autopsy scare

[rika]

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hi

Could anybody please tell me if it is mandatory to do autopsies in private practice?How many autopsies does one have to observe or do in a an AP/CP residency....I like pathology except for the autopsy part...I want to be careful before making the decision to join pathology and not regret later on. Please reply

 

[pathstudent]

hi

Could anybody please tell me if it is mandatory to do autopsies in private practice?How many autopsies does one have to observe or do in a an AP/CP residency....I like pathology except for the autopsy part...I want to be careful before making the decision to join pathology and not regret later on. Please reply

Autopsy is a dying industry. Due to many reasons autopsies are going the way of the Do-Do. Even at Universities and VAs, numbers are way down even from just ten years ago.

One private practice pathologist told me that their autopsy number has gone from 250/year in the 80s and 90s to 10/year recently. He was fine with that as they don't get paid for doing them and basically were doing the 250/year as a service to the medical staff. I think the reasons for this include the folloing:
1) Hospitals have gone from being non-profit to for-profit and autopsy clearly cost money which reduces hospital profits which reduces the stock price of the corporate giants that "own" hospitals.
2) The federal gov't has become more lax about maintaining and enforcing a minimum autopsy number for hospitals.
3) Clinicians are worried about something turning up that could get them a law suit.
4) Clinicians believe that radiology, lab test, and other clinical assessments of patients are adequate to determine the cause of death.
5) Also there are many more fictional and documentary shows on network TV and cable that deal with the post-mortem exam. So the public might be less enthusiastic and less trusting about agreeing to the autopsy.

All that being said, you will have to do at least 50 autopsies to sit for the boards. Ten years ago this was no problem. Now it is difficult for most programs to get 50 autopsies for their residents without pulling shenanigans like like letting 2 or more residents get "credit" for the case, and even with that it is still won't add up to 50. So, most programs send you to the coroner's office to ensure you get your numbers.

In regards to the future, there are many careers in pathology where you don't have to do autopsies. Academics don't do them (the residents do). People who work for reference labs don't do them. If you work for a county hospital or community hospital you might have to do one once in a great while. However, surely you could pay a PA or tech to do the evisceration for you and you just examine the organs without ever getting your hands bloody.

Fear/dislike of autopsy is not a reason to not go into path. Besides, they are only dead people. One day everyone you know will be dead.

 

[Cabbage Head]

hi

Could anybody please tell me if it is mandatory to do autopsies in private practice?How many autopsies does one have to observe or do in a an AP/CP residency....I like pathology except for the autopsy part...I want to be careful before making the decision to join pathology and not regret later on. Please reply

pathstudent is right, but just to reiterate: you will have to do autopsies to sit for the AP boards. You most likely aren't going to be able to just observe 50.

 

[sapience8x]

also if a pathologist is at a residency program at least the one at my institution, he/ she just observed unless they were teaching or they came down when the resident was almost finished.

 

[rirriri]

i've done 5 in my first 7 days on autopsy month...not bad, eh? 😉

but yeah, observing ain't gonna cut it, you have to be primary prosector in the majority of the required cases......50 in 4 years is not that much. just suck it up and do them! (i'm not too fond of them either...but the quicker i meet the requirement, the quicker i'm done with em)

 

[DarksideAllstar]

The worst news that I ever got was that I couldn't use my 28 posts from my post-soph year towards AP BE. 🙁

 

[rika]

Thanks Pathstudent, CabbageHead,rirriri.Your advice has calmed me down. Now I know what to anticipate beforehand and atleast make a right decision. Yeah I think I shouldnot let the autopsy part bogg me down so much. It sounds ok if Iam going to be done with it in 4 years. I just want to clarify that autopsy means they give you a dead person and u have to cut him open from scratch do the evisceration and them examine it right. In my medical school the technicians would do the job and the doctor would intervene only after the initial part is done. Iam just too worried coz I nearly experienced a Acute stress disorder during my Forensic med postings. It literally made me puke. Although the deceased are dead they appear like they are sleeping . I was introduced to a Cadaver the very first day even before i got introduced to my friends , that didnt scare me coz they looked like some models,no blood, no color.Sometimes I feel Iam being too silly and Kiddish. Cant help it Iam like that .

 

[rika]

The worst news that I ever got was that I couldn't use my 28 posts from my post-soph year towards AP BE. 🙁

hi I didnt understand why you feel this way?Are u kidding?Whats the matter?

 

[DarksideAllstar]

hi I didnt understand why you feel this way?Are u kidding?Whats the matter?

Just because I don't mind doing a post or two or ten in one week doesn't mean I want to do them. They were tolerable, except the several I did on the 350lb + morbidly obese. But I would rather put a hot poker in my eye than do more than I have to (with regards to posts). So yeah, it sucks that none of these count. Although I am sure that wherever I match I would still have to staff the autopsy service anyway so it really wouldn't have mattered.

 

[mlw03]

i'm just glad to see there are pathologists out there who are NOT wanting to do autopsies. forensic path is one of the areas i find most interesting and appealing as a future career (you definately can't outsource that job), so i'm glad to see that if i apply for a forensic path fellowship down the road i'll be competiting against every path resident out there.

as to the original question, i would think that in any specialty a private practice doc would have a lot of say over what they do or don't want to do (unless you're an emergency physician). but if a family practice doc says they don't want to do obstetrics then they don't have to, so i would think it's similar with pathologists want to exclude a particular aspect also.

 

[Cabbage Head]

as to the original question, i would think that in any specialty a private practice doc would have a lot of say over what they do or don't want to do (unless you're an emergency physician). but if a family practice doc says they don't want to do obstetrics then they don't have to, so i would think it's similar with pathologists want to exclude a particular aspect also.

They can't force you to do autopsies, but you can't force them to give you a job. Saying that you refuse to do them just makes you less marketable to smaller private practice places. Probably none of the people in that practice want to do autopsies.

 

[mlw03]

They can't force you to do autopsies, but you can't force them to give you a job. Saying that you refuse to do them just makes you less marketable to smaller private practice places. Probably none of the people in that practice want to do autopsies.

very good point. I would think the ability to be more selective in one's work goes with being in a more specialized practice (path or other specialty). to use my original example, the FP doc in smalltown, kentucky better be prepared to do all aspects of family practice (maybe even the minor surgery stuff). same with a small path group working at a small hospital subserving a large chunk of land in a rural area - those guys would be expected to take care of all the path in that community. but i do think one could find path work without having to do autopsies ever. even in those smaller rural practices you may get 1 pathologist in the group who enjoys the forensics work and agrees to take all of the autopsies that get referred to the group.

 

[Apollyon]

So, most programs send you to the coroner's office to ensure you get your numbers.

King's County (Brooklyn) does ~10 posts a day, every day of the year (or else they get backed up).

 

[yaah]

They can't force you to do autopsies, but you can't force them to give you a job. Saying that you refuse to do them just makes you less marketable to smaller private practice places. Probably none of the people in that practice want to do autopsies.

Well said. There are objectionable parts to every job, and objecting just because one thinks it's icky or hoping someone else will do it is often not really appropriate, nor is it professional. I would hope that in whatever job I end up in, I will be able to avoid FNAs. Doesn't mean I will be able to though.

I know someone who dropped AP and went to CP only because they did not like autopsies, and felt a little woozy after experiencing ONE of them. I thought that was a little strange. Not many people like doing autopsies, but they do them because they are part of the job and can be educational and helpful to others. At some point we all have to confront our fears instead of running from them.

But yes, autopsies really don't reimburse well, so people are often stuck doing them. The thing is though, a lot of people who do autopsies in private practice do them for someone else - through a contract or something that you wouldn't have to participate in. I would imagine it wouldn't be hard to find a job where you wouldn't have to do autopsies, but as said above, it might limit you a little.

 

[pathstudent]

King's County (Brooklyn) does ~10 posts a day, every day of the year (or else they get backed up).

I should do a week elective there, get my 50 and be done with it.

I recently read that Cook County Coroner's does 17 per day. I could just do three days there and be elegible to sit for the boards.

 

[deschutes]

I should do a week elective there, get my 50 and be done with it.

I recently read that Cook County Coroner's does 17 per day. I could just do three days there and be elegible to sit for the boards.

...except that if a certain number (not sure exactly) of the 50 must be in-hospital autopsies. A medical autopsy is really quite different from a forensic one.

 

[Patholog]

I should do a week elective there, get my 50 and be done with it.

I recently read that Cook County Coroner's does 17 per day. I could just do three days there and be elegible to sit for the boards.

I realize you were being sarcastic, but for those who may not know...just cutting in the case does not mean you get credit for the post. You are supposed to look at all the slides, assemble all the necessary ancillary studies and write the report. If you just cut, you can't (and shouldn't) count it.

I wish my program would cut you off after 50 posts, but alas, here I stumble along with 95 and still 10 months to go...

 

[djmd]

I realize you were being sarcastic, but for those who may not know...just cutting in the case does not mean you get credit for the post. You are supposed to look at all the slides, assemble all the necessary ancillary studies and write the report. If you just cut, you can't (and shouldn't) count it.

I wish my program would cut you off after 50 posts, but alas, here I stumble along with 95 and still 10 months to go...

What program are you in where you got 95 solo autopsies?
Or are you in one of those porgrams where everybody helps with every case so you have three residents per case.

 

[mlw03]

perhaps someone could indulge me as to why the dislike of autopsies? is it just a lot of busy work in most cases and you have a pretty good idea of the cause of death before you even start the case, is the the "yuck" factor, or something else?

 

[Cabbage Head]

perhaps someone could indulge me as to why the dislike of autopsies? is it just a lot of busy work in most cases and you have a pretty good idea of the cause of death before you even start the case, is the the "yuck" factor, or something else?

At first it's the yuck factor, then it's the paperwork/annoyance factor.

 

[anencephalic]

At first it's the yuck factor, then it's the paperwork/annoyance factor.

And then there's the time factor...especially if you're doing them solo without a diener/PA.

Do "problem oriented" or "limited" posts count as credit towards the 50 posts needed for board eligibility or do they need to be complete posts?

 

[Patholog]

What program are you in where you got 95 solo autopsies?
Or are you in one of those porgrams where everybody helps with every case so you have three residents per case.

I am at a fairly large midwestern program with 18 residents and over 400 autopsies per year, so no, there is generally one resident per case. In addition, we do every evisceration with only minimal support from the mortician/autopsy technician, so needless to say, we get pretty good autopsy training. That number does not include fetuses under 20 weeks, as you can't count those.

I do have a few cases where I was secondary prosector, as I was assisting an extern (PSF) or a brand new resident on how to do a post as a more senior resident, but the board says you can only count 10 secondary prosector cases towards the 50, so my number is only those that I can count.

 

[anencephalic]

Just because I don't mind doing a post or two or ten in one week doesn't mean I want to do them. They were tolerable, except the several I did on the 350lb + morbidly obese. But I would rather put a hot poker in my eye than do more than I have to (with regards to posts).

I had an autopsy on a 400 lb + gentleman...his weight exceeded the capacity of our morgue lift. I ended up doing the post on the refrigerator tray so I wouldn't have to move him.

 

[Patholog]

And then there's the time factor...especially if you're doing them solo without a diener/PA.

Do "problem oriented" or "limited" posts count as credit towards the 50 posts needed for board eligibility or do they need to be complete posts?

As far as I know, they count. There have been residents who have only had to do a lung biopsy or liver biopsy or something like that and they get counted as posts, per our autopsy director. It's kind of unfair, because obviously the work is less. That being said, I had a brain only post in a 23 year old with a neurodegenerative disorder of undetermined etiology that took like 3 months to sign out, because it was so complicated. So not all partial autopsies should be assumed to be easy.

 

[TPS report]

The worst news that I ever got was that I couldn't use my 28 posts from my post-soph year towards AP BE. 🙁

😍 😍 😍 😍 😍 😍 😍

UCSFBound ---wanna look at my TPS report...?!😍 😍

 

[TPS report]

The worst news that I ever got was that I couldn't use my 28 posts from my post-soph year towards AP BE. 🙁

😍 😍 😍 UCSFBound --your icon excites me

 

[djmd]

UCSFBound --your icon excites me

Yours scares me.

 

[DarksideAllstar]

I had an autopsy on a 400 lb + gentleman...his weight exceeded the capacity of our morgue lift. I ended up doing the post on the refrigerator tray so I wouldn't have to move him.

Ha...refridgerator tray. Well three of my five morbidly obese patients were brought down to the morgue on their "specially ordered" beds that inflate and weigh the mutha****as. We did the posts on the beds and it was horrific trying to eviscerate these MO's (as I call them) because your back hurt like hell leaning waaaaay over trying to get in there. They all had expired the previous afternoon/night so they were toasty warm on the inside (and autolyzed) due to all that insulation. The smell was godawful. The micro on these people was virtually worthless.

I think the worst posts are the "we suspect sepsis". I'm like, "uh, did you get any blood cultures?" Since when do you need a post to dx sepsis. Ahh, the good old days....

 

[DarksideAllstar]

😍 😍 😍 😍 😍 😍 😍

UCSFBound ---wanna look at my TPS report...?!😍 😍

I'll check out your TPS report, but first I am gonna need verification that you yourself aren't morbidly obese. I'll need a pic of you holding a piece of paper that says "I heart TPS reports". Umm...yeah.....right.

 

[LADoc00]

Umm TPS report.....

WTFFFF?!! Im gonna need official RL pic verification. PM me.