Best Fellowships
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You're gonna have to do better than that.
georgewbush said:
The most mad wicked fellowship combo would be a year of D-path and a year of GI path, or a year of D and a year of GU (with heavy emphasis on prostate).
You could get a good job making serious bank for a top notch private group. You'd be moneymaking machine.
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LADoc00 said:Okay...
OKAY.... I DON'T GET IT
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b&ierstiefel
It's a picture of a b*tchslap.
I don't read japanese but I can venture a guess...the caption probably reads "OWNED!" or "PWNED!" or "OWN3D!" or "PWN3D!"
I don't read japanese but I can venture a guess...the caption probably reads "OWNED!" or "PWNED!" or "OWN3D!" or "PWN3D!"
Okay, you are right that was a weak post. What are the best surgical pathology fellowships, i.e. MGH vs. Wash U vs. Sloan-Kettering vs. MD Anderson, to name a few.
dermpathlover said:
So if you did that and you were in a partnership group you would be...
Signing out the most cases, and then the "bank" you make gets split between the partners...
Man, I want to work where you work, Sign out all those skins and prostate bx, and then I get a cut of all your work... sweet.
georgewbush said:
What's your goal? "Best" is a relative term - the ones you list aren't not the same format nor do they tend to train the same types of people. MSKCC almost always go into academics. MGH people tend to subspecialize in something. It varies.
AndyMilonakis said:
Why does he PWNED me?
dermpathlover said:
If you are dermpath trained, then you're going to be cranking out skin stuff all day, everyday (well, at least 4 days a week). I can't think of any possible benefit of doing an added GI or GU fellowship (not to mention the opportunity cost of wasting another year).
B
b&ierstiefel
Beats the hell outta me. I'm just trying to interpret the picture, man.dermpathlover said:
AndyMilonakis said:
I just think D-path and GU or GI would make you a potent force in trying to develop and maintain a group's out-patient path empire! Most private groups won't have enough material for you to sign-out only D-path, but if you could split your time doing D-path, Prostate-path and doing some of their surgical work, you would be a huge money maker. Plus after awhile they would have to start paying you more than they are making because once you have your biz built up you could split the group and just be a path king-pimp signing out 15,000 cases a year at 1.5Xmedicare. $$$$$
B
b&ierstiefel
Dude I wasn't trying to argue otherwise...yeah, if excess skillz pay the billz, then more power to ya. Now to interject my opinion on this thread...I believe that if you have more skillz, you have more job opportunities opening up and that's great. But if you do come with multiple skillz, then "the Man" can make you do more work and the increase in your compensation for your services may not be linear...and THAT, my man, is NOT cool. But this mentality may be more inherent in academics.dermpathlover said:
dermpathlover said:
Be aware, there comes a point when too many fellowships are a drawback. If someone does three fellowships that aren't necessarily related (like GI, Derm, and cyto) many employers will shy away (based on what I have heard). They want people to focus and be an expert in a specific area. Most would have little use for someone with two unrelated subspecialty fellowships.
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yaah said:
Depends, if you are in a small community and a group is looking to have multiple areas covered with minimal seats at the partnership table, derm+something like heme, GI, GU or cyto becomes very attractive. But otherwise, big groups tend to want a specialist in one area, not someone with 4 board certifications. Big group is say 14+ pathologists up to 44 (which I believe is the largest in the US, based in Wisconsin).
^That's the page that I am on! Smaller group! Bigger paychecks!
LADoc00 said:
Yeah, but good luck getting a derm or GI or GU fellowship if you've already done or will do one of the others. If you were running a derm fellowship, for example, would you take someone who was planning a surg path and a GI year for the two years prior?
yaah said:
Sure why not?
dermpathlover said:
Because you might come off as flighty, indecisive, and lacking dedication. Maybe you get bored easily, so you have to mix it up. Then there is the whole "jack of all trades, master of none" idea.
A group that is big enough to need a GU specialist is big enough to need one full time. Most smaller groups appreciate that you have a niche, but are also well served by a good generalist who can competently sign out anything and make accurate frozen sections.
I'm not completely sure why you would need a GU fellowship with emphasis on prostates anyway. There is basically one disease you are going to see in the prostate. You are going to have some difficult cases because you are dealing with only a few suspicious glands. On those occasions, you have immunos and if that still doesn't do it for you, then you can send the case off to an expert in prostate pathology (who won't have a second fellowship in dermpath and is mostly likely not making bank at an academic center, by the way). Why would a group pay a premium for a prostate specialist when they might have 2 cases a month that they would otherwise have to send out for consult?
You are not going to make more money with multiple fellowships. Trust us.
yaah said:
Not following you. Actually, many dermpath fellowships require you have done either a full AP/CP residency or AP+1 fellowship before you do dermpath. Besides, you are applying like years in advance, sometimes 2-3. In fact you might even be applying for dermpath BEFORE you are applying to fellowships of the year prior.
And if I was running a dermpath fellowship program, I would heavily weight experience even to the point of marketing the fellowship specifically to practicing pathologists with >2 years of work experience. That would provide me with a chance to learn from them.
B
b&ierstiefel
Yup. I am seeing this with my very own eyes. You gotta apply 2 years in advance and you have to accept the possibility that you will be doing your dermpath fellowship at a different institution. Thaaaaat...suuuuccckkkss!LADoc00 said:
AndyMilonakis said:
You definitely have to apply 2 years in advance, but you need to get the process going 3 years in advance in terms of making contact and greasing the wheels.
I think you people are missing the point. It is not like by doing GU Path that you are saying that you will never look at anything but prostate and bladder biopsies again. Same thing with Skin, GI and even heme. You do these fellowships so that private groups can have a "specialist" in the group in order to placate clinicians and for attracting new business. Hell, you might not even look at prostate biopsies more often than other people in the group, and hell doing a year fellowship won't give you any expertise over people that have been looking at prostates or GI biopsies for 20 years, but it sure helps get your foot in the door.
A lot of you are stuck in academics mind frame where you need to "demonstrate committment" and "have an area of interest" where that's all that you will do and it doesn't make sense to be trained in different areas. That's academic BS.
But even in big academic centers the prostate "specialist" spends 1-2 hours a day signing out. How could a private practice guy even get 4 times as many cases.
You should definitely do 2 fellowships (Cyto+Heme, GI+Heme, Derm+Cyto, GU+GI, and so on) to really land a great job and be ready for the future when general pathology whithers as a moneymaking business.
dermpathlover said:
I dont know if I would say "definitely" but piggybacking GI or derm on almost any resume seems like a good idea these days. The problem is these fellowships are so insanely rare, we are back at the main of issue of residencies training WAY THE HELL too many people.
LADoc00 said:
Fellowship directors don't want to train someone (from what I hear) who doesn't have great plans to focus on that area. Why would they give someone a GI fellowship if they were doing derm as well? Why not give it instead to someone else (since there are other good candidates) who is going to focus on GI? This is why it doesn't make much sense. Surg path doesn't really count when it comes to this - because it's kind of an extension of residency.
Dermpath is not really a 3 years in advance application, neither is GI/GU, or any really. Occasionally a program will take someone more than two years ahead of time, but not usually. Whether it helps or not to "grease the wheels" and start throwing your name out more than two years prior is anyone's guess. I'm betting it doesn't matter much, but it makes people feel better.
Because residency is now only 4 years required (for combined), realistically if you want a competitive type fellowship (i.e. not Surg path or cyto) you have to apply more than 18 months prior to the start, preferably about 24-20 months prior. Going beyond two years I don't think is going to be standard - what do you do with AP only folks? Make them apply for fellowship 6 months into their training? That's insane.
My proposal would be to have fellowship application timelines, similar to residency. It doesn't work that way now because programs want to act before other programs do, so they can compete and get their choice of candidates before the candidates choose some other place. It is probably reasonable to have an application timeline of submitting applications before the end of december of your third year for a fellowship in your fifth year, and then having interviews in the winter and early spring, and hearing about results then. Of course, that begs the question of what to do if you apply for a competitive fellowship and don't get it, and now you're ****ed because surg path, cyto, etc are no longer available either.
yaah said:
Because it is possible to focus on two different areas. It is possible to pursue two different areas. Kempson didn't restrict himself to a single area. Is he just a "general pathologist".
It sounds like your fellowship directors only want to train academics. The silly part of that is that doing GU, GI or Derm biopsy cases is fairly unacademic. It is about grinding out as many cases as possible in order to get paid. NP on the other hand is a perfect academic field. Fortunately there are some out there that understand there are other options.
dermpathlover said:
If you are dermpath trained, there is no way that spending an extra year to do a GI or GU fellowship is going to provide any benefit. The loss of a year of attending salary compounded over 30 years could easily cost you 1-2 million dollars. And for what gain? A group isn't going to pay you more than dermpath salary just b/c you have an unacredited fellowship in GI. To ensure a job? I don't know of too many dermpaths who are having trouble getting a job. To ensure your marketability in a changing marketplace? Maybe, but that's some expensive insurance. And as pointed out, things are changing. Maybe GI will be a boarded fellowship in the future (rendering your training obsolete) or medicare and insurance companies decide to only pay 5 bucks per colon biopsy.
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CameronFrye said:
Here's my take, lets say you spend 2 years doing general AP, then maybe a third year doing a GI fellowship, since its unacred it doesnt matter that you arent BE before you do it. Then you do a year of dermpath. 4 years and you got a solid skill set to be able to sign out general path with a derm focus. That would be one way to go. Another would be to simply do 4 years of AP/CP sit for boards and dermpath. Total of 5 years.
Now....lets say for a moment you had 5 years to play with:
1. General AP residency
2. AP PGY2
3. GI fellowship
4. GU fellowship Sit for AP boards
5. Dermpath fellowship
6. Surg path job, Sit for dermpath boards
Notice Im forgoing CP, which is risky but Im building such a powerhouse CV it wont matter. You COULD substitute GU for hemepath and market yourself as having CP training via hemepath year if it was conducted under a lab medicine residency program and not an AP department. Interesting, being CP boarded is not a requirement many places to run transfusion medicine services, micro, chemistry or even blood banks. You are bringing the ultimate outpatient biopsy resume to the table, almost a 3-man team in one guy.
Now, should GI or GU ever become board certifiable, you can be grandfathered in as they did for dermpath long ago and just test for the certificate. Theoretically, you end up quadruple board certified (AP, GI, GU and Derm) for only 5 years of training.
I would say that training template MAY be the single most optimized path in the current market.
to get around PDs inquiring about what you are doing, I would do the last 2 years elsewhere. When Im applying to derm, Im applying simply as a AP resident, year 2. The 2 years between that and derm training will be spent refining the AP skill set, no one will ask ?s. The GU after GI will be the most dicey. For this I would recommend doing a basic research project covering malignancy, something like a transcription factor thing or some other abstract widely applicable B.S. toss away project you can get an easy pub in to prove your "academic creds". Now, the important thing is to get the project rolling asap, so you have some data to flash to derm crowd. Maybe the end of year I. Also I would start at the highest prestige residency I could and accept the fact I might be moving down the academic ladder with each fellowship.
As a model:
Year 1 Brigham and Women's, research project begins in Spring, apply to GI fellowship at BWH, BID AND MGH
Year 2 BWH applying to GU and derm fellowships, getting publication out at least into press.
Year 3 BWH GI fellowship or BID/MGH GI
Year 4 JHU GU fellowship
Year 5 Yale dermpath (somewhat scrub program)
But this is the ideal, it could look like:
BWH
BWH
BID
Indiana
Florida or whatever
dermpathlover said:
Fellowship directors don't necessarily want to train only academics. But they do want to ensure that their fellowship training is at least going to be used for something other than a resume. The truth is, I would say the majority of people who do these extra training years have a desire to focus on that field, if not in academics than in a similar type setting.
And your career plans don't make sense - what do you want to do, make as much money as you can? As has been said, you aren't adding much by having two areas of expertise (or three, or four, or whatever). Of course there are people who are experts in two areas - we have surg path attendings here who are breast + GU experts, some GI + cyto, whatever. Are you trying to be the go to guy for everything? That doesn't make sense either. With enough work, you can be the go to guy for everything, doesn't mean you have to keep doing fellowships, especially in things that aren't board certified.
Go ahead - apply for two different subspecialties in consecutive years. See how much respect you get. But don't say I didn't warn you. It's not only not very realistic but it's silly.
yaah said:
Ill tell you I know for a fact faculty with 4-5 fellowships at top tier programs. Ive known guys who did Surgpath, GU and Heme. I know some of the best earners in private prac rolls with what used to a double knockout punch of AP/CP/Heme/Derm (BCx4). I would guess that with so many people doing mad fellowships, BCx3 or triple board certification will become a standard in some groups. In fact, I interviewed for 400K/3 months of vacation gig that said they only were interviewing people with 2+ fellowships and at least BCx3. Is it silly? YES. Is it happening? YES. Which just goes to show how completely out of whack the job market/overtraining has become. Im currently debating whether to go BCx4 or get an MBA at an evening program.
^Yeah two fellowships (surg path not really counting) is the way to go to remain competitive in the future. Maybe in the middle of nowhere 4+ Surg Path is fine, but in the cities where most people want to be, you better not bring a knife to a gun fight.
You should all consider GI-Cyto, GI-GU, GI-Derm, Cyto-GI, Cyto-heme, and so on.
You should all consider GI-Cyto, GI-GU, GI-Derm, Cyto-GI, Cyto-heme, and so on.
This has got to be a California only thing.LADoc00 said:
Think about it. The only way groups can require 3 fellowships is if there are enough idiots out there with three fellowships. You can't be board certified in more than two subspecialties anyway. Do multiple fellowships make a person a better pathologist or just more marketable in certain places? Maybe we need to do the union thing, demand less training, and blacklist those scabs with 3 or more fellowships. Then groups will have to give out the primo jobs to the smart people who decided to leave the fellowship womb and get real world experience.
RyMcQ said:
Yeah, I'll add a disclaimer to my comments: I have no idea what it takes to be an attractive applicant in California. That place is insane and nothing makes sense out there (path jobs, real estate market, Laguna Beach, etc.).
That being said, I know residents have left our program with zero fellowships and have gotten sweet jobs (but in rural "less desirable" areas). Whatever floats your boat. Different strokes for different folks. (Insert third cliche here). If you want to live in Cali and you have to be triple boarded to get an entry level position, then I guess you better grab your ankles and take it like a man. If you want to go somewhere where you are paid more and there is a cheaper cost of living, then I think you can get by with "just" your dermpath fellowship.
georgewbush said:
Hello everyone. I'm a long time lurker but this is the first time I've posted. Has anyone heard anything about Mt. Sinai's surg path fellowships. I heard they are starting subspecialty/surg path positions for breast, GU, bone/soft tissue, and head/neck. Is this true?
LADoc00 said:
I think this is my issue too. I feel compelled to argue.RyMcQ said:
Seconded. It still doesn't make any sense to me - even if there are some groups out there looking for people with multiple certifications, what does that mean? Who are they trying to impress?
RyMcQ said:
RyMcQ, hear me now and believe me later: We have an IDIOT SURPLUS here that dwarfs our trade deficit with China. Trust me, that group interviewed plenty of candidates with those creds.
This has nothing to do with value or real world and everything to do with the absolute buyer's market when it comes to employers and the massive deluge of applicants.
B
b&ierstiefel
This whole credential inflation in pathology is quite unsettling. Since when was pathology residency/fellowship supposed to be a 6-7 year deal. Hell, that's bordering on like a general surgery residency! 😱LADoc00 said:
Random thought: had dinner with a former colleague in Baltimore the other night...he was saying that a lot of the jobs he applied for were NOT posted. He found out about them by word of mouth (i.e., phone calls made to certain powerful individuals at certain powerful institutions). Thing is...he did PSF/AP/CP (that's 5 years), and then is doing 2 years of fellowship afterwards. Is this what is necessary to get the nice private practice jobs? Not that I'm looking in that direction but it put the whole notion of "credential inflation" in my head. Unsettling.
LADoc00 said:
I emailed an ex-grad of my program who landed a sweet private practice job in North Cali a few years back and asked him what it would take for me to be a competitive in Cali. He said most of the applicants they get for positions are from Stanford, UCSF, and UCLA, with occassional people from USC and Cedars-Siani, and fewer people from around the country like him. He said the majority of applicants from the first three programs have two fellowships in subspecialy areas and that every applicant has at least surg path + subspecialty and that some people even have Surg Path + 2 subspecialites (that is they spent 7 years in residency!) He chalked it up to the number of fellowships in those programs and the ease at which they can get them. Evidently it is the norm out in KALIFORNIA.
These are the fellowships those places offer
UCSF
Cytology Fellowship X2
Dermatopathology Fellowship X2-3
Dermatopathology Visiting Fellowship
Neuropathology Fellowship X2
Liver and GI Pathology Fellowship X1
Surgical Pathology Fellowship X7 according to UCSF bound
Transplant Pathology Fellowship X1 (this sounds like a waste of time)
UCLA
Dermatopathology X2
Neuropathology X2
GI/Liver X2
Transfusion Medicine X1
Hematopathology X2
Cytopathology X2
Clinical Microbiology X2
Surgical Path X4-6
Women's Pathology X1
Stanford
Cytopathology (1 position, contact Dr. Christina Kong),
Dermatopathology (2 positions, contact Dr. Sabine Kohler),
Hematopathology (2 positions, contact Dr. Daniel Arber),
Neuropathology (2 positions, contact Dr. Hannes Vogel), and
Molecular Genetic Pathology (1 position, contact Dr. Iris Schrijver).
Surgical Pathology ( 6 positions our non-accredited "Hot Seat" Fellowship in Surgical Pathology, contact Dr. Gerald Berry),
Autopsy Pathology (1 position, contact Dr. Donald Regula) This sounds popular
Immunopathology (2 positions, contact Dr. Roger Warnke).
Transfusion medicine
That is a lot of fellowships especially if they go mostly to internal candidates.
That one cyto position must be tough to get at Stanford
B
b&ierstiefel
That's the thing...at many programs (especially the top-tier ones), it can be hard to bust into a fellowship from the outside since they can easily fill with internal candidates. One notable exception to this is Harvard Dermpath (and probably other dermpath fellowships out there) which takes applications from all over the country and doesn't give necessarily much preference to internal candidates from MGH, BWH, and BI. If you're interested in a fellowship at an outside program, I would inquire early but not expect to get a sure yes/no answer because they have to wait to see if they will fill with internal folks (who usually get first dibs).dermpathlover said:That is a lot of fellowships especially if they go mostly to internal candidates.
Cyto fellowships, from what I hear, are popular. It's a boarded specialty, gives you a marketable skill, and your work hours are not likely to be too killer. So yeah, the one cyto position at Stanford is probably difficult to snag.
Anyone from Stanford know if that Autopsy path specialty ever fills? It doesn't sound like Forensics, so I don't think it is boarded.
What a waste of time in this day and age.
What a waste of time in this day and age.
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Forensics....waste of time?!? Granted...some Medical Examiners start at salaries lower than Family Practice Physicians, but do you really see it as a waste of time....I personally see it as a necessary art/science that complements our justice system? From the list you posted, Forensics/Tox...etc. didn't even make it in the "Loser Fellowships" category... as you called it.
Now, if you meant it could be better incorporated into the AP curriculum certifying you in both in a shorter amount of time...good point, especially considering you are not making much more than a coroner (who may or may not be a physician) or a justice of the peace who under some states' laws can do the same job as you with far less education.
Now, if you meant it could be better incorporated into the AP curriculum certifying you in both in a shorter amount of time...good point, especially considering you are not making much more than a coroner (who may or may not be a physician) or a justice of the peace who under some states' laws can do the same job as you with far less education.
kittykat said:
I don't think anone here would ever say that forensics is a waste of time and no one should do it, because the impact on our society would be devastating. Forensics was not listed in the loser, winner, whatever categorization that was posted earlier because they were talking about those fellowships that would make you attractive to general private practice (at least that was my understanding, but I did not read all of the posts). One does not go into forensics to become rich, unless you "*****" yourself (as my forensics faculty calls it) when you are an expert witness to anyone with a checkbook. Forensics can be lucrative if done in the right circumstances...ie general private practice group in a smaller area that has a forensics person, because you get 100% of what you bill. You set a fee schedule of $2000/autopsy and you get all of it, because you are billing the local government and not insurance companies. If you are an ME in a government position, you will often make <100K starting, and that is in some awful big cities with high costs of living (I know a guy with a couple year's experience who got 80K starting in a big office in a big city). Dr. Zumwalt in NM makes quite a bit, but he has been doing it for years and years and he is the State ME.
I personally don't think the hassles (testifying, lawyers, report polishing) are worth it unless you have altruistic reasons for doing it. Not to mention it can be so emotionally taxing (child abuse, etc). I really like forensics, though. I came awful close to doing it.
kittykat said:
I don't think it is a forensic pathology fellowship or they would have called it that. I think it is a year doing autopsies at Stanford. Non-boarded not trainied for forensics
PathOne said:
Yeah because sarcomas are so freaking common with so many good treatments. You might as well do a joint transplant pathology with soft tissue and then try to get a job in private practice
