Autopsy fellowship=forensic fellowship?

[KayBee]

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Hi, quick question. 3rd year student here, with a recent interest in pathology, mainly for the autopsy part of it. Now i realise autopsies count for less than 50 percent of what a pathologist actually does on a daily basis, hence my interest in doing a forensic fellowship coz i know that's their bread and butter. But can you actually do a fellowship in autopsy without neccessarily dealing with forensic stuff per se？

Thanx

 

[LADoc00]

Hi, quick question. 3rd year student here, with a recent interest in pathology, mainly for the autopsy part of it. Now i realise autopsies count for less than 50 percent of what a pathologist actually does on a daily basis, hence my interest in doing a forensic fellowship coz i know that's their bread and butter. But can you actually do a fellowship in autopsy without neccessarily dealing with forensic stuff per se？

Thanx

Facts to consider:
~There is NO CPT billing code anywhere, for ANY insurance company in the United States I know of for autopsies. Which means that whatever % autopsies make of your practice, that is % you will receive NO INCOME for.

~"Autopsy" fellowships that non-forensic do exist but only as a method to fund basic science research. You would be lucky to spend more than 4-5 hours TOTAL a week doing autopsies; the rest of the time, you will be pipeting small amounts of crap into slightly larger amounts of crap and hoping the government continues to punch your mealcard.

~Autopsies are pretty much obsolete, OBSOLETE due to radiologic advancements. Even people that are DOA can be probably be scanned in an imager and then a cursory physical exam done by a technician to seal the deal. Autopsies do not need MDs to perform them, I will say this now and forever: Autopsies are beyond WORTHLESS. I have bowel movements that have more value to society than 90+% of the post mortems Ive done and that is a fact you can take to the bank.

 

[djmd]

~Autopsies are pretty much obsolete, OBSOLETE due to radiologic advancements. Even people that are DOA can be probably be scanned in an imager and then a cursory physical exam done by a technician to seal the deal. Autopsies do not need MDs to perform them, I will say this now and forever: Autopsies are beyond WORTHLESS. I have bowel movements that have more value to society than 90+% of the post mortems Ive done and that is a fact you can take to the bank.*

*Do not actually take BMs or PMs to the bank.

otherwise I agree with everything LADoc said .

What about autopsies do you like? I like gross anatomy plenty, and I don't mind the dissection part of the autopsy (the paperwork pain in the ass always annoys me)...

Grossing in cases is a part of what pathologist do (at least in residency and sometimes even as pathologist...)

It would be hard to imagine any way to do autopsies as a primary focus outside of forensics. Most large academics hospitals have an attending who handles the autopsies, but usually they do something else also...

 

[mlw03]

the government has an interest in knowing why its citizens die, and i doubt that's going to change during my lifetime. thus there will always be a need for forensic pathologists. while i agree that the majority of autopsies end up being mundane and don't contribute much to society, a few do and it's hard to know which those will be until the work's been done. if doing autopsies is what you want to do then do a forensic fellowship and work as a medical examiner. but i would also agree with djmd that you won't be doing autopsies as the main component to your job as anything other than a forensic pathologist.

as to whether you need an MD to be a forensic pathologist, I don't have the experience that LADoc does, but I'll still disagree. perhaps most autopsies could be done by a technician who does 2-3 years of training for the job rather than someone with 9 years post college training. but you could say the same thing for not needing MDs to treat most patients with diabetes, hypertension, provide well child care, or a lot of other things primary care docs do. you could argue these patients could be cared for by ARNPs or PAs, with MDs acting only as sub-specialists or consultants on refractory cases (such as a 33 year old with hypertension not controlled by 3 meds). but i simply don't see that happening, in primary care or in forensic pathology. forensic pathologists, because of their medical school and general pathology training, bring more to the table than would a technician. and that gives them a greater understanding of not just why people are dead, but their clinical course while alive.

 

[EAB]

"Techs" are quite capable of doing virtually any autopsy by themselves. However, they have no knowledge of natural disease processes, histology, toxicology, molecular, etc. They are not able to decode medical language for juries or differentiate all natural deaths from accidents (or homocides versus suicides for that matter).
But most importantly, they probably don't want to. Just like I don't want to sit on my ass looking at slides all day. They are however, quite good at reading xrays.

 

[Mindy]

Don't worry MLW03, it is clear to me that LA does not have much experience with either forensics or autopsy pathology. You probably have more. In fact since he considers imaging so excellent, the natural question (albeit of course drippingly sarcastic) is, why do we need surgical pathologists?

LA can read some of the published research that I and others have done on the subject of the autopsy, if he wants to educate himself. Just because they are under-utilized in medicine currently and just because each subsequent generation of pathologists are becoming less and less well-trained in autopsy pathology, does not in any means make them useless. In fact, for those few of us who are dedicating our lives to forensics and autopsies, there are plenty of jobs available. And since we will be one of a handful of decent autopsy pathologists left, a lucrative consult service would be readily available for those who desired it. Particularly for those interested in testifying. Sometimes, the more obscure your particular area of interest, the more valuable it is. I have found this to be quite true so far with autopsy pathology, and I will definitely challenge anyone who tries to tell me I do not know what I am talking about in this regard.

My perspective to all of you out there---do what you enjoy doing and rewards will follow. Don't listen to others tell you what you like, or tell you that your ideas are crap. I personally cannot stand the thought of sitting at a desk all day going through slide after slide after slide any more. Autopsies (particularly forensics) are much more interesting. Sometimes I think those that complain about how useless autopsies are just wish their jobs were half as interesting... Reread LA's old posts about how much he hated his job/life as a pathologist, you'll see what I mean.

As far as a technician or nurses go, an autopsy should be (though clearly some of our colleagues seem not perform them in this manner), the most comprehensive of all pathology examinations. Anything less is a disservice to the $3000 a pop price tag that we charge for outside autopsies at my hospital. Just because we can get away with poor quality because we are behind closed doors, I think it is criminal to do so. Not to mention, sometimes you will need to defend your work in court, and us well-trained consultants may steamroll you. Afraid of court, and don't want to do autopsies? More work for me...

Mindy

 

[LADoc00]

Ed Marrow once said Most truths are so naked that people feel sorry for them and cover them up, at least a little bit and that is how I feel about autopsies.

I think we are in a great era of change and I think many many pathologists and fellow physicians are resistant to this..as Demmings once said It is not necessary to change. Survival is not mandatory.

Forensic pathology wasnt even what I was originally discussing. I was referring to hospital-based medical autopsies. I have other posts where I clearly expound on my futuristic idea that Forensics be its own medical speciality out of pathology and perhaps even its own graduate program funded by the State outside of medicine. I dont doubt this will happen, one day it WILL happen.

But for now we are left with the anachronistic model of our professional forefathers, who while great, lacked the ability to predict the volatile nature of modern medical economics and properly prepare us for it. In some ways their professional dedication is a beacon of purity but in many others is hopelessly naive, destined to failure, poverty and despair.

Che once said "The true revolutionary is guided by a great feeling of love" and that is what I see in Mindy's post, love.

The only problem I have is once we have collectively dispelled the myth that man and woman can live solely on "love", what is the future??

Ponder that.

 

[Mindy]

La: What the *&^% are you talking about ???!!!!

 

[2121115]

Ed Marrow once said Most truths are so naked that people feel sorry for them and cover them up, at least a little bit and that is how I feel about autopsies.

I think we are in a great era of change and I think many many pathologists and fellow physicians are resistant to this..as Demmings once said It is not necessary to change. Survival is not mandatory.

Forensic pathology wasnt even what I was originally discussing. I was referring to hospital-based medical autopsies. I have other posts where I clearly expound on my futuristic idea that Forensics be its own medical speciality out of pathology and perhaps even its own graduate program funded by the State outside of medicine. I dont doubt this will happen, one day it WILL happen.

But for now we are left with the anachronistic model of our professional forefathers, who while great, lacked the ability to predict the volatile nature of modern medical economics and properly prepare us for it. In some ways their professional dedication is a beacon of purity but in many others is hopelessly naive, destined to failure, poverty and despair.

Che once said "The true revolutionary is guided by a great feeling of love" and that is what I see in Mindy's post, love.

The only problem I have is once we have collectively dispelled the myth that man and woman can live solely on "love", what is the future??

Ponder that.

LOL! Classic! This is why I read this forum.

 

[King Arthur]

Really enjoying both the serious and humorous portions of this thread. Thought I'd throw in what i've seen at my med school. We do have an attending that does entirely medical autopsies. he does not have a lab or actively perform much research. we are a hospital w/ a huge volume of transplant pts and these pts often die with an unclear cause. therefore, his ability to determine the cause of death is very helpful to the clinicians when looked at as a whole. he is also involved in internal policy discussions about iatrogenesis. all that being said, he is 1 attending in a large dept, so obviously this isn't the most common situation in the world, however it does exist at my medschool.

 

[dermpathlover]

For those that know what I am talking about, if you recall, autospy fellowship was a zero star fellowship in DPL's world.

 

[Gut Shot]

in DPL's world.

Hmmmm... what's it like in DPL's World? I wonder...

Go placidly amid the noise and waste,
And remember what comfort there may be in owning a piece thereof.
Avoid quiet and passive persons unless you are in need of sleep.
Rotate your tires.
Speak glowingly of those greater than yourself,
And heed well their advice, even though they be turkeys.
Know what to kiss and when.
Consider that two wrongs never make a right,
But that three lefts do.
Wherever possible put people on "HOLD".
Be comforted that in the face of all aridity and disillusionment,
And despite the changing fortunes of time,
There is always a big future in computer maintenance.
Remember the Pueblo.
Strive at all times to bend, fold, spindle and mutilate.
Know yourself. If you need help, call the FBI.
Exercise caution in your daily affairs,
Especially with those persons closest to you;
That lemon on your left for instance.
Be assured that a walk through the ocean of most souls,
Would scarcely get your feet wet.
Fall not in love therefore; it will stick to your face.
Carefully surrender the things of youth: birds, clean air, tuna, Taiwan,
And let not the sands of time get in your lunch.
For a good time, call 606-4311.
Take heart amid the deepening gloom that your dog
Is finally getting enough cheese;
And reflect that whatever fortunes may be your lot,
It could only be worse in Sioux City.
You are a fluke of the Universe.
You have no right to be here, and whether you can hear it or not,
The Universe is laughing behind your back.
Therefore make peace with your God whatever you conceive him to be,
Hairy Thunderer or Cosmic Muffin.
With all its hopes, dreams, promises, and urban renewal,
The world continues to deteriorate.
Give up.

 

[yaah]

For those that know what I am talking about, if you recall, autospy fellowship was a zero star fellowship in DPL's world.

Ah yes, the ultimate arbiter of primness and propriety, true satisfaction, and all that is good and decent in the world. Tell us more, oh great and powerful muse, you have been absent from these hall e'er so long.

 

[mlw03]

For those that know what I am talking about, if you recall, autospy fellowship was a zero star fellowship in DPL's world.

thanks for chiming in just to share your eminently qualified opinion that forensic path is beneath you. very classy and professional.

 

[dermpathlover]

thanks for chiming in just to share your eminently qualified opinion that forensic path is beneath you. very classy and professional.

At least I am smart enough to know that autopsy fellowship doesn't equal forensic fellowship. I never mentioned forensics once.

 

[djmd]

At least I am smart enough to know that autopsy fellowship doesn't equal forensic fellowship. I never mentioned forensics once.

What does that make forensics then?
A null-star fellowship?
Unmentionable-fellowship?


The fellowship that man was not meant to know?

 

[mlw03]

At least I am smart enough to know that autopsy fellowship doesn't equal forensic fellowship. I never mentioned forensics once.

ah yes - you're much smarter than me. i mean, you have to be, since you're doing dermpath? that intrinsically makes you a superstar, right? if we ever run into each other at a path conference please point out that you are in fact the notorios DPL so i can recognize you for the fine example you are of how to become a super awesome pathologist who's going to make oodles of money.

whether talking about forensic fellowship, autopsy fellowship, or any fellowship - to give them ratings like you did is insulting and degrading. we all get that you think dermpath is awesome, and we certainly need them. we also need every other type of pathologist, so please get off your high horse and show your future colleagues the respect they deserve by not ranking them beneat what you're going to do just because they make less money. you make think breast path isn't as prestigious as dermpath, but if you mother had a mass removed from her breast you'd definately want someone with breast expertise looking at it... even if they don't get as many stars as you do.

 

[DarksideAllstar]

whether talking about forensic fellowship, autopsy fellowship, or any fellowship - to give them ratings like you did is insulting and degrading. we all get that you think dermpath is awesome, and we certainly need them. we also need every other type of pathologist, so please get off your high horse and show your future colleagues the respect they deserve by not ranking them beneat what you're going to do just because they make less money. you make think breast path isn't as prestigious as dermpath, but if you mother had a mass removed from her breast you'd definately want someone with breast expertise looking at it... even if they don't get as many stars as you do.

pwned

 

[1Path]

ah yes - you're much smarter than me. i mean, you have to be, since you're doing dermpath? that intrinsically makes you a superstar, right? if we ever run into each other at a path conference please point out that you are in fact the notorios DPL so i can recognize you for the fine example you are of how to become a super awesome pathologist who's going to make oodles of money.

whether talking about forensic fellowship, autopsy fellowship, or any fellowship - to give them ratings like you did is insulting and degrading. we all get that you think dermpath is awesome, and we certainly need them. we also need every other type of pathologist, so please get off your high horse and show your future colleagues the respect they deserve by not ranking them beneat what you're going to do just because they make less money. you make think breast path isn't as prestigious as dermpath, but if you mother had a mass removed from her breast you'd definately want someone with breast expertise looking at it... even if they don't get as many stars as you do.

 

[yaah]

ah yes - you're much smarter than me. i mean, you have to be, since you're doing dermpath? that intrinsically makes you a superstar, right? if we ever run into each other at a path conference please point out that you are in fact the notorios DPL so i can recognize you for the fine example you are of how to become a super awesome pathologist who's going to make oodles of money.

He would be easy to recognize, he'd be the one bathed in a heavenly glow and followed by the person holding the palm frond over his head.

 

[DarksideAllstar]

He would be easy to recognize, he'd be the one bathed in a heavenly glow and followed by the person holding the palm frond over his head.

Mental note: get rid of my heavenly glow so that I am not confused with DPL.