Ap/fp?

[Path Chick]

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Hey Everyone,

I noticed on ERAS that U of Texas-Southwestern has an AP/Forensics track, but when I visited their website it didn't mention anything about it.

Does anyone know anything about this, or if any others exist? Any opinions about excluding CP?

Thanks!

 

[deschutes]

Don't mean to be abrupt and not give you a direct answer (I don't personally know anything about the AP/Forensics track at UTSW), but here are a handful of threads that discuss AP/CP vs straight track vs. AP/NP etc, with a little bit of forensics mixed in:

http://forums.studentdoctor.net/showthread.php?t=81379
http://forums.studentdoctor.net/showthread.php?t=194590
http://forums.studentdoctor.net/showthread.php?t=186148
http://forums.studentdoctor.net/showthread.php?t=145360
http://forums.studentdoctor.net/showthread.php?t=139894

If you do a search for "AP/CP" you will likely turn up more helpful info in old threads.

 

[Brian Pavlovitz]

...for a minute I thought AP/FP stood for anatomic pathology/Family Practice!!

And I haven't even had my nightly medicinal wine yet!

Yep, some program surely won't know what hit them when I arrive!! 😉

 

[beary]

...for a minute I thought AP/FP stood for anatomic pathology/Family Practice!!

I thought that same thing! I was wondering why anybody would want to do that!

 

[mlw03]

here's another thread i'm bring back from the grave. i've recently been considering the prospect of an AP/FP residency, if that is even possible. as far as i know, UTSW is the only one that officially offers it, and i don't want to live in dallas so i wasn't going to apply to UTSW anyway. however many of the places i'm considering offer forensics fellowships, and i'm wondering if it's worth calling/emailing some of those PDs directly and asking if they'd consider me for an AP/FP track. i'm still in the early stages of even thinking about this, and i'm talking to some of the faculty at my school, but i always think the more educated opinions one has, the better it is.

some things i've thought about:
1. most of all, does a FP need the training obtained in the CP portion of residency? if the consensus is yes, then i won't even think about it. i want the training necessary to do my job.
2. would a PD even consider my request? would doing so mess up schedules to the point that they just wouldn't want to do it?
3. what's the current state of competitiveness for FP fellowships? are they so competitive that it's worth trying to secure a spot this far in advance?
4. anyone have any good data about the current job market for a forensic pathologist? are current fellows finding ME jobs fairly easily?

i look forward to the group's comments. thanks.

 

[djmd]

I don't think that forensics needs much (any?) CP. The most important would be Chemistry and toxicology. But AP/CP just for chemistry seems excessive...

I think places that had AP only might be willing to accomidate AP with forensic interest, but if they don't do AP only I think they would be less than interested.

And unless you are certain that you want to do Forensics only (you can do forensics as AP only), I would strongly recommend against AP only. It limits your job searches. (at least for normal private AP jobs, no idea about forensics)

 

[mlw03]

I don't think that forensics needs much (any?) CP. The most important would be Chemistry and toxicology. But AP/CP just for chemistry seems excessive...

I think places that had AP only might be willing to accomidate AP with forensic interest, but if they don't do AP only I think they would be less than interested.

And unless you are certain that you want to do Forensics only (you can do forensics as AP only), I would strongly recommend against AP only. It limits your job searches. (at least for normal private AP jobs, no idea about forensics)

i wouldn't do an AP only residency - the only way i'd even consider this is if i went into the deal with a guarantee of the FP part for the reason you said. while i'm pretty sure about forensics, there are no guarantees in life, and i know that for most any private practice pathology job, it's necessary to have the CP training. as for getting the necessary components like clinical chemistry, since me, the PD, and the forensic fellowship director would likely be making my curriculum from scratch for this to work, i imagine i could do electives in any CP rotations that were deemed important to such training.

thanks for your thoughts djmd.

 

[LADoc00]

Im confused..the last time I checked Forensics literally took anyone with a pulse, respirations and ability to sign their name..has it changed?

 

[josara]

I don't know about AP/FP tracks, but one place you can see what kind of jobs are available is the National Association of Medical Examiners website.
www.thename.org
They accredit the forensic programs and also have a list of the programs available as well as job openings.
For the most part, forensics is not competitive. There are a handful of top programs that you just find out about by word of mouth. New York is one and they expect a one month rotation as or before your interview. I have also heard Miami, Albuquerque, Detroit, Boston, and Dallas are good programs.

 

[LADoc00]

Am I only the one who thinks forensics has basically nothing to do with pathology??

The only connection is both have procedures called "autopsies".

Surgery and Internal Medicine are vastly more related, yet 2 separate fields...maybe its time forensics was made its own thing, maybe even outside of the MD world, maybe like a PhD type thing. I dont know, just throwing out ideas.

 

[mlw03]

thanks for the comments, josara and LaDoc. LaDoc - i know you've made those comments before, and at this point i won't venture an uneducated opinion. but that's why i wonder if an AP/FP track would provide adequate training to becoming a practicing medical examiner. i agree that there is a big difference between general surg path and forensic path, but at this point i gotta play by the rules, and if i want to become a ME, this is the way i gotta do it. until they make you king of course and change things. 🙂

 

[Circumflex]

Am I only the one who thinks forensics has basically nothing to do with pathology??

The only connection is both have procedures called "autopsies".

Surgery and Internal Medicine are vastly more related, yet 2 separate fields...maybe its time forensics was made its own thing, maybe even outside of the MD world, maybe like a PhD type thing. I dont know, just throwing out ideas.

I agree that forensics should be it's own residency - that would make the training much more relevant to future work. I do think that they should be MDs - need to know how to read charts and know the basics of what specialists do for "therapeutic complications." However, I think all of the surg path training in an AP only program is relatively useless for forensics. Histology could be learned in the context of the autopsies and residents could do various sub-specialty rotations (neuropath, ped. autopsy, etc.) that are more relevant.

 

[docbiohazard]

It's my understanding that forensics is a great way to make very little money as a practicing pathologist, at least from the residents I've met who are interested in forensics (i can't do the FP abbreviation thing, I think Family docs own that one...)

Heck, in the great state of Louisianna, coroners are *elected*... I'm assuming they still have pathologists around to do autopsies and such, but still - wacky. They've got that whole napoleonic common law thing going too, but I digress. Great food, good times, good people.

(is it obvious how much I am trying to avoid seeing patients this morning? I'm still working on the last patient's progress note, honest!)

BH

 

[gungho]

It's my understanding that forensics is a great way to make very little money as a practicing pathologist, at least from the residents I've met who are interested in forensics (i can't do the FP abbreviation thing, I think Family docs own that one...)

Heck, in the great state of Louisianna, coroners are *elected*... I'm assuming they still have pathologists around to do autopsies and such, but still - wacky. They've got that whole napoleonic common law thing going too, but I digress. Great food, good times, good people.

(is it obvious how much I am trying to avoid seeing patients this morning? I'm still working on the last patient's progress note, honest!)

BH

sorry to partially hijack the thread, but La. has the Napoleonic Code as opposed to Case Law seen in the other 49 states. the code may be antiquated, but at least it is a standard to refer back to, instead of the constantly moving target of case law which depends on what the latest jury decided was appropriate (ok, a huge oversimplification). all you JD's out there, fire away.

 

[LADoc00]

It's my understanding that forensics is a great way to make very little money as a practicing pathologist, at least from the residents I've met who are interested in forensics (i can't do the FP abbreviation thing, I think Family docs own that one...)

Heck, in the great state of Louisianna, coroners are *elected*... I'm assuming they still have pathologists around to do autopsies and such, but still - wacky. They've got that whole napoleonic common law thing going too, but I digress. Great food, good times, good people.

(is it obvious how much I am trying to avoid seeing patients this morning? I'm still working on the last patient's progress note, honest!)

BH

Cool, what the hell is that? Like as coroner you have the right to establish and empire and take over neighboring parishes? Or is it one of those laws that allows you to plunder the cultural treasures of neighboring states? Are bad coroners banished to an island?

 

[Circumflex]

Cool, what the hell is that? Like as coroner you have the right to establish and empire and take over neighboring parishes? Or is it one of those laws that allows you to plunder the cultural treasures of neighboring states? Are bad coroners banished to an island?

The current coroner in New Orleans trained as an OB/GYN (does not do autopsies). He has been coroner for something like 20 years or so.

 

[yaah]

I'm not sure why you would need to do an AP/FP track. As said above, FP fellowships are not very competitive and it is not hard to get into one. The only reason I can foresee doing an AP/FP track would be for security and knowing you will be in one place, but is that really that relevant or realistic anyway?

 

[mlw03]

I'm not sure why you would need to do an AP/FP track. As said above, FP fellowships are not very competitive and it is not hard to get into one. The only reason I can foresee doing an AP/FP track would be for security and knowing you will be in one place, but is that really that relevant or realistic anyway?

part of the appeal would be knowing i'd be in the same place throughout training. part of it would also be entering the working world 1 year sooner, which is a financial bonus. i suppose another part would be the ability to focus on that which is specifically going to be useful in my future job. one thing no one has offered an opinion on is whether a forensic pathologist needs the CP training to do their job well (aside from the clinical chemistry comment). i honestly don't expect this will happen, but i think it makes for interesting discussion and allows us to think about the merits of the way forensic pathologists are trained.

 

[Circumflex]

part of the appeal would be knowing i'd be in the same place throughout training. part of it would also be entering the working world 1 year sooner, which is a financial bonus. i suppose another part would be the ability to focus on that which is specifically going to be useful in my future job. one thing no one has offered an opinion on is whether a forensic pathologist needs the CP training to do their job well (aside from the clinical chemistry comment). i honestly don't expect this will happen, but i think it makes for interesting discussion and allows us to think about the merits of the way forensic pathologists are trained.

Most forensic pathologists that I have taled to say the same thing - the more you know, the better (true of anything in life), but none of them use their CP knowledge in forensics. As for competitiveness, there are a few like NYC and Miami that are very competitive (most people do audition rotations and at NYC, they require a minimum of 75 autopsies prior to applying). Checkout the Fellowships section of pathologyoutlines.com and look at which programs still have openings for July 2007.

Are you sure that the 3rd year in AP only can be used as a fellowship? I thought that you could not use it to count for a board-certified fellowship. All of the forensic fellowships that I have seen that you have to be AP or AP/CP BE, which you would not be after 2 years of AP only.

 

[yaah]

I agree with the above - I doubt you could finish your training any sooner. Boarded fellowships in general require you to have completed your required training, which is 3 years of AP. There are only 24 required months (I think it's 24) but you have to do three years. The third year can't be a boarded fellowship. I guess they could potentially do a two year forensic extravaganza but that wouldn't end up in you getting finished any earlier.

The clinical path part is up to you. You don't need it, but you may find some things helpful (like learning about leukemias or blood diseases, blood bank issues, clinical chem, etc). But you may want to try to learn about that on your own or do electives instead of doing a full CP training. I would talk to forensic pathologists about it or program directors.

 

[mlw03]

Most forensic pathologists that I have taled to say the same thing - the more you know, the better (true of anything in life), but none of them use their CP knowledge in forensics. As for competitiveness, there are a few like NYC and Miami that are very competitive (most people do audition rotations and at NYC, they require a minimum of 75 autopsies prior to applying). Checkout the Fellowships section of pathologyoutlines.com and look at which programs still have openings for July 2007.

Are you sure that the 3rd year in AP only can be used as a fellowship? I thought that you could not use it to count for a board-certified fellowship. All of the forensic fellowships that I have seen that you have to be AP or AP/CP BE, which you would not be after 2 years of AP only.

i meant i'd finish 1 year sooner in that if i were able to do AP/FP in 4 years vs. AP/CP + fellowship in 5. in this plan that 3rd year of AP would be used to do some of the CP rotations that would serve a forensic pathologist. for example, clinical chemistry and hematology would probably be more useful than a month of blood bank. i didn't know about pathologyoutlines.com, so i'll check that site out.


yaah - you said to "talk to program directors". do you think this is something they would actually consider? any other upper-level residents or fellows want to weigh in? not on whether you actually think it's a good idea, but rather if you think it's something a PD would even consider? as i said above, i don't want to piss them off by making an unreasonable request and then hurting my chances of getting into the AP/CP programs.

 

[yaah]

You can do that anyway though. Ap-only + forensics = 4 years. There is nothing that says in an AP only residency you have to do AP based electives. And a lot of your CP learning could take place sort of as you go.

I meant to talk to program or fellowship directors (or people in the fellowships) about whether they think doing CP is necessary. Most AP/CP programs would take residents as AP only, because AP is where the bulk of the workload that residents are necessary for exists. Generally, through the match, AP and AP/CP positions are considered the same (CP only positions are different). It is perfectly reasonable to tell program directors you want to do AP only and then go into forensics. If they say that they would make you do AP/CP, then you can consider that if you really like their program. But they aren't going to refuse to take you if you would prefer to do AP only but would be willing to do AP/CP.

 

[CameronFrye]

One of our upper levels did his FP fellowship in the middle of his residency and now he's finishing up the CP part of his residency. His reason for finishing CP: when he's testifying at a trial, he wants to be able to discuss toxicologies and other lab reports without the defense attorney bringing up his lack of certification. He just doesn't want to give the defense any ammo to question his qualifications.

 

[mlw03]

You can do that anyway though. Ap-only + forensics = 4 years. There is nothing that says in an AP only residency you have to do AP based electives. And a lot of your CP learning could take place sort of as you go.

I meant to talk to program or fellowship directors (or people in the fellowships) about whether they think doing CP is necessary. Most AP/CP programs would take residents as AP only, because AP is where the bulk of the workload that residents are necessary for exists. Generally, through the match, AP and AP/CP positions are considered the same (CP only positions are different). It is perfectly reasonable to tell program directors you want to do AP only and then go into forensics. If they say that they would make you do AP/CP, then you can consider that if you really like their program. But they aren't going to refuse to take you if you would prefer to do AP only but would be willing to do AP/CP.

thank you for your thoughts and if you get a chance to talk to others i'd be interested in what they said too. personally, i would not do AP only without the guarantee, preferably in writing, that i could have the program's forensic pathology fellowship slot in 2011-2012. as has been discussed many times, any private practice job is going to want the CP training, and without the guarantee of forensics i wouldn't be willing to take that chance. i know this is a personal decision, but it's one i'm sure of.

 

[Mindy]

Hi:

I think I am the only truly forensic-pathology bound resident on this forum! I'm starting my fellowship this summer in Boston. There are so few forensic fellowships, that competition in the "good" ones is definitely present, though not to the degree derm & heme are experiencing.

CP has been an invaluable part of my training. Chemistry/toxicology is imperative to forensics and learning how toxicology tests are actually performed is very useful, both for troubleshooting unexpected results and for deciding what actually contributed to death. Molecular pathology (whether ran officially out of an AP department or not, to me it is a CP lab) is of course extremely useful, again, best if known hands-on (e.g. how to extract DNA from samples, etc.)

If you climb the forensics administrative ladder, you will probably end up running laboratories, such as histology, toxicology, DNA, and sometimes other forensic science labs. At a minimum, you will contract with them. A good CP program (like ours at the General!) trains you to be able to run a lab when you leave. Lab management training is not universally available in AP. Someone said that FPs do not use their CP training. I would argue that they may not have had decent CP training. How can you not utilize CP training when you are dependent on lab tests to do your job? Particularly toxicology? Where in AP do you ever learn about cross-reactivity profiles of immunoassays???? Or what an immunoassay is for that matter? How about microbiology? Useless to understand the ramifications & interpretations of what you culture on dead tissue? I think being a strong laboratory pathologist really enhances being an FP--at least the lab is not a black box to you. I'll let you know better in a few years, though.

So for me, CP is actually what solidified my desire to become a medical examiner. I especially love toxicology.


That being said, it is important to realize that you can do a 3 year, AP-only residency ANYWHERE, and then apply for an FP position afterwards anywhere. I do not know if your references to "private practice" are because you do not know if you want to be an ME or not. If not, all the more reason to wait to decide what fellowship you want. The last year of AP training is usually fairly flexible, so I doubt you would rub a program director the wrong way by showing such direction in an area of interest.

I am not really sure I answered any questions or provided any insight, but I sure love talking forensics...

Mindy

 

[LADoc00]

As for competitiveness, there are a few like NYC and Miami that are very competitive (most people do audition rotations and at NYC, they require a minimum of 75 autopsies prior to applying).

Your joking right?

.... ......

Does doing a fellowship in Miami get some type of better government job than one who does their fellowship in Baton Rouge or Akron?

Tell me this isnt because of CSI...tell me people arent making major life decisions based on a TV show...losing...faith....in my fellow physicians...

Mindy-Dont you feel Forensics could be better served by having its own field with its own training program instead of being bundled in Pathology?? Im mean seriously, will knowing the WHO classification of lymphoma help you do your job better??? A year spent in a trauma environment would be FAR superior training for a pre-ME than a path residency.

What I purpose: A separate 18-month residency program done after a transitional year/PGY-1. At the end of that, take a certification exam and have so much on the job experience (similar to ortho credentialing) before you are boarded.

By making it 5+ years to get the FP boards, you pretty much eliminate anyone with serious debt and the ability to calculate the compounding interest for the years they are wasting diagnosing seb k's.

The current training scheme is a clear indication that there is no one at the helm of Pathology leadership actually seeing what is going on..

In terms of FP, many programs are flooded with IMGs who need to stay in the country doing a fellowship due to visa status and cant get a job post-residency in private prac path..yes that is a broad generalization and doesnt mean everyone but still the situation is gravely broke.

I hate to be a chicken little here but the sky is falling and someone somewhere needs to do something about it!

 

[tardieu]

Most people who go into forensic pathology make the decision during residency, so having a separate FP training program would likely prolong the process rather than shorten it for a significant number of people. That, and people who might be tempted to go FP would be discouraged by the thought of leaving one training program and starting another-- especially if the latter involves a clinical intern year (what have you been smoking man?).

Similar musings are also occasionally heard about pathology: That it's so different from the rest of medicine so why do we have to go through the same medical school as everyone else and learn how to use reflex hammers and what not. I think that idea has been floated on this forum. And the same problem with a special training track applys-- that most people make the decision to go into path during medical school. That and it is somewhat useful to know what all those clinical monkeys are jabbering about. Same goes for FPs compared to other pathologists, although admittedly to a lesser degree.

In an earlier post I talked about how the center of gravity in FP is moving in a more accademic direction (http://forums.studentdoctor.net/showthread.php?t=217497) - I'd appreciate anyones thoughts, see Mindy you're not the only FP junkie here, but unfortunately I don't get to post much. I think the idea of a separate training track will gain very little traction among the up-and-commers in what I think is a new -- and GOlden-- era for FP. If anything, I can see the more elite fellowships going to two years, perhaps offering an optional year for research or extra management training, as some other subspecialties do.

Having said all that, it's worth if only for the sake of interesting conversation to speculate about what a special FP training track could consist of. Defintely more autopsies.

 

[LADoc00]

As I suggested, by making FP have a transitional year rather than a path residency, you would actually give someone MORE options not less should they decide against Forensics for whatever reason. As it now, if someone doesnt like Forensics they are often stuck with Path credentials that can be very hard to market without certain other fellowships..wasting more of their time.

The analogy that FP is like Path is completely bogus...Path is INSIDE a Hospital, Path interacts with clinicians, Path requires clinical correlation...Forensics is NONE of these. Forensics has a totally different focus, unrelated to patient care.

It just boggles my mind that people endure 4+ years of AP/CP and do Forensics all that time allowing MASSIVE interest to compound on students loans, only to come out the other end and not make that much more than a 21-year old sheriff deputy. Who would do that?? Answer: Not many.

Basically this is how it should be: Year I rotating transitional year funded by CMS/Social Security like other residencies. Spend so much time in ER, IM, PEDS AND SURG etc. At the end of this you take step III of the boards and get a medical license.
Year II-Forensics funded by COUNTY and STATE government, not the Feds. You are given a salary consumerate with your education, which in my area's sheriff's dept would be about 100K/year with no overtime, much more for overtime.
Year III-you get a credential to practice, have to do so many autopsies etc. and in the following year take your FP boards.
Year IV-real Job, unfort. you are likely making less than the sheriff (sheriff and dep. sheriff probably at 150-200K), but you join the Peace officers union, not the AMA/State medical group. That way you can at least ensure you get overtime, pension etc to cover the basics.

 

[1Path]

The analogy that FP is like Path is completely bogus...Path is INSIDE a Hospital, Path interacts with clinicians, Path requires clinical correlation...Forensics is NONE of these. Forensics has a totally different focus, unrelated to patient care.

Forensic pathology doens't require clinical correlation? That's a new one on me!

 

[LADoc00]

Forensic pathology doens't require clinical correlation? That's a new one on me!

other than some chart review, MINIMAL correlation. I did or witnessed at least 42 coroner cases and when I was pouring through a chart, it likely meant we were fishing for a reason NOT to even do the autopsy and just sign off on it.

Nothing a nurse couldnt also do. Certainly nothing that requires a Stanford medical degree with a PhD in Biochemistry..🙂

That would be another option, make Forensics a nursing subdiscipline with MD supervision.

 

[tardieu]

I think you underestimate the extent to which good knowledge of medicine is necessary in forensic pathology. I'm certainly not going to say that FPs need to know the WHO classification of lymphoma, and I agree that most of CP is pretty useless, but to say that FP involves NO clinical correlation is flat out wrong. Most of the deaths over which FPs take jurisdiction are naturals. Having a clear and well-rounded understanding of disease processes is essential to making a correct diagnoses, which often must be done with suboptimal material and incomplete information.

The alternative track you propose could be adequate to produce FPs who could do an OK job. Altho the clinical year kind of baffles me, especially given your insistence that FP is so far divorced from patient care. A similarly truncated course of training could be postulated for many subspecialty areas of pathology. Witness dermatologists signing out derm cases. I recognize that for most subspecailists their daily working environment requires covering other services, so the comparison is not perfect. But let's face it, anyone with a reasonable amount of intelligence, eye for detail, and ability to discriminate when they are in over their head so as to call for help could be trained up to do surgical pathology in 8-10 months, and do so without causing much trouble (in my opinion). Maybe this would be a better way to do things, I don't know.

Regardless, it aint gonna happen, at least not deliberately. Your comment about no one at the helm is exactly right. For better or worse, there's too many competing interests to allow for any drastic changes to come from within, in FP or elsewhere (changes will be forced from without, and they will be reactionary in nature, and thus most pathologists will likely get shafted while a few will cash in). Again, I refer back to my 2005 post. I think your postulated alternative training track comes from a perspective firmly grounded in the Classic view of FP. What you propose amounts to modifying the training so it seems more in line with that concept of FP. But the field is slowly shifting (hopefully). What I call the Nuevo perspective is more about modifying the practice and profession of FP so that it more faithfully honors and takes fuller advantage of the kind of training which is firmly grounded in pathology, medicine, and science. Wishful thinking, to be sure. But I'm not ready to give up yet.

 

[LADoc00]

the clinical year is required in many states to get a full unrestricted medical license, hence why I have it in there.

I will restate for the record, you could be a perfectly great forensic pathologist with no real pathology training beyond medical school. It is WAY excessive and wastes precious GME monies to train as such.

 

[Mindy]

I am for forensic pathology becoming an entirely separate residency when autopsy pathology is no longer a pathology discipline. So many of the medical examiner cases are natural disease, that I think pathology training prepares you well for it. Grossing experience (i.e. fostering the gross recognition of disease) is invaluable to FP. You cannot possibly do decent autopsies without a medical degree. You simply have to understand what disease is in order to decide what disease contributed to death. Any one who doubts this can search autopsy mistakes made by non-physician coroners. I always think that the people who believe that anyone can do autopsies stink at doing autopsies. If you do not see the skill required to do an autopsy, you probably are missing something. That being said, I think that LaDoc's idea of a separate FP (?legal medicine) training is not a totally rotten idea.

As far as CP not contributing to an autopsy, I will leave you with these very relevant scenarios: Some point-of-care immunoassays detect only benzoylecognine. Others detect cocaine and benzoylecognine. When you use a POC test in the morgue that detects BE only, you are going to have a higher limit of detection (~30 mg/L or so) than tests that detect both BE & cocaine (~20 mg/L). Therefore you can have positive lab tests at the dissection table that do not match what your toxicology lab is telling you. This is a very difficult place to be in when you are telling police that drugs contributed to death. A knowledge of chemistry will save you (provided you learned something on chemisty.)

How about coagulation? Some pediatricians will tell you that no less than a 2 story fall will kill a child. Will von Willebrand factor deficiency cause a subdural and retinal hemorrhages in a kid who fell off a bed onto a rug? Or is this scenario invariably a cover-up for shaken baby syndrome? Is there even such a thing as SBS?

Do you understand the consequences of the these scenarios? Are you willing to call a kid with an (antemortem obviously) activity level of 40% a homicide after fell off a bed onto a carpeted floor and sustained retinal hemorrhages & subdural hematoma? What if he had a depressed skull fracture as well. Remember that the dad is going to be charged with murder if you call this a homicide. If you call it an accident a potential murderer remains home with his 3 kids. What do you think? Do you want a nurse to make this decision? Do you really believe this (not rare) scenario does not require a certain medical expertise? Do you think that CP training does not play a pivotal role here?

Like I said before, the top forensic programs are competitive. In order to be considered for New York, for example, a 1 month rotation is mandatory. There are not many top tier forensic programs and although we are a small number, residents pursuing forensics all want to experience one of a handful of programs.

 

[mlw03]

residents pursuing forensics all want to experience one of a handful of programs.

are you trying to imply that aside from the "top" programs, the others do not provide good training for someone to become an FP? perhaps more importantly, what factors are you considering when you decide that NYC or Miami are such strong forensics fellowships? what about their program makes them so much stronger than say, Detroit or Richmond? in fact, what about the lack of cold-weather pathology in Miami? i'm just wondering what makes this select group of forensics fellowships, whichever they are, so good.

as to the other points - thank you for sharing those scenarios. you made some strong points about the merits of particular aspects of CP training contributing to a FP's practice. i still think such training could easily be done under an AP/FP residency. UTSW offers it and clearly is confident that they produce competent FPs. what i wonder is why no one else does it? especially some of the "less competitive" places that may not fill their fellowship every year. i don't think i'm that unique in being an MS3/4 strongly leaning towards forensic path, so if there were every 5-10 spots per year around the country, i think they might fill. and the current system of AP/CP then FP fellowship could easily exist alongside the handful of AP/FP combined residency spots for those that decide during their AP/CP training that they want to pursue an FP career.

 

[tardieu]

the clinical year is required in many states to get a full unrestricted medical license, hence why I have it in there.

I will restate for the record, you could be a perfectly great forensic pathologist with no real pathology training beyond medical school. It is WAY excessive and wastes precious GME monies to train as such.

I think you are correct, if you are content to let forensic pathology continue to be practiced the way it has largely been practiced up to recent years. However, that represents a rather unimaginative and anemic view of what FP could and in my opinion should be. It's the same point of view that thinks FPs are really just out there looking for bullets and documenting traumatic injuries. The level of understanding that demonstrates approaches those who think that hospital pathologists spend most of their time doing autopsies.

A lot of cases, too many, at a given ME's office may look slash and dash (it's easy to come away with that impression if you just spend a little bit of time there and are captivated by the voyeuristic cheap thrills), but that's NOT because that way of practicing is integral to the field. It's because ME offices are across the board overworked and underfunded, and in the big picture THAT in large part stems from these very undiscerning notions of FP.

Also at a given ME's office, there's are a lot of cases one would like to work up further, and thanks to a good AP (with or without CP) residency you may have the training and knowledge to do so. However, you distinctly lack the time, people, and resources. As said, the majority of cases handled by an ME are unexpected/unattended natural deaths. For the survivors, the ME is often the only physician these people interact with, their only interface with the medical system as per the death of their loved one. It's over and over a shame when you can only give them incomplete information.

For the record, I will restate that rather than dumb down FP training to concord with a weenie notion of how FP is done, I think it would better serve the public to revamp the practice of FP to incorporate a more intelligent and ambitious view of what's possible.

 

[Mindy]

Tardieu: I cannot agree with you more. If you are at the NAME meeting this year, please introduce yourself. I think we share a similar vision of the future of FP.

Mindy

 

[josara]

I think the main reason there aren't more AP/FP programs is because many people change their minds about forensics once they have to deal with the dreaded paperwork of hospital autopsies and, of course, decomps turn a lot of people off. Many people also may find it difficult to turn away from the much higher starting salaries in surgpath even without a fellowship.

 

[mlw03]

you make some decent points, josara. i would counter with 2 things. 1) hospital autopsy does not = forensic autopsy. 2) i'd rather make less money doing something i really enjoy, and $125K is plenty for me to live a lifestyle that i'd be very comfortable with. but i definately see your points and think there's some truth to them.

 

[josara]

Yeah, I think forensic pathology is the coolest, most interesting of the specialties and I'm very excited about practicing it one day. I think, however, many residents that go in contemplating forensics have a vague idea of the field, get fed up with the hospital autopsy and don't get to spend very much time with forensics. Add to that the lower salary (which I am okay with) and you get less interest.