AP only + dermpath

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alabaster

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The general advice I have seen is that unless you are going hardcore academic, one should definitely train in AP & CP. Is this true for dermpath as well? I've heard that AP only + dermpath still puts you in a fantastic position for private practice/ group practice. Whaddya think? Any other fellowships that are so in demand that CP becomes unimportant for getting a job?
Motive behind question... ultimate dream: AP + dermpath -> done with training in only 4 years and eminently employable
Any advice would be great
 
My advice: Don't do a fellowship because it makes you employable.

CP is still a requirement for many private or group practices. Whether that is shifting away is debatable, people disagree. The problem with AP-only + dermpath is that you have to start applying at the end of your first year or very beginning of your second year - very little time to either distinguish yourself for the purposes of interest and recommendations and very little time to do projects, etc.
 
yaah said:
My advice: Don't do a fellowship because it makes you employable.

My advice: pragmatic considerations should be factored into any career decisions. If you like dermpath buy also like TM and also like cytology and also like transplant pathology etc..., then doing derm because it might make you more easily employable and give you more flexibility in what type of job you want and where it is located makes a lot of sense.

Now couldn't you theoretically do two years of core AP and one year of derm fellowship (as the third year)?

I have seen three others do that (2 years of AP, then one did one year of renal, another did one year of heme, and the third did one year of cyto). All three were hell-bent on doing academics, and I think the two in the boarded fellowships were board eligible.

So you could do two years AP, then one year derm, and you could get a great job doing nothing but dermpath, where you work completely as an outpatient pathologist (no call, no weekends, no frozens). This is a theoretical scenario, unless you are a whiz kid and go into a path program with a d-path fellowhip where the d-path program director is smitten with you, it would be very hard to pull off.

Lastly, everyone says that you need CP to work in private practice and I know that is true in general. But I have seen multiple people now go into private practice at community hospitals with AP only backgrounds. Some even take BB call, as most of the calls are basic and routine. One woman said that she takes the rare routine calls and if the rarer truly complex issue comes up, the BB knows to call the medical director (which she says hasn't happened in the 3 years she has been taking call).
 
Hmmm...legally that sounds fishy. I wouldn't imagine you could get away with having a non-CP boarded person take CP call. Maybe I don't understand the laws though.

I am not sure if your theoretical 2 year AP + 1 yr derm is valid - Hypothetically you could consider it all elective, but I'm not sure it would work since derm is an ACGME certified subspecialty. I have never heard of it replacing a normal training year - I have heard of people doing subspecialties (like heme, e.g.) in the middle of their training, between 3rd and 4th years though.

Perhaps some day there will be AP/derm tracks you go into right out of med school, similarly to how some programs offer AP/NP tracks. probably wouldn't be a bad idea.
 
alabaster said:
The general advice I have seen is that unless you are going hardcore academic, one should definitely train in AP & CP. Is this true for dermpath as well? I've heard that AP only + dermpath still puts you in a fantastic position for private practice/ group practice. Whaddya think? Any other fellowships that are so in demand that CP becomes unimportant for getting a job?
Motive behind question... ultimate dream: AP + dermpath -> done with training in only 4 years and eminently employable
Any advice would be great


Im going to shoot myself.....no there is no ultimate dream!! I have seen dermpath boarded pathologists that scrounge for locums jobs, pick something that fits you or bear the consequences.
 
LADoc00 said:
Im going to shoot myself.....no there is no ultimate dream!! I have seen dermpath boarded pathologists that scrounge for locums jobs, pick something that fits you or bear the consequences.

Shush. You're crushing the dreams of gunner premeds everywhere who want there to be a definite way to go to med school, work less than 5 days a week, and be able to afford their daughter's sweet 16 party in style.

There must be a way!
 
yaah said:
and be able to afford their daughter's sweet 16 party in style.

You mean a bottle of Boonts Farm and the DVD box set of Laguna Beach?
 
UCSFbound said:
You mean a bottle of Boonts Farm and the DVD box set of Laguna Beach?

Speaking of Laguna Beach, what do I have to do to get a job in path there? Would dermpath help?
 
yaah said:
Speaking of Laguna Beach, what do I have to do to get a job in path there? Would dermpath help?

Funny, I know a bunch of dermpath dudes in OC. Although some may drive around in CLK Benz convert's, I dont think they are all that happy.
 
LADoc00 said:
Funny, I know a bunch of dermpath dudes in OC. Although some may drive around in CLK Benz convert's, I dont think they are all that happy.

Yeah, but nobody's happy anymore. Everybody's a pain in the ass.
 
yaah said:
Hmmm...legally that sounds fishy. I wouldn't imagine you could get away with having a non-CP boarded person take CP call. Maybe I don't understand the laws though.

I am not sure if your theoretical 2 year AP + 1 yr derm is valid - Hypothetically you could consider it all elective, but I'm not sure it would work since derm is an ACGME certified subspecialty. I have never heard of it replacing a normal training year - I have heard of people doing subspecialties (like heme, e.g.) in the middle of their training, between 3rd and 4th years though.

Perhaps some day there will be AP/derm tracks you go into right out of med school, similarly to how some programs offer AP/NP tracks. probably wouldn't be a bad idea.


In my experence, I knew someone personally who was canned in a community hospital setting because she was AP only, and no one wanted to cover her CP call or do all of the other regulatory/ QC QA crap required for her lab by law. It was just easier to hire someone with AP/CP who could cover the call for the hospitals the group serviced and take care of the lab at that site as well as sign out AP cases.
 
mcfaddens said:
In my experence, I knew someone personally who was canned in a community hospital setting because she was AP only, and no one wanted to cover her CP call or do all of the other regulatory/ QC QA crap required for her lab by law. It was just easier to hire someone with AP/CP who could cover the call for the hospitals the group serviced and take care of the lab at that site as well as sign out AP cases.

The director of USCAP (Silva) came here last year, and he said he was offered a large paying job recently (he is well out of residency having done AP only and renal path) at a private facility. Then in the course of finding out more about him they found he was AP only. They withdrew their offer.

Thus, you take a large risk by being AP only. IMHO, it is too much of a risk for only one extra year of training. My preference is an academic career but who knows if that is what I will end up doing all my life.
 
yaah said:
The director of USCAP (Silva) came here last year, and he said he was offered a large paying job recently (he is well out of residency having done AP only and renal path) at a private facility. Then in the course of finding out more about him they found he was AP only. They withdrew their offer.

Thus, you take a large risk by being AP only. IMHO, it is too much of a risk for only one extra year of training. My preference is an academic career but who knows if that is what I will end up doing all my life.


Fred Silva?? hahahahahahahahahahaha WTF.

I agree there is risk BUT I will also say after 19 interviews (that is 19 different pathology practices), I have run into wierd groups that employ AP only people to do CP stuff. One place, an AP only was running a blood bank. Another place, an AP only was in charge of microbiology. So I will agree, with the caveat that being AP only and getting a job is WAY WAY different than being CP only and trying to get a job doing some AP, which in my experience never happens. Hmmm, that was kinda ramblemode, I hope that make sense...
 
It would seem impossible for a CP trained person to do much of anything on the AP side. However, there is no reason at all an AP only person couldn't cover CP call. Answers to questions about utilizations of blood products when supplies are low, switching blood types, etc are all mostly common sense and could be learned in one day.

Now I don't think you would want an AP only person being the medical director of a lab, but even that isn't out of the question. If you are with a group at a hospital for 15-20 years, you probably can easily know what's going on with the lab and how to direct it.

I don't think there are laws that say who has to be trained in CP to do what. I think there are some regulations that require people with MDs to make the decesions.
 
Hmmm...I always thought part of lab certification was having CP accreditation. Otherwise, what's the point of CP accreditation?
 
yaah said:
Hmmm...I always thought part of lab certification was having CP accreditation. Otherwise, what's the point of CP accreditation?

I regularly get into debates with pathologists and residents on what it takes to be a medical director. The answer is: it is seems to be state dependant. Meaning, that in order to be a qualified Medical Director for Clin Lab in California, you must be CP boarded. That may or may not be the case in Arkansas. Even that has its loopholes, the way through tho I am not sure. I have spoken to at least 2 medical directors of huge academic centers who were either a primary care doc (Internist usually) or an AP only Pathologist, which seems to defy the readings of the law I have been explained...
All in all, even if you continously fail the CP portion, it does not from my experience lock you out of any particular job/contract at the moment. Now that could change in the future tho!!

Regardless, only 1 person in a group needs to be the lab Medical Director. Meaning if you had 1 CP boarded guy, you are okay. Once you get into groups that are say larger than 4-5 people, you can almost guarantee you have the CP side covered. In terms of call, that is group preference. Meaning the hospital and contractual bylaws almost never state that CP call must be down by a board certified CP pathologist.

But dont think Im arguing FOR AP only, Im not. AP/CP is still the most marketable combo, especially at mid tier pathology residencies. Some places (a very very short list of places like BWH, Stanford, UCSF, JHU and others), you have such an overabundance of AP fellowships you could theoretically forgo CP for super specialization and the possibility of big bucks.
 
yaah said:
Hmmm...I always thought part of lab certification was having CP accreditation. Otherwise, what's the point of CP accreditation?

I think the point of 18-24 months of CP training is becoming less and less clear in this day and age of almost fully automated labs which can be run by techs off the street who basically know nothing and are overseen by a few specialists who really know what's going on.

But for sure you can get a job in academics, at Quest, US Labs, Ameripath, or in outpatient private practice (working for a large group of dermatologists, urologists, or gastroenterologists in one of their new histo lab set ups), and it seems you can get some regular private practice work in larger groups with AP only, but clearly a man who is AP/CP boarded with boarded fellowships in Heme and Cyto will get the job over someone is AP boarded with boarded fellowships in Heme and Cyto, assuming all else is equal (knowledge, personality, business savvy, etc..) However, if the AP only was a super hot chick or a cool guy's guy and the AP/CP person was a socially awkward tool, I would hire the hot chick or the guy's guy because that is who I want to be around.
 
dermpathlover said:
However, if the AP only was a super hot chick or a cool guy's guy and the AP/CP person was a socially awkward tool, I would hire the hot chick or the guy's guy because that is who I want to be around.

Who the hell are you?? Ricki Bobbi? Or Walker/Texas Ranger??

....I would like to thank baby Jesus, all 8 pounds 6 ounces of him, lying all cute in the manger, for all our dermpath wealth and our smokin' hot new associate pathologist, Bambi. (oh yeah)....
 
LADoc00 said:
Who the hell are you?? Ricki Bobbi? Or Walker/Texas Ranger??

I'm the life of the party! You can call me Frank the Tank, because I'm always willing to lead the charge.

All else being equal (and even not quite equal), I'd rather hire a "vince vaughn/ Will Farrel" type personality or a hot chick over some gloomy nerd type even if the gloomy nerd is CP boarded.
 
dermpathlover said:
All else being equal (and even not quite equal), I'd rather hire a "vince vaughn/ Will Farrel" type personality or a hot chick over some gloomy nerd type even if the gloomy nerd is CP boarded.
When you get around to interviewing for a job, I would recommend not letting people know that you are dermpathlover from SDN Forums.
 
Epstein said:
When you get around to interviewing for a job, I would recommend not letting people know that you are dermpathlover from SDN Forums.

OK, I'll take that off my CV? 😛
 
Epstein said:
When you get around to interviewing for a job, I would recommend not letting people know that you are dermpathlover from SDN Forums.

I would also not recommend saying you are in it for the money and that you want to do three different unrelated fellowships so that you can make more money.
 
damn double post
 
yaah said:
I would also not recommend saying you are in it for the money and that you want to do three different unrelated fellowships so that you can make more money.


I recommend he not talk....
 
I'm the life of the party! You can call me Frank the Tank, because I'm always willing to lead the charge.

All else being equal (and even not quite equal), I'd rather hire a "vince vaughn/ Will Farrel" type personality or a hot chick over some gloomy nerd type even if the gloomy nerd is CP boarded.


Wow you amaze me everytime you post. You are definitely something else. I won't even bother with saying anything more, you really take the prize buddy. Congratulations
 
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