AP/FP only?

[jace's mom]

So I'm LOVING my forensics rotation (third year med student), and some of the fellows and docs there have talked with me regarding my options for residency training. The idea is that since pathologists now have to recert every ten years, some FPs are thinking that they won't recert in CP because they never use it. The fellow said he regretted doing an AP/CP residency and would do an AP only if he had it to do over again.

I'm 99.99% sure that forensics is it for me, but I'd always assumed I'd do a four year traditional AP/CP residency. Now I'm thinking about the three-year AP option. It's one less year, and I'd get more total AP than I would with a traditional program.

Thoughts? Thanks, as always.

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[jenesaispas0005]

Very few of the forensic pathologists I have met or know of did AP only. Some of them didn't have the option to do a straight AP path, and some of them did and chose to do both AP and CP. The ones who did AP only seemed divided on whether that was a good decision.

Having just gone through the residency interview trail this past year, I know I was asked at almost all of my interviews whether I planned on being both AP/CP boarded and/or if I would do a straight AP or CP track if given the option. The response I would get from saying that I wanted to at least go through training in both was almost always a sigh of relief from my interviewers, even at places that offered an AP only track.

Forensics is a strong possibility for me but I personally feel that having both AP and CP training is important for all pathologists. Plus, you never know what will happen during your training, and if you're AP only, your options afterwards will be very slim if you end up not going into forensics.

Of course, if you do want to do straight AP, make absolutely sure that the residencies you apply to in the fall either offer a straight AP track through ERAS, or contact them directly to see if they do offer them. You're not going to make a good impression of you show up at a program that doesn't offer AP only and say "I want to do AP only".

 

[Unty]

Very few of the forensic pathologists I have met or know of did AP only. Some of them didn't have the option to do a straight AP path, and some of them did and chose to do both AP and CP. The ones who did AP only seemed divided on whether that was a good decision.

Having just gone through the residency interview trail this past year, I know I was asked at almost all of my interviews whether I planned on being both AP/CP boarded and/or if I would do a straight AP or CP track if given the option. The response I would get from saying that I wanted to at least go through training in both was almost always a sigh of relief from my interviewers, even at places that offered an AP only track.

Forensics is a strong possibility for me but I personally feel that having both AP and CP training is important for all pathologists. Plus, you never know what will happen during your training, and if you're AP only, your options afterwards will be very slim if you end up not going into forensics.

Of course, if you do want to do straight AP, make absolutely sure that the residencies you apply to in the fall either offer a straight AP track through ERAS, or contact them directly to see if they do offer them. You're not going to make a good impression of you show up at a program that doesn't offer AP only and say "I want to do AP only".

IMO it seems as if most pathologists that do AP/CP eventually focus on AP the rest of their career after having taken boards. Yes, there is some CP when it relates to your cases, but I feel like no one is going to remember all that micro, blood banking, chemistry stuff they studied for boards 1 year, 10 years down the road. Yes, I think if you go into private practice, you will have CP responsibilities but it seems as if it's all management and questions you have from clinicians (which you can look up anyways). At times, I feel like the training is really broad and you are a "jack of all trades master of none." If you are going to master anything, master surgpath, cytopath and hemepath.

 

[HbyHA]

i'm an FP fellow. I always knew that i was going to do Forensics, but i still did AP/CP. I just don't see how spending another year learning more about the field of Pathology isn't time well spent. Heme Path was CP at my program, and after the 5th heme-related case just came my way this year, i'm so glad i devoted those extra months. i think having the CP training just makes me a more well-rounded pathologists. Some MEs may not agree and wouldn't make the same choice. That's fine. I did it and i'm glad. 4/4 FP fellows this year as are AP/CP as are many of the MEs in our office.

 

[KCShaw]

The majority of programs will push you to do AP/CP, because they generally need the cheap labor around and it's generally easier to schedule if everyone is on the same 4 year track. That's just the way it is.

There are two ways of thinking about this. One is the academic/idealist way, which basically says the more you train, and the more broad your background, then the better you will be at what you do. I have spent a long time feeling that -everyone- who does forensic path -should- also get CP to be FP eligible -- it should be a requirement, not an option. You spend way too much time ordering and interpreting CP tests, and although postmortem CP testing is very forensic-niche, you also look at oodles of hospital records with labs, etc. and have to be comfortable drawing conclusions from those..even when those conclusions are different from the clinician.

The other approach is more simplistic and pragmatic. You aren't currently required to do CP. It IS currently optional. It's likely at this point that when recertifying many to most FP/AP/CP pathologists will only recert FP. Most of what you need to know about the practice of FP you should learn during fellowship. Most of what you need to know about CP in the world of FP you learn either in medical school, residency electives, or fellowship -- or look up/ask someone, if you aren't on the stand when you really need to know. There's really no need to spend the extra year with interest accruing on your loans, earning peanuts, pay for another exam you may or may not even pass, all for something you don't technically need and will probably officially drop at recert. The only thing you lose is the ability to look down on anyone else who didn't bother "wasting their time" getting CP.

So.. while I do think the requirements should be different, they aren't, and to be painfully honest one should seriously consider taking advantage of that fact and save around 75-100k in lost salary...if a program will take you straight AP up front.

 

[ALMD2B]

It's likely at this point that when recertifying many to most FP/AP/CP pathologists will only recert FP.

I am sure that ABP won't let you recert FP without at least AP (primary cert).

I did AP/CP and soon FP. Honestly, I don't think i can do all those SAMs/MOCs and 3 additional exams every 10 yrs. Trying to keep up with the paperless paperwork seems insane right now to upkeep 3 boards.

 

[KCShaw]

Actually, that's been a discussion going around -- that FP's and other subspecialty certifications may not have to recert AP, though they would then be limited to practice in their subspecialty area. Defining the limits of practice at that point wouldn't necessarily be easy, and I'm not sure how well thought out the process is. Don't know if that's actually how it will go, and it doesn't seem to mesh with the current sketch of module selection for recertification. But it's been out there in more than just backyard gossip; I dug up some emails which 2nd and 3rd hand quoted ABP staff on the point. An issue of confusion was that everyone has to -maintain- certification in both the primary and subspecialty for 10 years, but at the point of -recertification- they could choose to only recertify in the subspecialty (and therefore drop the primary certification).

 

[ALMD2B]

Actually, that's been a discussion going around -- that FP's and other subspecialty certifications may not have to recert AP, though they would then be limited to practice in their subspecialty area........but at the point of -recertification- they could choose to only recertify in the subspecialty (and therefore drop the primary certification).

Should be interesting, whatever plays out, though i think, the boards will definitely think of ways to massively charge for anything they can...(as they are now)..$$$$$$$$$$$$$$$

I think I would continue AP and FP...keeping doors open for the future never hurts.

 

[KCShaw]

Good in theory, but in practice few FP's/ME's see much micro beyond a certain range of non-tumor material, at least with regularity. Even those who submit micros on every single case. Given that much of AP is focused on tumor pathology, I would appreciate the opportunity to recertify in the area I work day in and day out rather than being forced to take time away from what society pays me for in order to review outside information (almost) solely for an exam.

Don't get me wrong, there is some tumor path as well as general AP in FP, and when the opportunity presents itself I try to keep up with what doesn't change as well as the re-naming and re-classifying and progression of the field. But when one isn't in a setting to be able to spend a few minutes a day or a week with surgical pathologists across the hall, it's just not practical. Otherwise it's a benefit vs loss scenario, for the most part with tax dollars that would have to pay for study sets, time away from work, etc.

If I can get a good grasp of what exactly the recertification exams will be like, it will be much easier to determine how much extra effort to expend trying to recert AP/CP, because if I don't "have" to then there may not be much reason to. Which I think is unlike many other path subspecialties, where one is far more likely to also regularly sign-out general surg path, or cross-cover chemistry/blood bank/etc., or expect to have to do so upon changing jobs.

 

[HbyHA]

I am sure that ABP won't let you recert FP without at least AP (primary cert).

I did AP/CP and soon FP. Honestly, I don't think i can do all those SAMs/MOCs and 3 additional exams every 10 yrs. Trying to keep up with the paperless paperwork seems insane right now to upkeep 3 boards.

i just hope that all this crap will be ironed out by the recert class of 2016 (who will take the early test in 2014). that gives me 4 to 6 years after that to figure out what the hell is going on

 

[Torsed]

IMO I think most defendant attorney's would prefer a forensic pathologist who didn't do (or flunked) CP. Only makes a stronger case against the state.

Remember the first thing they do is discredit you on the stand. If someone's flunked or didn't take CP when 90 percent of other pathologists did, the jury of 4th graders may be swayed that you really can't take pictures of bullet holes or really know what you are doing.

 

[HbyHA]

IMO I think most defendant attorney's would prefer a forensic pathologist who didn't do (or flunked) CP. Only makes a stronger case against the state.

Remember the first thing they do is discredit you on the stand. If someone's flunked or didn't take CP when 90 percent of other pathologists did, the jury of 4th graders may be swayed that you really can't take pictures of bullet holes or really know what you are doing.

i'm not sure if the average defense attorney knows what the difference between AP and FP is, let alone that there is a CP. sure there are super savvy ones who may, but those will be few and far between. now if their expert is AP/CP/FP and you aren't maaaaaaaybe they'll say something about it. but i really don't think this is a valid reason for doing CP.

FYI: there are MORE than a few FPs who are practicing without any boards at all...

 

[KCShaw]

Exactly. For the average criminal proceeding, the lack of CP, even the lack of FP, doesn't automatically preclude one from being recognized as an expert witness. Where the issue of boards is more likely to be a factor is in complicated criminal cases where there are experts with competing opinions, and in some civil cases also with competing opinions. It depends on the case.

Absolutely there are times when one's credibility will be attacked and all avenues aggressively attempted, it's just not as common, or as fruitful, as some might think. Jurors can sometimes see the ploys, and many have their own dislike of them, so the strategy of nitpicking at credentials has the possibility of backfiring by alienating the jury.

Taking that general question towards recertification -- I think if most FP's were to also recert in AP, then most people would at least attempt to. But if only a scattered few privateers or academicians end up doing so, I imagine the masses will stick together. We'll see..

 

[deleted314957]

Exactly. For the average criminal proceeding, the lack of CP, even the lack of FP, doesn't automatically preclude one from being recognized as an expert witness. Where the issue of boards is more likely to be a factor is in complicated criminal cases where there are experts with competing opinions, and in some civil cases also with competing opinions. It depends on the case.

Absolutely there are times when one's credibility will be attacked and all avenues aggressively attempted, it's just not as common, or as fruitful, as some might think. Jurors can sometimes see the ploys, and many have their own dislike of them, so the strategy of nitpicking at credentials has the possibility of backfiring by alienating the jury.

Taking that general question towards recertification -- I think if most FP's were to also recert in AP, then most people would at least attempt to. But if only a scattered few privateers or academicians end up doing so, I imagine the masses will stick together. We'll see..

in my experience most judges don't put with that crap either

 

[KCShaw]

Good point.

Once the court recognizes you as an expert witness then the issue becomes limited. Unless you've been kicked out of something, disciplined, etc., if you have current boards in anything relevant and are an active practitioner it seems to be kinda hard to -not- be qualified as an expert witness. Non-boarded fellows in FP get qualified as forensic path experts and testify fairly regularly. If the judge decides they can't ask you on the stand whether you ever failed/didn't pass a board exam it's pretty difficult for them to find out and parade it around in front of a jury -- if you testify within the realm of your expertise/training (the boards you -do- have) then in the grand scheme of things it doesn't matter and it seems like many judges agree. If you drift outside of that and start answering questions outside your area of expertise, then you potentially open yourself up.

That said, I know of it coming up; one FP reported giving the honest answer of CP being difficult for them and by golly they were glad they finally passed because some people don't, though it was above and beyond the requirements for AP and FP (or words to that effect), and evidently something in the style of the question & answer garnered what was perceived to be a turn of the jury "for" the witness and "against" the weenie trying to make the witness look bad about something irrelevant to the case or their qualification as an FP expert.