autopsy necessary?

[condyloma]

I just finished my IM residency and wondering about pathology residency too - do all pathology residencies ( AP and CP) require you to do autopsies?

Or are there any fields/programs where we dont have to do autopsies/ forensic pathology?

Any help is appreciated - I really love pathology - and feel they are really the brains of the hospital sometimes! But I dont think I can perform autopsies...!

 

[mlw03]

To be eligible for AP boards, one must complete 50 autopsies. Beyond that, it's a matter of choice as to whether or not one does autopsies in their job. But unless you're a CP only resident, you must complete the minumum of 50.

 

[KCShaw]

And realize that while the majority of pathology residents go through AP and work in AP, and therefore have to do at least the minimum number of autopsies in training -- a sizeable proportion of both attendings and residents consider them simply something they have to get through. Point being, I certainly wouldn't let an expected aversion to autopsies dissuade you from going into pathology, if after some realistic exposure to path it otherwise has a strong appeal. Who knows, might turn out that you like them.

 

[gbwillner]

I thought autopsy seemed anwful and unnecessary too- until I did a few. Then I really ended up liking it.
On the flip side, I don't know why you would complete IM residency and decide you hadn't had enough punishment so you want another 4 years' worth.

 

[LADoc00]

I just finished my IM residency and wondering about pathology residency too - do all pathology residencies ( AP and CP) require you to do autopsies?

Or are there any fields/programs where we dont have to do autopsies/ forensic pathology?

Any help is appreciated - I really love pathology - and feel they are really the brains of the hospital sometimes! But I dont think I can perform autopsies...!

How could you get through IM residency being that squimish?!

Why would you do IM and then another 2 board certs anyway? Just practice medicine! Go, get on with it. Start paying down your debt.

 

[sirenomelia]

I think this guy is on to something. Get boarded in medicine maybe do GI and then train in path. Now you can scope, biopsy all afternoon and then read out your slides yourself in the morning. Thats something between full-service medicine and world domination.

 

[gbwillner]

Thats something between full-service medicine and world domination.

In theory. In practice it's simply not understanding the how to benefit from division of labor. By that I mean being a GI and buying a lab, and hiring a pathologist out of training for $140K while you pocket the $1M he brings in.

 

[deleted314957]

If you are in residency and on an "autopsy rotation" and have essentially no other daily obligations (except conferences, etc) during that period then autopsies can be quite instructive and fun. you can even get practice with fna's, touch preps, little brain biopsies for squash preps to get a handle for "normal" and things like that. In an academic group if you are a staff pathologist and you have a rotation every so often they are fine. however, if you are like me, solo medical director in a 170 bed hospital with loads of surgicals, cytos, admin etc they are nothing but a complete distraction and pain in the ass. thankfully, i have very few and when i do one of the pa's from our group hq comes and does the dissection and i stick my head in the door a few times and look at the micros the next day.

 

[mlw03]

This is how a lot of private practice gigs seem to do their autopsies. And it's why the non-forensic autopsy is rapidly dying out. That's not to rag on anybody - it just is how things are in the modern work of pathology.

If you are in residency and on an "autopsy rotation" and have essentially no other daily obligations (except conferences, etc) during that period then autopsies can be quite instructive and fun. you can even get practice with fna's, touch preps, little brain biopsies for squash preps to get a handle for "normal" and things like that. In an academic group if you are a staff pathologist and you have a rotation every so often they are fine. however, if you are like me, solo medical director in a 170 bed hospital with loads of surgicals, cytos, admin etc they are nothing but a complete distraction and pain in the ass. thankfully, i have very few and when i do one of the pa's from our group hq comes and does the dissection and i stick my head in the door a few times and look at the micros the next day.

 

[gbwillner]

This is how a lot of private practice gigs seem to do their autopsies. And it's why the non-forensic autopsy is rapidly dying out. That's not to rag on anybody - it just is how things are in the modern work of pathology.

That's only because you don't bill for them. If autopsies paid $10K per, you'd jump mikesheree's jock to do one.

 

[mlw03]

That's only because you don't bill for them. If autopsies paid $10K per, you'd jump mikesheree's jock to do one.

Fair point, but the system reflects what "we" as a society value and are willing to pay for. I strongly agree hospital pathologists would be more inclined to do them if they could bill even $1K per complete case.

You threw out $10K. For discussion, if a forensic pathologist makes $150K per year and does the recommended max of 250 cases per year, that's $600 per case. Just throwing the numbers around.

 

[Enkidu]

Fair point, but the system reflects what "we" as a society value and are willing to pay for. I strongly agree hospital pathologists would be more inclined to do them if they could bill even $1K per complete case.

You threw out $10K. For discussion, if a forensic pathologist makes $150K per year and does the recommended max of 250 cases per year, that's $600 per case. Just throwing the numbers around.

Yeah, 10k pet case would make forensic pathologists $2.5 million per year. That's like that dermpath dude at UCSF.

 

[gbwillner]

Fair point, but the system reflects what "we" as a society value and are willing to pay for. I strongly agree hospital pathologists would be more inclined to do them if they could bill even $1K per complete case.

You threw out $10K. For discussion, if a forensic pathologist makes $150K per year and does the recommended max of 250 cases per year, that's $600 per case. Just throwing the numbers around.

I heard private autopsies cost ~$6K per. Maybe someone with forensics knowledge can back that up. Regardless, if medical autopsies were $6K a pop, you'd never get 250/year. You'd all be fighting mikesharee's jock for them.

 

[Tissue issue]

I heard private autopsies cost ~$6K per. Maybe someone with forensics knowledge can back that up. Regardless, if medical autopsies were $6K a pop, you'd never get 250/year. You'd all be fighting mikesharee's jock for them.

I'm not fighting anyone's jock to do an autopsy- they can have the 6K.

 

[mlw03]

I heard private autopsies cost ~$6K per. Maybe someone with forensics knowledge can back that up. Regardless, if medical autopsies were $6K a pop, you'd never get 250/year. You'd all be fighting mikesharee's jock for them.

Where I did residency our charge was $3K for a complete autopsy. Among the FPs I know that will do private autopsies on the side, most charge around $2K base, then hourly for meeting with attorneys, testifying, etc.

To bring it back to the original issue though, no one has to do autopsies beyond their required 50 for AP board eligibility.

 

[KCShaw]

Since the tangent is more interesting to me personally:

I don't have access to very many detailed budgets, but taking a tiny fraction of generic ME offices and looking at their budgets vs autopsies only -- they ranged from about $2400 to about $5300 per autopsy, with the average probably about in that mid range of $3500~$4000'ish. But that's a misleading number, because ME offices do more than just pay pathologists to do autopsies. In addition to costs an average hospital-autopsy would normally incur (pathologist, tech/PA/deiner, facility, supplies, and histologic slides; only a few will do toxicology, though more "private" autopsy services will do so), ME offices also generally pay for forensic investigators, secretarial and administrative staff, photography, x-ray equipment, transport of bodies from scenes, time for pathologists to deal with the court system, and cost of investigating cases which either don't fall under ME jurisdiction or only get either an external inspection or a partial autopsy -- among other things, some of which vary by local preference or statute. Of course, they get to consolidate expenses and focus their employees on related tasks, as opposed to hospital/private surg path staff whose primary responsibilities (by volume) are elsewhere.

That said, I pretty much agree with mlw that most pathologists who charge separately for private autopsies do so in roughly that $2-3k range, up to around $5k, unless you're talking about the rare big names. By contract or prior agreement that may or may not include providing anything beyond an autopsy report +/- histology or certain laboratory/tox studies -- much of the time a pathologist (primarily talking about someone working as a forensic pathologist, even if not boarded as such) also charges hourly for almost anything beyond that, such as testimony or review of records/reports from someone else. The hourly rate is also pretty variable, but currently seems to usually be in roughly the $300-$450 range and accounts for some of that "extra" cost ME offices generally include in their annual budget.

In the end, the salary of an average FP broken down solely by autopsy numbers is probably in that $550/autopsy range -- most seem to do somewhere between 250 and 300 autopsies per year, depending -- with the rest going to other, obviously not insignificant, costs.

 

[condyloma]

thanks for your replies - so if there are programs which are CP only ( I think I have seen a few) - then are autopsies NOT necessary for these?

I did 3 years of IM and realized I dont want to be an internist.

 

[mlw03]

thanks for your replies - so if there are programs which are CP only ( I think I have seen a few) - then are autopsies NOT necessary for these?

I did 3 years of IM and realized I dont want to be an internist.

Yes, that'd be correct. But realize this will almost certainly greatly narrow your post-training employment options, mostly to academic centers or blood banks.