BE v. non-BE fellowships...does it really matter?

[jayman]

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Why is it that some fellowships are BE (board eligible) and others aren't (for example heme, peds, derm, cyto, neuro v. gi, gu, surg path, gyn)? Does being able to sit for another test after fellowship really matter? I've heard some folks say that "they want the official certification," but does it really matter (assuming of course you're interested in the subject material to begin with)?

I guess if something isn't BE, the content can't be necessarily regulated...I mean, what really qualifies as a "GI" or "GU" fellowship anyways...100% exposure to the organ system, "a majority of time spent", or a "focus" in it? But then again making the training flexible is probably a good thing...but then they should just let folks take a test and make it a "boarded" specialty.

And to those out in the community who may not have done a "fellowship" in something per se, but had a focused training in it during residency or surg path fellowship and now are extremely competent in the diagnostics of an organ system(s) having practised for a number of years, shouldn't they be allowed to take a "test" to show their competence and then have the "certification," thus being able to say that they are "certified in X" and can apply for positions that are looking for someone with these credentials? Wouldn't this reduce the shortages in certain subspecialties that we're always hearing about?

The system the way it is seems confusing in terms of a pathologist being able to demonstrate their complete level of knowledge...to me, anyways. I don't think it should make a difference whether you get a piece of paper afterwards, but others may know more about this.

Sorry for what may seem to be a rant...been drinking beer, and now I'm losing my buzz and pontificating. Happy St. Patrick's Day! Drinking resumes in 6 hours with "Eggs and Kegs."

 

[PathOne]

Personally, I think the important thing is the quality of the training you receive, not some fancy piece of paper that you can file away (or frame, if you're really vain).
If somebody has spent a full year full-time focusing on a specific organ system, under the close guidance of a recognized expert in that field, I'm perfectly happy to call them specialists, certified or not.

 

[yaah]

Certain specialties have tests because they want to ensure that there is a curriculum of knowledge that all trainees will know. Surg path subspecialties are not under this category, it's just extra training, and in a good residency program you will see more than enough to become competent in these areas. In that case, subspecialty training is useful if you are academic inclined and are going to focus on that, it is a year to learn the nuances, do projects, etc.

A lot of the training you get in surg path subspecialties is that of pure experience, which allows you to make judgement calls on cases which do not really have an answer that people could necessarily agree on (especially for the purposes of taking a test). For cyto, derm, etc there are lots of additional diagnoses and information you need to know to be a subspecialist, and it can be tested. The reason they don't allow just anyone to take the dermpath boards, cytopath boards, etc, is because they have other requirements, namely for derm that you have seen patients, and for cytopath that you do enough FNAs, all that. But probably the more important reason is that people in the field want to protect their own careers and niches. I feel like if a smart person really studies, they could likely pass the dermpath or hemepath boards without necessarily doing a fellowship in it, but the higher ups certainly wouldn't like that.

Personally, I think people go a little nuts over fellowships, in particular multiple fellowships, as I have posted about before. If you work hard during residency training you can become competent enough in areas without fellowship training.

 

[LADoc00]

There is a HUGE discrepancy is both the real world and perceived value of different Path Fellowships be they BE or not. Many are a waste of time with a IOL (income opportunity loss) of hundreds of thousands of dollars (ie more than the entire meal ticket of your MD degree) while others are a golden ticket. Do your research as to which are worthwhile.

In terms of comparing GI/GU vs. Derm-Cyto-Heme, eventually IMO the ABP will offer exams in these areas (esp given the number of WORTHLESS areas they do offer BC for), having done a fellowship will likely allow you to challenge the exam.

But overall being AP/CP/Heme Derm or Cyto boarded is a nice marketing tool for outpatient business. If I built a practice, and I just did...I would take AP/CP+Hemex1, Dermx1 and a Cytox1 as my base and THEN later add GI and GU(GU would come before GI for my area).

 

[triguy]

I know many people feel that good AP training should be sufficient to be a practicing pathologist, and that fellowship training is mainly a margeting tool to sell yourself. My question is how have people found looking for jobs with only four years of training? Do older pathologists feel that we are being trained well enough to work for them? Maybe we are marketing ourselves to both the clinicians and our future collegues.

 

[yaah]

We have had a couple of private practice paths visit to talk to us here (as well as more academics) and the universal assumption is that anyone out of training, whether they did a fellowship (or multiple) or not, is going to require a certain amount of supervision and hand holding for various lengths of time. Many people doing the hiring seem to want at least some kind of fellowship, but it also doesn't seem to be required, depending on the type of job you want. One guy we met said they hired someone right out of the 4 year residency and she was great. As with everything else, it probably depends on the person. Fellowships are unnecessary for a lot of people, except simply for "proving" your expertise or extent of knowledge. I have been told my almost everyone here that doing an extra year of surg path with my career goals, current skill set, and current fellowship (GU) would pretty much be overkill.

So in short, yes, people have found jobs with only the 4 years, but I'm not sure how many have looked. I haven't heard of anyone who finished the 4 years and tried to find a job and couldn't find one, but like I said I've only heard anecdotal evidence of the converse. I think if you train at a good program you probably don't need a fellowship to do well in community practice provided you work hard during residency and you don't have severe weaknesses in your application (like your personality). But most residents at good programs do fellowships, so it's hard to gauge, especially since you have to apply for fellowships so early. It's not like you have the luxury of waiting until midway through 4th year before you decide if you want to do a fellowship after all.

 

[LADoc00]

We have had a couple of private practice paths visit to talk to us here (as well as more academics) and the universal assumption is that anyone out of training, whether they did a fellowship (or multiple) or not, is going to require a certain amount of supervision and hand holding for various lengths of time. Many people doing the hiring seem to want at least some kind of fellowship, but it also doesn't seem to be required, depending on the type of job you want. One guy we met said they hired someone right out of the 4 year residency and she was great. As with everything else, it probably depends on the person. Fellowships are unnecessary for a lot of people, except simply for "proving" your expertise or extent of knowledge. I have been told my almost everyone here that doing an extra year of surg path with my career goals, current skill set, and current fellowship (GU) would pretty much be overkill.

So in short, yes, people have found jobs with only the 4 years, but I'm not sure how many have looked. I haven't heard of anyone who finished the 4 years and tried to find a job and couldn't find one, but like I said I've only heard anecdotal evidence of the converse. I think if you train at a good program you probably don't need a fellowship to do well in community practice provided you work hard during residency and you don't have severe weaknesses in your application (like your personality). But most residents at good programs do fellowships, so it's hard to gauge, especially since you have to apply for fellowships so early. It's not like you have the luxury of waiting until midway through 4th year before you decide if you want to do a fellowship after all.

Youre AP+CP+Surg Path Year + GU year=6 years? That is a alot, yes another year would be crazy overkill.

 

[yaah]

I'm not doing a surg path year. 5 years total.

 

[deschutes]

Someone told me that it is possible to do a BE-fellowship in between residency years, which doesn't count towards residency, but will allow you to sit for an exam.

I haven't come across anyone who has done this - I can't see the advantage of say, doing a year in cytology before returning to complete years 3 and 4 of residency.

Any takers?

 

[yaah]

Someone here did hemepath between 3 and 4, then came back to do 4th year. Seems like it worked out really well. It might help when looking for jobs because you have that extra year to look and weigh offers.

 

[triguy]

You can do a BE fellowship at any time, but must sit for your general AP and/or CP boards and pass before you can sit for your specialty boards. Surgpath is not BE, so some programs allow their residents to do this year instead of residency electives, and it wouldn't affect their schedule at all. If a cytopath or heme spot was only open during your 4th year, then you could do it, hold off on boards (because if you sat for them at this time the heme would count as part of residency), and finish up your program.

I would be interested in other peoples opinion on this though. Not the actual possibility of doing it, but whether anyone feels it is beneficial. I would say that the only reason to go out of sync is to get a fellowship that wouldn't otherwise be available to you. Other than that, I would stay on track. You will be an entire year smarter and get more out of specialty training, and if you needed, you could change your mind to get a new fellowship/job. If you do a fellowship early, then you are locked in. Not that I would advocate leaving a fellowship that you committed to, but it would put you in the driver seat rather than the program.; In the end, the residency/fellowship has their own interests at heart, not yours.

I may not be representative of this opinion, so please write in if your viewpoints differ on this topic.