yes both can be involved by lymphoma but so can the GI or CNS!

Surgical pathologists can do nodes, hematopathologists can do ALL.

 

[LADoc00]

I am limiting my second choice to board-certified specialties. It is sexier, though GU+derm GI+derm would probably make you a bigger money maker.

I would say right now, the winds of change are pulling GI>GU.

 

[dermpathlover]

I would say right now, the winds of change are pulling GI>GU.

Is that just a gut feeling?

 

[LADoc00]

Is that just a gut feeling?

Mid transverse colon, yes. but it could be the baked beans from last night. Ask me again tommorrow.

Do you remember when we used to dance
And incidence arose from circumstance
One thing lead to another we were young
And we would scream together songs unsung

 

[Click Here!]

I would say right now, the winds of change are pulling GI>GU.

I don't really understand this. Half of your rants are about the pod labs and GI groups taking advantage of young/naive pathologists. Is there really that much GI to go around, or do you forsee rule changes forcing out the GI docs? Or are you just saying that the fellowship will allow you to compete more effectively against the Evil Empires?

 

[LADoc00]

I don't really understand this. Half of your rants are about the pod labs and GI groups taking advantage of young/naive pathologists. Is there really that much GI to go around, or do you forsee rule changes forcing out the GI docs? Or are you just saying that the fellowship will allow you to compete more effectively against the Evil Empires?

The later. One big reason GI docs can make a case for starting their own lab is that community pathology groups supposedly lack the expertise to sign out their cases.(where have we heard that before: Derm, Prostate...)

By being GI trained you can help nullify that leverage the evil empires might have....and if you happen to do some moonlighting for the evil empire and might a little bundle of cash, so be it!

And um no, half of my rants are not about pod labs. Ive maybe posted a dozen times about this with 2700+ to my name....a dozen/2700 does not equal 50% unless that is new math you are using.

 

[Click Here!]

Thanks for clarifying.

And I guess I should have been more general. It seems like half of your rants regard pathologists with low business IQ which makes them easy targets for a variety of more saavy businesses-be they older pathologists, GIs, Derms, Ameripath, etc, etc.

I really appreciate your posts, because they've opened my eyes to real-world issues I've never been exposed to and don't expect to hear much about during residency. Now hopefully, with some small-business type reading on my part, I won't end up being just another cog in a huge corporate machine.

Sorry to hijack this thread.