AP Only Programs

[jxr902]

Does anyone know programs in the NY-NJ-CT area that offer an AP only track?
FREIDA doesnt specify and some of the program websites dont clarify well.
Of these AP residencies how many are three year programs? How many make you do four years?

Also,
Are these tracks more competitve then doing AP/CP?

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[KCShaw]

A lot of places don't advertise an AP-only track, which should be 3 years, even if they may be willing to take someone into such. But most programs seem to prefer all 4 year AP/CP residents; this allows the program more flexibility and availability to schedule residents on service rotations -- mainly surg path and grossing -- and it's a little easier to plan for the future based on incoming and outgoing "classes". That said, it seems like a lot of programs end up with someone who goes AP only...though they may not formally drop CP until too late to get out of a 4th year. Programs which otherwise might discourage a new AP-only may actually want one in certain circumstances, such as filling out a class in which someone else transferred/dropped out/never matched a position the previous year. IMO your best bet is to discuss it directly with any programs of interest (or claim you want to start as AP/CP and try to drop the CP after matching...won't earn you any brownie points and I don't recommend it, but you may get what you want).

 

[mlw03]

AP (or CP) only training is often rather individualized. If you enter as AP only it should be a 3 year program. Note that one disadvantage to this is you'll need to start lining up fellowships early in your pgy2 year. if you're going to do AP only, you need to have a reason for it, for both real world and interview questions. legit reasons are interest in particulary subspecialties or career tracks, such as neuropath, forensic path, or academic plans for derm or cyto. not liking micro is not a good enough reason.

 

[scienceguy19]

how about the reason that in most jobs you'll spend 95% of time doing AP?

 

[mlw03]

how about the reason that in most jobs you'll spend 95% of time doing AP?

what's your point? that 5% of blood bank, lab management, or other CP-tasks are necessary in many private practice jobs, so if you have two decedent candidates and one can't do those tasks, why would you pick him/her?

 

[jxr902]

But back to me 😉
I want to be a dermatopatholgist. My uncle and his partner and they have been offering me career advice. They feel since I know I want to be a Dermpath that it would be far more beneficial and worth my time for me to do AP only and in addition do a soft tissue year then Dermpath. It would make it easier for me to get the fellowship and also will be more career relevant to do soft tissue. I don't want to do more years then I have to also!

So I guess the question is.. Does this make me unattractive to a residency program. I'm a 3rd year medical student from a middle of the line med school and my step 1 scores are nicely above average... I'd like to train at a high level program like Cornell, Columbia, monte, nyu, etc. do you think if I made my plan known during the interview it would hurt me match time? If I wanted to pursue this should I apply for ap/cp then drop cp after I get in?

Any advice would be helpful.

J

 

[scienceguy19]

maybe they would pick someone who couldn't do those tasks if they were paid less.

what's your point? that 5% of blood bank, lab management, or other CP-tasks are necessary in many private practice jobs, so if you have two decedent candidates and one can't do those tasks, why would you pick him/her?

 

[KCShaw]

But back to me 😉
I want to be a dermatopatholgist. ..snip..

So I guess the question is.. Does this make me unattractive to a residency program. ..snip.. do you think if I made my plan known during the interview it would hurt me match time? If I wanted to pursue this should I apply for ap/cp then drop cp after I get in?
..snip..

Unfortunately I think the answer is a big fat "maybe." Some programs/PD's have an unspoken bias against those who dare to think they already know what they want to specialize in, and I already mentioned some of the administrative reasons they usually want 4 year residents. And honestly, many if not most people who say they want to do X when they start end up doing something else instead. Additionally, dermatopathology fellowships are competitive, to the point that some people might find it a little arrogant for one to assume they're going to do it when they haven't even started residency. On the other hand, some might find the decisiveness a point in your favor.

Personally, when I was interviewing I knew I wanted to do forensic path, though I had talked myself into valuing CP despite it not being necessary for forensics. Now being on the other side I get the sense that CP is really only necessary if it's necessary -- it's not like an AP resident can't, shouldn't, or doesn't get any CP training at all, just not enough to be board certified. For the time being, some private/community jobs still require CP certification. My suspicion is that this will continue to fade, as the financial incentives for being CP board certified have faded -- I don't necessarily -like- what's happening with CP, but that's not the same. Further, I suspect the number of CP boarded individuals will drop further as some with stable jobs decline to recertify in CP when it comes around, and PhD's or other specialists continue to take over the clinical labs.

All of which is to say that if you "really" know what you want to do and it isn't likely to require CP, I wouldn't waste the extra year on resident income -- but do realize that even dermpaths don't all do solely dermpath. Really, not many AP subspecialists outside of forensic path (and not even all of those) "always" take jobs with zero CP coverage component requiring or strongly preferring CP board certification. I'd be honest during interviews about what you want, but consider verbalizing the understanding that your feelings may change, you're open to options, but prefer an AP only track. Be prepared for questions about it.

 

[jxr902]

Thank you very much for your response.
So say I apply and start an AP/CP residency program. Already Knowing that I would like to do Dermpath, what is involved in dropping cp? Like how frowned upon is dropping cp pgy1? And even know it might be frowned upon would there ever be a situation where I wouldn't be allowed to drop cp?
Most residency programs that publish their curriculums have pgy1s doing mostly ap.
I'm sure people have dropped cp after starting their ap/cp programs but is it common or stigmatized?

As you can see by reading my posts I'm trying to figure out what's best for me match wise. I'd like to get into a top program, my scores are there, I've published, and I'm a likable guy. So if I want to train at sinai or Cornell do you think making it known that I only want to do AP then telling them my Dermpath plan is going to detract from my competitiveness?

 

[KCShaw]

Again, it depends on the program and the PD. No one answer fits all such situations, IMO.

Most programs/PD's probably don't want to be blindsided by someone trying to change from AP/CP to AP only within a few months of starting. It seems to be uncommon but not 'rare' that individuals end up dropping CP -- often that simply means not taking the CP boards but still doing the 4 years of AP/CP -training-, while sometimes it means dropping the CP training and cutting down to only 3 years. This is all dialogue which, personally, I would have with the programs of interest. Feel them out, then decide how you want to handle them -- stick with your preference to do straight AP in 3 years or open the doors a little bit. There are advantages (shorter time, more focused training, etc.) and disadvantages (may limit program opportunities, may limit job opportunities, etc.) to each.

 

[mlw03]

Agree with KC about dropping CP, which is what I did. It's just too program and PD dependent. I dropped CP around March of PGY1, but my program was all AP PGY1, so it didn't affect anything. Had I gone to an integrated program I probably would not have been able to do that. Unfortunately, only a resident at the programs you're interested in can give you any sense of how their program would react to your questions, and that is at best an educated guess.

 

[Euchromatin]

My residency program is on the smaller side (3 per year - 12 total) and all of us are AP/CP, so my two cents are limited to impressions I got while interviewing:

It seemed like (judging from the "roster" or list of current residents posted on their websites) academic programs with very large classes tended to have a couple of AP-only or CP-only residents vs. most smaller programs which had none. This seems likely to be do to a combination of factors, including the fact that there would be less difficulty/disruption of scheduling (for call, rotations, etc.) in programs with lots of residents, as well as a greater likelihood that an occasional resident might end up off by a year (making it easier/more convenient to have a 3 year resident thrown in) just because there are so many people involved. I seem to recall some of these residents that wanted to go AP- or CP-only had gotten roped into (wanted?) a fourth year at those programs anyway to do research.

Another factor that you might want to consider would be the curriculum schedule. I feel like it would probably be easier for a program which has residents do an entire year of AP or CP at a time to fit in an AP-only resident (vs. programs which switch back and forth between AP and CP rotations that only last a month or two each).

I have no idea whether it would be better for you to pretend to want to do AP/CP during interviews and then switch once you've started or to just be up front with PDs...probably would depend on the PD. I know many candidates (who are leaning toward private practice/more clinical-focused career) have a similarly tough time deciding whether to exaggerate/fake their interest in research and/or an academic career to get ranked higher at big academic programs.

 

[the alchemist]

My residency program is on the smaller side (3 per year - 12 total) and all of us are AP/CP, so my two cents are limited to impressions I got while interviewing:

It seemed like (judging from the "roster" or list of current residents posted on their websites) academic programs with very large classes tended to have a couple of AP-only or CP-only residents vs. most smaller programs which had none. This seems likely to be do to a combination of factors, including the fact that there would be less difficulty/disruption of scheduling (for call, rotations, etc.) in programs with lots of residents, as well as a greater likelihood that an occasional resident might end up off by a year (making it easier/more convenient to have a 3 year resident thrown in) just because there are so many people involved. I seem to recall some of these residents that wanted to go AP- or CP-only had gotten roped into (wanted?) a fourth year at those programs anyway to do research.

Another factor that you might want to consider would be the curriculum schedule. I feel like it would probably be easier for a program which has residents do an entire year of AP or CP at a time to fit in an AP-only resident (vs. programs which switch back and forth between AP and CP rotations that only last a month or two each).

I have no idea whether it would be better for you to pretend to want to do AP/CP during interviews and then switch once you've started or to just be up front with PDs...probably would depend on the PD. I know many candidates (who are leaning toward private practice/more clinical-focused career) have a similarly tough time deciding whether to exaggerate/fake their interest in research and/or an academic career to get ranked higher at big academic programs.

I just recently completed interviewing for pathology residency. Some of the AP/CP programs were up front that they would no longer allow any residents to drop one or the other (my CV points out that I am much more CP oriented so they decided to preemptively tell me) so interviewees better know that they are in for 4 years. Others heavily frowned upon dropping CP or AP but looked like they would be willing to allow it if necessary but you'd have to justify it. As Euchromatin pointed out, the larger, mostly academic programs tend to have at least 1 AP or CP only spot which tend to be competitive since they are so few and at top programs usually.

 

[jace's mom]

I just finished interviews and had a little bit of both...some programs made it clear up front that they frowned upon AP or CP only, and some programs who volunteered that they would be more than willing to let a resident drop AP or CP if they wanted to.

 

[malchik]

Going in with the plan to drop CP is a bad idea. You don't know if they'll let you and you may irritate some important people, which is exactly what you must avoid if you want to get into dermpath. If you do AP/CP, having an extra year before interviewing in dermpath will also help a lot in getting your CV padded. If you apply as AP only, it is a smaller pool of open positions and applicants, so it is unpredictable. If you don't have a PhD, you may have a harder time at the big name AP only slots. I know an AP only dermpath fellow who is having a hard time in the private job market, for what that's worth. I recommend just doing AP/CP.

 

[jxr902]

Yes but in terms of Dermpath wouldn't a year of soft tissue make you a lot more marketable then being cp board eligible? And as far as the extra year advantage before fellowship, wouldn't a planed pgy4 year in soft tissue be more valuable and make you more competitive for the fellowship? I know many Dermpaths who never re certify in cp when their in practice. I don't know many who say being cp certified has been useful in attracting clients or for their careers. With that being said, I wouldn't want to drop cp after i started ap/cp program but I also don't want my desire to only do ap to make me less competitive for residency. Does anyone know of any big hospital centers in ny who willingly take ap only doctors with out bias?

 

[the alchemist]

Yes but in terms of Dermpath wouldn't a year of soft tissue make you a lot more marketable then being cp board eligible? And as far as the extra year advantage before fellowship, wouldn't a planed pgy4 year in soft tissue be more valuable and make you more competitive for the fellowship? I know many Dermpaths who never re certify in cp when their in practice. I don't know many who say being cp certified has been useful in attracting clients or for their careers. With that being said, I wouldn't want to drop cp after i started ap/cp program but I also don't want my desire to only do ap to make me less competitive for residency. Does anyone know of any big hospital centers in ny who willingly take ap only doctors with out bias?

as already stated, the programs that tend to have one to a couple of AP (or CP) only spots tend to be at the larger, more competitive programs and looking to stay in ny severely limits you when its already competitive b/c these spots are so few and at the most competitive programs.

looking at the nrmp counts to make the rank order list for this year, the ap only programs i see for this year are 1@ bidmc (one of the harvard hospitals), there can be ap only at barnes jewish (washu) - when i interviewed they seemed to say that they included the ap only in their 8 for ap/cp if they found a candidate they liked but they don't have to take any like they do for cp only where they have 3 spots designated, brigham (harvard) also allows for ap only w/in their 7 ap/cp (though honestly if they take any, it'd prob be a low # like 1), upenn includes ap in their 6 ap/cp, mgh in their 8 ap/cp, mayo has 1 spot, utah has 1 spot, uw has 1 spot, and yale has 2. and these are all top programs in path, some tend more to the academic side than others. and some of them like washu seem to favor md/phd types (lots of research/pubs even if u weren't md/phd) but they're different that way - very academic with a very strong research program. so that's 6 definite spots in the country (none in ny) with possible ap only spots at 3 other programs. some that i interviewed at that are not in this list did indicate that you could do ap or cp only if u let them know b4 ranking (and then they'll decide whether to take u for that) even though they are listed on nrmp as ap/cp.

take this advice w/ a grain of salt as i haven't started residency but this is what friends who are residents/dermpath fellows told me. i wouldn't do a soft tissue fellowship unless u want to and not as a means to the end of dermpath. i know ppl who got dermpath fellowships w/o doing one and i also know a couple who had to do one b/c there wasn't an open spot at their school the year they were applying but would be the year after. i'm not a dermpath person but from what my friends say, it takes knowing early that u want to do dermpath and getting into derm related research right away -> pubs by the time u apply help which may end up being 2 years before u graduate instead of the year b4 like for other less competitive fellowships. someone i know who just matched dermpath felt that his audition rotation was impt in helping him get that spot - this is an impt thing when interviewing to look at b/c some programs don't let u do away electives esp if they have most of the fellowships at their program (but this doesn't guarantee that u will get it or that they favor their own residents for it - though it highly favors it at some places). dermpath is highly competitive b/c there are so few spots and so many more ppl applying to it (esp since it compensates well usu) than spots available but in general, i hear to get fellowships is more competitive than getting into residency. also dermatologists also compete for dermpath fellowships with pathologists and the politics at some institutions are such that they may favor dermatologists or pathologists over the other so that lowers the # of spots available to u as a pathology resident.

the truth is that most programs are ap/cp and most ppl like one more than another but end up having to do both and yeah, may never again recert in the other thing (ap or cp) they don't like or do. and some programs i interviewed said that u could drop one by the end of 1st year but would still end up doing cp call (and at some, u don't have to do cp call) to help out the other residents since when u matriculated they expected to have another set of hands for whatever it was u dropped (ap or cp). most of the programs i interviewed at though either frowned on dropping one or said that it was not possible at all anymore in their program. a minority had no issues about this issue (my issue is whether to rank as cp only since i'm more oriented toward cp but applied to all ap/cp programs) but i'd def have to let them know before they rank me. and i've heard of cp only residents from top programs who couldn't find a job after fellowship right away and had to "push glass" (do ap) for a year while applying for jobs so i'll prob end up ranking as ap/cp b/c there is always that possibility of no jobs in the cities/specialties that i want when i graduate and i need to be more marketable - plus i will need some ap for what i want to do anyways. so u may have to do other things (and most want u to cross cover cp even if u are doing surgpath) while waiting for that dermpath job unless u have something lined up already.

so i would def not go in w/ the mentality of matching ap/cp then trying to drop if u don't have an ok from the program b4 u rank them that they will let u and just what the conditions are about dropping (whether u still have to take cp call). if u dropped w/o giving them some warning, it is likely u will then get on the bad side of a PD who might feel u misrepresented yourself and path is a very small field so it could really mess with you getting that coveted dermpath fellowship ever. in general, pissing off a PD is not a good idea. i know at a program (not for path), a guy with high #s was going to be ranked b/c he looked good on paper and behaved during interview. but in the end, they didn't even rank him last b/c the PD from another specialty at the same hospital that this dude did a rotation on where he cared zero for it and showed it talked to the PD from the specialty he was trying to match into.

 

[malchik]

Yes but in terms of Dermpath wouldn't a year of soft tissue make you a lot more marketable then being cp board eligible?

No

And as far as the extra year advantage before fellowship, wouldn't a planed pgy4 year in soft tissue be more valuable and make you more competitive for the fellowship?

Don't think so. Although if you do it that way at least you wouldn't be applying earlier by being AP only, thus allowing time for publication etc. You need time to do audition rotations, schmooze at ASDP, etc.

 

[Myelofibrosis]

so i would def not go in w/ the mentality of matching ap/cp then trying to drop if u don't have an ok from the program b4 u rank them that they will let u and just what the conditions are about dropping (whether u still have to take cp call). if u dropped w/o giving them some warning, it is likely u will then get on the bad side of a PD who might feel u misrepresented yourself and path is a very small field so it could really mess with you getting that coveted dermpath fellowship ever. in general, pissing off a PD is not a good idea.

It is not always so stark. You can join an AP/CP program, then break gently to the PD that you are thinking of doing AP only. Chances are that PD will advice you against it, but will let you do it anyways if you are determined and yet respectful. Of course this would mostly happen only at bigger programs.

 

[PathApplicant]

The UCSF Chairman actually gives you a difficult time during the interview if you are applying AP/CP rather than AP only. Judging from that, it seem their program actually encourages AP only candidates.

 

[pathstudent]

The UCSF Chairman actually gives you a difficult time during the interview if you are applying AP/CP rather than AP only. Judging from that, it seem their program actually encourages AP only candidates.

People like that are annoying. I met them along the way too. Just remember that they are trying to justify the decision tree they followed by pushing their trainees to become just like daddy rather than wanting to see trainees realize what is best for their lives and helping them become the best they can be.

 

[gbwillner]

People like that are annoying. I met them along the way too. Just remember that they are trying to justify the decision tree they followed by pushing their trainees to become just like daddy rather than wanting to see trainees realize what is best for their lives and helping them become the best they can be.

Please. Really? You really believe that? That's pretty sad.

If you said that they are looking for academic pathologists, and that's not what you want to do, then you may be better off somewhere else. But to think that your attendings are trying to f*ck you over just to justify a "decision tree" that probably didn't even exist when they trained is pretty ******ed, IMHO.

 

[KCShaw]

I think there's a line, if sometimes a fine one, between screwing someone over and simply pushing decisions one thought was useful for themselves and thus may be useful for someone else. Yeah, from the outside looking in things can appear a lot different, especially if you disagree with that series of decisions, but that doesn't make it inherently malignant. Really, I think there's some expected and natural truth in the fact that supervisors/educators/etc. tend to encourage things that they think work well or which worked for them, even if it's biased and perhaps isn't ideal for a given pupil. The better educators can tell the difference, but that's one of the things that may make them stand out and isn't necessarily the norm -- which is more how I read the initial comment on that point.

 

[jxr902]

Im confused on this current topic of conversation, I am somewhat of a neophyte. Can someone explain this to me?

 

[pathstudent]

Please. Really? You really believe that? That's pretty sad.

If you said that they are looking for academic pathologists, and that's not what you want to do, then you may be better off somewhere else. But to think that your attendings are trying to f*ck you over just to justify a "decision tree" that probably didn't even exist when they trained is pretty ******ed, IMHO.

No I don't think they are trying to F*CK anyone over. I think it is a natural subconscious thing. We want people to follow our footsteps to justify the path we took.

 

[the alchemist]

It is not always so stark. You can join an AP/CP program, then break gently to the PD that you are thinking of doing AP only. Chances are that PD will advice you against it, but will let you do it anyways if you are determined and yet respectful. Of course this would mostly happen only at bigger programs.

i do agree that there's a great variability which is why i suggested to the OP to find out what the situation (what's allowed) is b4 matching into a program where it may turn out that he doesn't have the option to drop CP (i did interview at a couple of places where they said that there was no option to drop and to know b4 ranking them that u were signing on for 4 yrs of p/cp). i'm not a risk taker (but maybe others are) so i wouldn't go to a ap/cp with the intention of breaking it to them after i match that i want to drop to ap only to find that i can't. plus, its somewhat deceptive if one knows before they matriculate that this is what they plan to do and don't tell a program b/c they're afraid it'll affect their chances to match.

 

[dr.weiner]

It seems several people are combining DP and soft tissue, especially in the academic setting, which is where I think you can carve out a good niche for yourself and really show you are an expert in cutaneous soft tissue lesions. But, just like combining hemepath and derm, you can become very good at cutaneous lymphomas/cutaneous soft tissue lesions by just learning and showing interest in the field and develop expertise by publishing on the subject. You definitely don't need to do a HP or ST fellowship, and there's many entities (all bone lesions in ST/bone fellowships, basically all the AML/marrow stuff in hemepath) that don't apply at all in derm, you are probably better off just learning the derm-related stuff on your own and showing interest/publishing.

Besides, often times those who train in another fellowship and derm do so because they couldn't get derm on the first try, and people may think that come application time, although it may be incorrect. And more importantly, the market seems a little tight with the economy and potential cuts to the 88305 looming. The extremely lucrative pure-dermpath private practice jobs are declining in number (at least at the moment), and CP training is necessary to make sure you are still desirable to private general SP groups. So I personally would go with AP/CP + derm myself, which is that I did.

 

[Tiki]

It is not always so stark. You can join an AP/CP program, then break gently to the PD that you are thinking of doing AP only. Chances are that PD will advice you against it, but will let you do it anyways if you are determined and yet respectful. Of course this would mostly happen only at bigger programs.

That is a great idea. You are only screwing your fellow residents who will most likely have to take extra CP call to make up for the fact that you aren't there.

Unless you are absolutely sure you want to stay in academia forever, it is stupid to not do CP.

 

[mlw03]

That is a great idea. You are only screwing your fellow residents who will most likely have to take extra CP call to make up for the fact that you aren't there.

Unless you are absolutely sure you want to stay in academia forever, it is stupid to not do CP.[/QUOTE]

I'll repeat my earlier disagreement with this statement. I think for most pathologists, this is accurate, but for certain niche subspecialties I do not see the harm in doing AP only.

 

[Ruination]

The UCSF Chairman actually gives you a difficult time during the interview if you are applying AP/CP rather than AP only. Judging from that, it seem their program actually encourages AP only candidates.

I had the same experience when I interviewed there, but I wouldn't qualify it as difficult per se. I think asking for someone to elaborate on why they want to have a certain career path is reasonable. It made me think a little bit more about why I was going the AP/CP route vs any other. The rest of the faculty certainly didn't care that I was applying AP/CP.

The PD also said that it wouldn't be a big deal to add or drop AP or CP as long as you gave them enough notice (i.e. tell them before they submit their rank list for the next match).

 

[Tiki]

That is a great idea. You are only screwing your fellow residents who will most likely have to take extra CP call to make up for the fact that you aren't there.

Unless you are absolutely sure you want to stay in academia forever, it is stupid to not do CP.[/QUOTE]

I'll repeat my earlier disagreement with this statement. I think for most pathologists, this is accurate, but for certain niche subspecialties I do not see the harm in doing AP only.

And I disagree with your statement. The niche specialities, like renal or neuro, are predominantly at academic medical centers, not private practice. I'm sure there might be a few private practices that are big enough to need a renal pathologist, but I'm betting the majority of private practices would rather have someone who can cover CP call. One is far more likely to find a "niche" job in academics, which is the only reason someone should go AP only (or if they want to do forensics).

But besides that, it is still RUDE to go in AP/CP with the intention of dropping CP later down the line. You are messing up the scheduling, creating more work for the chiefs, as well as your fellow residents who will have to cover whatever services you were suppose to cover. So if you know you want to do AP only, then go in to residency being AP only.

(I don't harbor grudges for those who honestly think they want to do both and then change their mind midway through. But if someone knows they only want AP and goes in AP/CP just to get a spot....yeah I have a problem with that)

 

[mlw03]

Tiki- I agree with what you said, but still reach the my prior conclusion. I also would add there are plenty of AP-only forensic pathologists in practice. Plus, you did say "predominantly", so even you concede there are some jobs out there for AP-only diagnostic pathologists.

Ultimately, this guy has to decide what he thinks is best for his career overall. I do agree it's not cool to match AP/CP with full intent to drop CP, for the reasons you stated. But to me that's an ethical issue, not a career one.

 

[gbwillner]

But besides that, it is still RUDE to go in AP/CP with the intention of dropping CP later down the line. You are messing up the scheduling, creating more work for the chiefs, as well as your fellow residents who will have to cover whatever services you were suppose to cover. So if you know you want to do AP only, then go in to residency being AP only.

Meh. I guess I only agree if you mean someone would start residency, and that first day decide to drop CP and have the staff and chief redo the entire year's schedule. I doubt that every really happens.

If you are AP/CP and during the 2nd year decide to drop CP (after the year), congrats- you've just wasted all that time you already put into CP during residency. Plus, depending on your schedule, you might not have had sufficient time in AP service to qualify for the boards and may need that additional year to finish. If you do the same during the first year, then the program may have a slightly more difficult time filling that CP spot for the following year (if it's even necessary). Chances are, regardless of when you decide to drop, you would finish that year's already determined schedule- not require everyone to accommodate to your whim.

However, if your program is split AP then CP, and you decide to drop CP during your AP training, you probably don't even hurt anyone since the program can just try to fill that CP vacancy with another CP resident. From what I've seen, few programs have this set up, and those that do can afford to lose that CP resident anyway.

 

[Ombret]

Agree with gbwillner. A program that let you drop CP (or AP for that matter) will not let you just drop it like a rock starting next week. You will have to finish out the year with the schedule they made for you when you were AP/CP. At least you will not be dumping extra call on your co-residents right away. WIth sufficient notice from you, the program might be able to recruit an extra CP-only PGY1 or maybe someone to transfer in at some higher PGY level.

To the OP, your plan to do AP only then dermpath seems totally reasonable to me. You will find plenty of programs that will let you do it (other posters have listed many). To increase your shot at a dermpath slot you want to be training at one of these fancy places anyway. The thing is though, it is a gamble. You may do AP only and find yourself unable to get a dermpath fellowship (or unable to do it the year you want it). That is a risk that you have to assume and that no one can assume for you. It's like deciding to drop your dental insurance. It's up to you to decide whether you are comfortable with that risk. Doing CP is a hedge against that risk. So you have to ask yourself--Do you feel lucky?