AP or AP/CP?

[abefromann]

Hi, if I want to do a fellowship in something anatomical (not hemepath) can I go the AP only residency route? I've heard that residents at my school typically don't like CP but do the combined program because that's just what you do. Any help appreciated.

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[b&ierstiefel]

Hi, if I want to do a fellowship in something anatomical (not hemepath) can I go the AP only residency route? I've heard that residents at my school typically don't like CP but do the combined program because that's just what you do. Any help appreciated.

You can do AP only/hemepath. That is a popular track in our program.

 

[abefromann]

Which program is that? You don't have to ID yourself if you're shy. However -- are these hemepaths with AP only training facing good job/career outlook? I don't want to make the mistake of not doing CP training just because I really like AP and want to focus on that track with a fellowship.

 

[dermpathlover]

Lots of places do 2 years AP and then 2 years NP.

I don't know if anyone has ever tried to do 2 years AP and then 1 year cytopath or 1 year DP.

Any ABP members know the rules?

 

[b&ierstiefel]

Which program is that? You don't have to ID yourself if you're shy. However -- are these hemepaths with AP only training facing good job/career outlook? I don't want to make the mistake of not doing CP training just because I really like AP and want to focus on that track with a fellowship.

I don't know since my name is not hemepathlover. But, my impression is that AP/CP/Heme folks will have the maximum flexibility of career options. Personally, it's safer to just tack on the CP training. AP only folks have significantly harder times finding jobs. For the most part, they are stuck in academics. Sure, some AP boarded folks will go into private practice but it's a much harder road and those people need more connections from big name people.

 

[b&ierstiefel]

Lots of places do 2 years AP and then 2 years NP.

I don't know if anyone has ever tried to do 2 years AP and then 1 year cytopath or 1 year DP.

Any ABP members know the rules?

This is not allowed anymore. AP only folks now have to do 2 years of AP and an extra half a year of non-boarded AP if they will be doing a board certified fellowship (e.g., cyto, derm, heme). Hence, the minimum time for AP/cytopath and AP/dermpath is 3.5 years. So usually AP only folks will do 2 years of AP core followed by one year of a non-boarded AP fellowship, whether it be general surg path, GI, GU, Gyn, etc, because in many cases, it's awkward to start a year long fellowship mid-way through the academic year.

C'mon man. I thought you'd know this by now.

 

[abefromann]

Thanks for your help on the issue everyone. Also, I'm an M3 right now with research in molecular dermatology and one publication in a major derm journal. I need to do more to try and get a dermpath spot. Can anyone suggest something fellowship directors are looking for vis-a-vis undergraduate education? Or is landing dermpath just about working hard in residency and/or connections?

 

[b&ierstiefel]

Thanks for your help on the issue everyone. Also, I'm an M3 right now with research in molecular dermatology and one publication in a major derm journal. I need to do more to try and get a dermpath spot. Can anyone suggest something fellowship directors are looking for vis-a-vis undergraduate education? Or is landing dermpath just about working hard in residency and/or connections?

You need to have a strong residency application to begin with. For dermpath, you're competing not only against path residents but also with derm residents. Derm residents tend to have stronger applications than path residents.

Then you do need to establish connections and make allies during residency. Doing a good job as a resident is certainly important for securing strong letters of recommendation.

 

[dermpathlover]

This is not allowed anymore. AP only folks now have to do 2 years of AP and an extra half a year of non-boarded AP if they will be doing a board certified fellowship (e.g., cyto, derm, heme). Hence, the minimum time for AP/cytopath and AP/dermpath is 3.5 years. So usually AP only folks will do 2 years of AP core followed by one year of a non-boarded AP fellowship, whether it be general surg path, GI, GU, Gyn, etc, because in many cases, it's awkward to start a year long fellowship mid-way through the academic year.

C'mon man. I thought you'd know this by now.

Is the same true for NP (which is board certified). Can you still do 2 years AP and 2 years NP and sit for the AP and NP boards?

Let's face it, the quickest you can get out is in 3 years and that is if you do AP or CP only or AP + a "fellowship" in a non-boarded area like GI or breast. You have to do 4 years if you want a boarded fellowship.

 

[dermpathlover]

Thanks for your help on the issue everyone. Also, I'm an M3 right now with research in molecular dermatology and one publication in a major derm journal. I need to do more to try and get a dermpath spot. Can anyone suggest something fellowship directors are looking for vis-a-vis undergraduate education? Or is landing dermpath just about working hard in residency and/or connections?

Besides working hard, I would go to a program that has 2 or more spots. Internal candidates almost always have an edge of external ones no matter what anyone else says.


You are already fine with your pubs.

 

[yaah]

He's not fine with his publications. Recent publications (or research) are more important than what you did five years prior. While it is nice to have a publication, it doesn't mean that much if you don't follow up on it.

 

[b&ierstiefel]

Is the same true for NP (which is board certified). Can you still do 2 years AP and 2 years NP and sit for the AP and NP boards?

Let's face it, the quickest you can get out is in 3 years and that is if you do AP or CP only or AP + a "fellowship" in a non-boarded area like GI or breast. You have to do 4 years if you want a boarded fellowship.

Actually, I was a bit mistaken...the extra 0.5 year AP rule does NOT apply if you're doing AP/Heme or AP/Neuro. Those are 4 years total at my program. So you're right, if you wanted to do NP, that's basically 2 yrs of AP + 2 yrs of NP. My bad.

CP only is 2 years minimum...many of these folks do postdocs afterwards.

A typical AP + fellowship program can be 3 years, again, if the 1 year fellowship is in a non-boarded specialty (Gyn, GU, GI, breast, etc). In this case, you "double dip" for half a year where half of the year long fellowship can apply to the 0.5 extra year AP rule.

 

[b&ierstiefel]

He's not fine with his publications. Recent publications (or research) are more important than what you did five years prior. While it is nice to have a publication, it doesn't mean that much if you don't follow up on it.

Yeah, I think this is just one of many aspects of an application. Plus, to apply to dermpath, you must decide and apply early, at least a year in advance for some places. Most residents' CV's are not too different from when they were applying to residency. Hence, I think the main prognostic factors for landing a dermpath spot depends on the following:

(1) The quality of your residency application.
(2) The reputation of your residency program.
(3) Your performance during your residency and the strength of the LORs you get from the pathologists you work with.

 

[abefromann]

Thanks guys. Most of the programs I am looking at for path have a 3Y AP + 1Y Dermpath option. Total of 4 years. Would you go for AP/CP + 1Y Dermpath or just do the AP thing and get out in 4? Most people seem to think that if you do only AP you're bascially obligated to be an academian. Yet, many of the current DP fellows at major programs are AP only dermpaths. Is this because they're going into academics or is there room for private practice work? Does anyone here find dermpath to be particularly boring in comparison with other subspecialties?

 

[LADoc00]

You need to have a strong residency application to begin with. For dermpath, you're competing not only against path residents but also with derm residents. Derm residents tend to have stronger applications than path residents.

Then you do need to establish connections and make allies during residency. Doing a good job as a resident is certainly important for securing strong letters of recommendation.

How would derm residents have a stronger app? Board scores, clinical grades etc. arent part of the criteria. It is very much a myth that derm residents are stronger applicants, it is entirely dependant on the philosophy/perspective of the dermpath director:
Dermpath is a business. Because only a percent of dermpath trained dermatologists actually end up reading their own slides (for a variety a reasons, I actually have a derm/dermpath boarded guy from a top program that sends me his junk to read out, for many its the time, money and government regs that limit one's ability to open a small histo lab), dermpath FACULTY would naturally be at the receiving end of their potential business.

Dermpath currently is being used like a marketing ploy, bring in dermies who will one day feed your consult service.

Pathologists are potential competitors, they WILL see meat-n-glass. They WILL market themselves as mini-UCSFs or mini-Harvards or wherever they went to take business essentially from you.

Everything in dermpath land appears calm at the surface but trust me when you have the LeBoits of the world making 1.5 million "real money" there is a distinct subculture you dont find in Pulmonary path or Heme or Soft tissue/bone etc...

Dont tell yourself because you are just a pathologist you cant get into derm, if you want it go for it. My philosophy is apply WIDE, spend a year in Buffalo NY or some other horrific place, get the cert and get a job in Pismo Beach.

 

[DarksideAllstar]

get the cert and get a job in Pismo Beach.

Ah yes, Pismo. One of the few places you can get run over by a truck while talking a stroll on the beach. I tried to push the slogan "Where Central Valley White Trash Comes to Play", but the city council wouldn't have it.

 

[b&ierstiefel]

How would derm residents have a stronger app? Board scores, clinical grades etc. arent part of the criteria. It is very much a myth that derm residents are stronger applicants, it is entirely dependant on the philosophy/perspective of the dermpath director:

I know people who have applied to dermpath spots. They take everything into account because of the competitiveness of landing a spot. Path residents who get dermpath spots tend to be strong anyways...they had good residency applications. I find it very difficult to believe that someone who had a lackluster residency application who ended up in a not so reputable path program would suddenly have an awesome application for dermpath spots.

Now, I do agree with your statement regarding the philosophy of the dermpath director. Much of this has to do with whether dermpath is run by the institution's DERM department vs. the institution's PATH department.

 

[yaah]

Thanks guys. Most of the programs I am looking at for path have a 3Y AP + 1Y Dermpath option.

I highly doubt they have this "option." Most likely what they are telling you is that you can do dermpath after doing 3 years of AP only, which means you will have to start applying after your first year. Are you really going to be that competitive after one year? Some people might be, because they are MD/PhD and did their thesis on melanocyte proteomics. But sounds like you don't fit this category, you're someone with a publication in derm during med school. I think some people would almost rather do the AP/CP because it gives them another year to improve their chances. Programs are NOT going to accept you (unless things have changed since I applied) into an AP/dermpath residency, akin to what some do with neuropath.

And yes, derm residents aren't necessarily stronger applicants, but they are basically all derm all the time (duh) as opposed to the average path resident who is doing everything else as well. I think that makes a difference to some people, makes them "seem" more competitive even if they are not. I agree though that to a large extent it probably depends on the program director and their own background.

Are lots of current derm fellows MD/PhDs? Yes. Are they necessarily going into academics? No. Whether the program directors know this at the time of the interview, who knows.

 

[b&ierstiefel]

I highly doubt they have this "option." Most likely what they are telling you is that you can do dermpath after doing 3 years of AP only, which means you will have to start applying after your first year. Are you really going to be that competitive after one year? Some people might be, because they are MD/PhD and did their thesis on melanocyte proteomics. But sounds like you don't fit this category, you're someone with a publication in derm during med school. I think some people would almost rather do the AP/CP because it gives them another year to improve their chances. Programs are NOT going to accept you (unless things have changed since I applied) into an AP/dermpath residency, akin to what some do with neuropath.

Exactly yaah...one of my classmates just scored a dermpath spot in the Harvard dermpath fellowship as a PGY-2. But his application was strong to begin with. His CV did improve as a PGY-1 but his qualifications were strong to begin with and I'm certain this helped. Connections helped too.

And yes, derm residents aren't necessarily stronger applicants, but they are basically all derm all the time (duh) as opposed to the average path resident who is doing everything else as well. I think that makes a difference to some people, makes them "seem" more competitive even if they are not. I agree though that to a large extent it probably depends on the program director and their own background.

Actually I pondered about this some more. I recall this conversation I had with a derm resident who went into dermpath. It brought up the whole "ladder theory" perspective in a way. OK. So she asked me, "I hear that dermpath is a highly coveted fellowship for path residents...do you think this is the case for derm residents?" I answered, "No idea...I don't know much about the fellowship options available to derm residents." She basically told me the answer to the question was a big fat NO because many derm folks want to do fellowships that are procedure-intensive (such as Mohs fellowship). So I thought this was kinda funny. My next question would be, naturally...does this mean that the not so great derm residents apply to dermpath and the awesome path residents apply to dermpath thereby leveling the playing field?

Are lots of current derm fellows MD/PhDs? Yes. Are they necessarily going into academics? No. Whether the program directors know this at the time of the interview, who knows.

I almost fell out of my chair reading this...cuz it's so true. Seriously, red flags go up and sirens start going off when you seen an MD/PhD applicant who has miniscule amounts of experience in derm/dermpath who apply to residency and are so firm in their convictions to do dermpath. Then some of them sell themselves as wanting to go into academics. I love messing with their heads to expose what little insight they have...for instance...

"Are you doing AP or CP only before dermpath?"
"AP only."
"You know there are more potential lucrative options with AP/CP rather than AP only, don't you?"
"So you think I should do CP?"
"Well, you're the one who wants to do AP only."
"Well maybe I should do CP."
"Oh, so ok then, you're going to do AP/CP and then dermpath."
"Yeah, it's only an extra 2 years."
"2 years is a lot of time, man, don't you think...hell, you're older than I am."
"I can lose 2 years."
"OK, OK. So academics for you, right?"
"Oh totally dude."
"Then why do CP? CP is not worth doing if you're gonna be in academics signing out surg path/derm cases all the time."
"Well, but if I don't do CP, private practice isn't really an option for me."
"Yeah, but you want to do academics."
"Well, I want to keep my options open."
"I think that's good...so why academics?"
"Well, I want to advance the field by investigating the mechanisms behind ____________(insert your favorite melanocytic and non-melanocytic lesions here_______."
"Oh, so you're gonna do a postdoc?"
"Do I have to do a postdoc if I want to do research?"
"Um...yeah...and you need to apply for grants such as K08's."
"Yeah I know..."
"OK...so here's your grand master plan...you're going to do AP + CP + dermpath fellowship + postdoc...you realize that's like 10 years before you start making 6-figures, right?"
"Wow that seems like a really long time..."

*Bierstiefel bangs head against wall*

EXACTAMUNDO!

Lesson for future applicants:
If you're one of these kind of folks...at least hide things a little by saying that you are interested in one of SEVERAL fellowship options which include dermpath and other specialties which should be specified and stated. Throw up a few smokescreens so that we don't see right through you.

 

[pathstudent]

My understaind is this, told to me by an experienced academic dermpath-pathologist.

Back in the 70s and before pathologists pretty much strictly read out skin, and in the 70s skin bxs went up in number. Not all pathologist liked skin due to the different terminologies and inflammatory diseases. Dermatologists got fed up with "chronic dermatitis" as a diagnosis, and some started to figure that they could do a better job. So dermatologists started reading their own slides and learned that not only could they do a better job but that they could quite a bit of money reading out slides and owning a skin lab. However, since the late 90s to now, cosmetic dermatology blows away dermpath in terms of how much you can make as everything is cash, credit cards and fee for service, so the door is opening for pathologists to get back in on the action, but you gotta do the fellowship to learn how dermatologists talk and to understand what they are looking for in a non-malignant skin bx.

In some sense dermpath was taken away from pathology by dermatologist because they realized that they understood it better and that they could make a **** load of money doing it.

It is kind of similar how GI bx's are moving away from us to the gastroenterologits, but they aren't going to waste time learning how to read the slides, even though GI bx for the most part are easy to read, as they can make so much more money just scoping and doing EUS/ERCP. But they did get clued in on how much money there was to be had in pathology, so many have decided to keep the tissue for themselves and hire some chump of a pathologist to read it for them. If you know any academic attendings or fellows leaving to go work for these groups, tell them "sac up and don't be a douche bag". Stay true to pathology. Go academics if you love to teach, interact with residents, and do research, or go to private pracitce if all you want to do is look at slides. Just don't go to a pod lab or reference lab (quest, us labs, etc...). By doing the latter, not only are you screwing yourself as they will keep over half of what you generate, but you are screwing the field of pathology.

 

[djmd]

Just so I'm clear (not sure why I care)
AP only or CP only. 3 years. (24 months structured + 12 less specific)
Some programs offer AP+__ where part/all of your +12 months is given to your fellowship (ie NP, HP), and +12 months of structured fellowship.

Right?

 

[LADoc00]

highly doubt they have this "option." Most likely what they are telling you is that you can do dermpath after doing 3 years of AP only, which means you will have to start applying after your first year. Are you really going to be that competitive after one year?

Affirmative. There is no such thing as AP/Dermpath even though others like AP/Neuro, AP/Heme or AP/Cyto are fairly common. Just too competitive.

Unless you are some kinda god applicant, which Ive seen. Juan Rosai, Jr. crossed with Goodwill Hunting.

 

[djmd]

Unless you are some kinda god applicant, which Ive seen. Juan Rosai, Jr. crossed with Goodwill Hunting.

Do you like keratoacanthomas?
--yeah
Well I got her number....How do you like them keratoacanthomas?

 

[dermpathlover]

Bierstiefel, I thought it was this thread where you said you are starting to consider veering from that hardcore medical scientist only career? Are you thinking of adding CP?

It is not too late. Don't feel obliged to do academics!

I feel sorry for those MD/PhDs that come from those high-power institutions. I think they get brainwashed over the years.

I like the MD/PhDs that go into derm or plastics. That's more common sense.

Let medical science be advanced by the IMGs.

 

[DarksideAllstar]

Do you like keratoacanthomas?
--yeah
Well I got her number....How do you like them keratoacanthomas?

That was so godd@mned cheesey.

 

[DarksideAllstar]

Bierstiefel, I thought it was this thread where you said you are starting to consider veering from that hardcore medical scientist only career? Are you thinking of adding CP?

It is not too late. Don't feel obliged to do academics!

I feel sorry for those MD/PhDs that come from those high-power institutions. I think they get brainwashed over the years.

I like the MD/PhDs that go into derm or plastics. That's more common sense.

Let medical science be advanced by the IMGs.

Dude, are you talking, AGAIN?

 

[b&ierstiefel]

Dude, are you talking, AGAIN?

Yeah...seriously...

I know what I'm doing and I'm keeping all my options open. That's why people like me do a residency instead of doing a straight postdoc after med school. Options!

 

[yaah]

I almost fell out of my chair reading this...cuz it's so true. Seriously, red flags go up and sirens start going off when you seen an MD/PhD applicant who has miniscule amounts of experience in derm/dermpath who apply to residency and are so firm in their convictions to do dermpath. Then some of them sell themselves as wanting to go into academics.

Yes indeed, this first came to my attention when I interviewed at U of C and one of the faculty told me they were getting sick of MD/PhD people who came in to interview and misrepresented themselves and their career intentions (i.e. overselling their research goals when in fact they would get to residency and go into private practice mode). Fellowships it might be worse, but I'm not sure. I know several MD/PhD residents who want nothing to do with academics or research anymore, but I get the sense that fact doesn't come out during fellowship applications. I mean, during my training so far I have written three papers (none are case reports, all are projects) and have three other projects progressing towards that phase, and a couple of other potentials. But could I lose a fellowship spot to an MD/PhD with a case report or no significant research/projects since med school? I guess it would depend on the fellowship.

What can happen, as it does frequently, is that the applicant/fellow "changes their mind" about their career path. Conveniently, this generally happens after key decisions have been made. The problem for program directors is that they never know exactly who is going to make this switch.

 

[dermpathlover]

6 months ago when I was interviewing with and speaking to many d-path fellowship directors, I can remember zero that were dead set on getting MD/PhDs with ultimate goals on doing basic research. Some encouraged academics, and usually that meant working under them for a few years, but I don’t think any would not train you if your goal was to go out and join private practice. Most fellowship directors want people that will end up sending them consults.

 

[yaah]

Most fellowship directors want people that will end up sending them consults.

Then why not select the bottom of the barrel then, so that way the person won't be as smart and will therefore send MORE consults.

So that's why you got a fellowship!

 

[DarksideAllstar]

Then why not select the bottom of the barrel then, so that way the person won't be as smart and will therefore send MORE consults.

So that's why you got a fellowship!

ZING!