Best path to Dermatopath: Derm vs Path

[GeneralTso]

Im an MS2 and I've trying to decide whats the best way to land a Dermatopath position. I think I have the numbers and the recs to land into Derm but its Dermatopath that I want to get into ultimately (I dont want to be a cosmetics ***** or treat warts or acne) . Considering how path is not that highly ranked I think I can land at the top of the heap in path programs or land a spot into Derm with no guarantees about the quality of the program.

For any you Path residents, is it true that the path fellowship of choice can be secured if you go through path and end up at a place like Harvard. I know that IM works in this manner where people can be virtually assured of a Cards or Allergy fellowship. I just want to plan accordingly and avoid the bs of matching into Derm.

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[pas]

It's easy to get into path, but it is not easy to get a Derm fellowship. If you want to be a dermatopathologist the best route would be to go through a derm residency. The numbers I've heard are this: about 80% of the fellowships are filled by pathologists because there are not enough dermatology residents applying. It is more desireable to have a derm trained fellow because they know the clinical scenarios so good. For example, tell a pathologist that this lesion is a granulomatous lesion on the back of a 12 year olds hand and they will give you a blank stare. Tell a derm resident that and immediately they will know they may be looking at granuloma annulare.
I wouldn't knock dermatology so much if I was you. I just did a rotation through derm and enjoyed it very much. There is a lot of acne and eczema and alopecia in peds derm, but in adults there are a lot of cool diseases that I saw, not to say the challenge of melanoma.

 

[pas]

I forgot to say that the path to a dermpath fellowship is very competitive and you cannot guarantee getting a fellowship coming from the path side of things. There are a lot of cool sub-specialities in path besides derm.

 

[GeneralTso]

Thank you Pas for weighing in. Gave me lots to chew on.

Im looking at the MS4s at my school with about 10 derm candidates and they're telling me how even more abritrary the match has become in derm with getting interiews much less a spot. We're also talking about >30 apps per person which is a heavy chunk of change (for me I guess I would have to go back to Amex financing) and interviews for some in single digits which a few people getting the disporportionate rest. We're talking about some the best in my class with >230-240 boards who are subjected to a major blow in their self-esteem and the prospect of not matching. Its a sucky situation to voluntarily place oneself.


About that 80% figure. You dont think its because Dermatopath is run by path rather than derm that its skewed toward that way. Iv heard the stuff about how Derm people can correlate more readily clinically and I suppose its plausible that the allure of cosmetic lasers and Mohs is too good to pass up for some but still wanted to get your perspective.

 

[Ironchef2]

Just a quick ?

why is a dermpath fellowship so competitive/sought after/popular?

And GeneralTso, as an MS2, how do you know you only want to do dermpath and why?

 

[GreatPumpkin]

Money is a very big draw to dermpath. Also, very low key comfortable job with little patient interaction. This appeals to some.

Personally I think both ways are viable for getting into dermpath. Your final job will be much more like general path than general derm. So make sure you like path before you go either route.

It is very very unlikely you could get a secured spot in dermpath upon entering residency. I have heard of one person doing this, but this person worked as a researcher in the program for years prior to entry into residency.

 

[lutz]

GP,
What are the criterion used to judge the applicants for dermpath fellowships?

Do Board scores from Med school come into play? or is it just recommendations from Profs during residency?

OUT

LUX

 

[GreatPumpkin]

Lutz more than anything for getting a dermpath fellowship it seem who you know, who you work with (ie research) and then maybe scores. That is why I believe if you really want to go Derm you need to go to a place with a dermpath fellowship from day one. And, immediately get involved. Even then getting one is still questionable. But, there are other parts of path that are just as interesting if not more so that are much easier to get into.

 

[pas]

I heard it's because surgical fellowships and just plain old dermatology is more interesting than dermpath to most derm residents. I couldn't disagree more though.

 

[DermpathDO]

generalTso
as you can see by my id I am a dermatopathologist. I trained in pathology and did a dermpath fellowship with Dr. A Bernard Ackerman when he was in Philadelphia.

You need to decide what you want to do specifically. The derm pathway is going to be much, much more difficult because of the competition. I have counseled many students who have tried hard to get into derm residencies and failed. This was not because they weren't good students or had poor scores. Many of these students were top 1/4 of thier classes, did research, schmoozed with the program directors. Everything they were told to do. Derm is tough because of many people, fewer slots, and politics.

Yes it MIGHT be better to go Derm route to dermpath, because of the afore mentioned clinical experience. However, any well trained and interested Pathology trained Dermpath, is just as good. Espeically if he or she concentrates on clinical derm during their training/fellowship and keeps up on Derm literature. Currently there is demand for pathology trained dermatopathologists, because managed care programs send their cases to big reference labs, who need dermpaths to read them. The reference labs generally do not hire Derm trained Dermpaths, unless they are a lab like Derm Diagnostics(a division of Ameripath). Getting into a Dermpath fellowship is the hardest part in either Derm Route or Path Route. You have a long way to go, but I am glad you are thinking about it now...
If you want more information, feel free to email me.

 

[eiroc]

Hi all,

Just reading through some of the responses and I thought I would give my 2 cents.

I think dermpath is appealing to a lot of the residents in my program because 1) most residents realize that a significant percentage of what you read as an outside pathologist will be skins, therefore, the skill of being a dermatopathologist makes you very marketable when you graduate. 2) At my program, one of our best teachers is a dermatopathologist, hence we interact with him a lot and he motivates quite a few residents into the field. 3) It's a challenging and fascinating field that probably has a greater spectrum of dieseases than any other organ system in the body. For example, some poeple find looking at skins all day more intellectually stimulating than, say, prostate biopsies.

I think everyone has made some good points, but I don't think it is necessarily better to come from dermatology than pathology if you are thinking of going into dermpath. It's true that some programs may favor derm residents, but I find the opposite to be true at my institution. I agree 100% with great pumpkin; a lot of it is who you know. Where I am at, if you're a resident and you want to do dermpath, you've got a huge advantage over a person from the outside, whether you're from dermatology or pathology.

I also think that it is not necessarily an advantage to be coming from derm. As a dermpath fellow, whether you are dermatology or pathology trained, you still do clinic and you still see patients during the fellowship. Now, I would never say that by just doing clinic, a pathologist will be at the same level as a dermatologist, but it's not like the pathologist will be completely clueless when they encounter clinical scenarios. As a matter of fact, you can't practice dermpath without knowing clinical histories, and most pathology trained dermpath people know the clinical aspects pretty well. It just comes from interacting with dermatologists on a daily basis. Now, you can turn it around and say that the dermatologist has the disadvantage when it comes to dermpath training because they don't have the experience of looking at other tissues in the body. Someone like Ackerman who comes from a dermatology background may know his dermpath better than anyone in the world, but get a metastatic lesion from another part of the body to the skin, and I guarantee that specimen is going out for consultation. It works both ways and there are strangths and weakness coming from both disciplines.

ANyhow, good luck in your decision.

 

[GeneralTso]

Originally posted by Ironchef2
Just a quick ?

why is a dermpath fellowship so competitive/sought after/popular?

And GeneralTso, as an MS2, how do you know you only want to do dermpath and why?

I think its the perfect wedding of an interest in skin and path/rads type work. The money to be made also is a plus considering Ive looking at close to 200K in loans.

Low patient interaction, more intellectually stimualting work in the derm field comapared to Mohs/Cosmetics/G Derm, is also a draw but to a much lesser extent.

 

[GeneralTso]

Thanks DermpathDo for sharing your experiences and insights.

Could you elaborate on how the career paths differ for derm trained Dermatopats versus Path trained. I thought as a Dermatopath, working in a reference/diagnostic lab was a common endpoint but you seem to suggest otherwise. What excatlty is the difference careerwise if you decide to go derm rather than path.

Also, whats the trends been like in reimbursements for dermatopath (i.e. melanomas, etc. etc). I know its a volume business but it seems path always seems to get screwed over time by insurance unlike rads.

Just out of curiopsity, whats the 411 on Bernie Ackerman. Even thought the guys a pretty prominant fellow in the dermpath field, Ive heard some sketchy things about him operating in NYC.

Thanks for sharing.

Originally posted by DermpathDO
generalTso
as you can see by my id I am a dermatopathologist. I trained in pathology and did a dermpath fellowship with Dr. A Bernard Ackerman when he was in Philadelphia.

You need to decide what you want to do specifically. The derm pathway is going to be much, much more difficult because of the competition. I have counseled many students who have tried hard to get into derm residencies and failed. This was not because they weren't good students or had poor scores. Many of these students were top 1/4 of thier classes, did research, schmoozed with the program directors. Everything they were told to do. Derm is tough because of many people, fewer slots, and politics.

Yes it MIGHT be better to go Derm route to dermpath, because of the afore mentioned clinical experience. However, any well trained and interested Pathology trained Dermpath, is just as good. Espeically if he or she concentrates on clinical derm during their training/fellowship and keeps up on Derm literature. Currently there is demand for pathology trained dermatopathologists, because managed care programs send their cases to big reference labs, who need dermpaths to read them. The reference labs generally do not hire Derm trained Dermpaths, unless they are a lab like Derm Diagnostics(a division of Ameripath). Getting into a Dermpath fellowship is the hardest part in either Derm Route or Path Route. You have a long way to go, but I am glad you are thinking about it now...
If you want more information, feel free to email me.

 

[DermpathDO]

Originally posted by GeneralTso
Thanks DermpathDo for sharing your experiences and insights.

Could you elaborate on how the career paths differ for derm trained Dermatopats versus Path trained. I thought as a Dermatopath, working in a reference/diagnostic lab was a common endpoint but you seem to suggest otherwise. What excatlty is the difference careerwise if you decide to go derm rather than path.

Also, whats the trends been like in reimbursements for dermatopath (i.e. melanomas, etc. etc). I know its a volume business but it seems path always seems to get screwed over time by insurance unlike rads.

Just out of curiopsity, whats the 411 on Bernie Ackerman. Even thought the guys a pretty prominant fellow in the dermpath field, Ive heard some sketchy things about him operating in NYC.

Thanks for sharing.

Gen Tso
Sorry to take so long to reply....Life has a way of getting in the way!
I wish i could relate what the difference is careerwise for the derm route vs the path route to Dermpath....Most of those who I have met duirng my fellowship went to doing dermpath in reference labs or large group practice....Usually as a Derm doing the dermpath for that group. Those who were derms who selected the route of doing the dermpath for a large group are doing it in either an academic practice or a veyr large private group. As such they have the chance and the time to actually see patients in the clinical setting. They may actually be required to spend some time in the clinics seeing patients. The pathologists who did dermpath, either went to a large reference lab, went into an academic setting, or like me did a mix of academic and anatomic path in hospital/academic setting. There is a large range of routes you can choose in either derm or path setting. Spend the time in your clinical rotations to look them up. Research is always an option if that is what you choose.

As for the 411 on ABA....I havent been in touch with Bernie over the last few years.....not thru any fault of his.....my current job keeps me busier than I would like ... and the opportunity to do some CME with him is not easy. His new program in New york is the Ackerman Academy..his own brainchild...and really if you wnat to take the time to do a rotation with him...it might be worthwhile. of course there are other demrpath programs to do short rotations with....look them up and choose the best for you.

 

[sleep deprived]

General TSO,

What sketchy things have you heard about Dr. Ackerman, please tell. Just be sure that you clearly state what you have heard is "hear say" in your reply. But please tell me, it is really important. Maybe I can e-mail you if you don't feel comfortable posting. That would probably be better.

 

[Jara]

Hello.... I'd be interested to know a little more about Ackerman, if anyone knows.
Does anyone know where we can get an idea of the current dermpath fellows and where they came from?

Thanks!

 

[Edamat]

Very informative stuff..... I was wondering if anyone had an idea of just how competitive dermatopath is (i.e. how many applicants per spot). I found the following info on FREIDA about dermatopath

Number of accredited programs 54
Length of accredited training 1
Minimum number of prior years required 4
Offers graduate year 1 positions, available immediately upon medical school completion No
Average number of PY1 interviews 6.0

Residents
Total number of active residents/fellows 62
Average number of residents/fellows 1.1
Average percent female 44.8%
Average percent international medical graduates 14.5%

Wasn't sure but does this mean that there are an average of 6 people interviewed for every 1 spot? Does anyone know how many apply vs. how many are granted interviews? Thanks!

 

[KeratinPearls]

Very informative stuff..... I was wondering if anyone had an idea of just how competitive dermatopath is (i.e. how many applicants per spot). I found the following info on FREIDA about dermatopath

Number of accredited programs 54
Length of accredited training 1
Minimum number of prior years required 4
Offers graduate year 1 positions, available immediately upon medical school completion No
Average number of PY1 interviews 6.0

Residents
Total number of active residents/fellows 62
Average number of residents/fellows 1.1
Average percent female 44.8%
Average percent international medical graduates 14.5%

Wasn't sure but does this mean that there are an average of 6 people interviewed for every 1 spot? Does anyone know how many apply vs. how many are granted interviews? Thanks!

I know for a fact a Midwest dermpath University program receives 100 applications for one spot. GOOD LUCK! You're premed. What are you doing looking into fellowships. You better put your effort into getting into medical school first!

 

[pathstudent]

I wonder if generaltso ever made it

 

[yaah]

When a lot of people apply for dermpath fellowships they apply to all the programs, so yes, fellowship programs get a lot of applications and can be selective in their interviews. I had thought there were more than 54 programs now though, there seem to have been many added in the past 3-4 years. A lot of reference labs are adding fellowships. Many dermpath fellowships also don't really even interview anybody, they just take a qualified internal candidate, although that can vary year to year depending on whether an interested qualified candidate is there.

The statement about "minimum number of prior years required" is wrong though. Some do dermpath fellowships after 3 years AP-only residency.

 

[KeratinPearls]

When a lot of people apply for dermpath fellowships they apply to all the programs, so yes, fellowship programs get a lot of applications and can be selective in their interviews. I had thought there were more than 54 programs now though, there seem to have been many added in the past 3-4 years. A lot of reference labs are adding fellowships. Many dermpath fellowships also don't really even interview anybody, they just take a qualified internal candidate, although that can vary year to year depending on whether an interested qualified candidate is there.

The statement about "minimum number of prior years required" is wrong though. Some do dermpath fellowships after 3 years AP-only residency.

I wonder if the dermpath/GI/GU path market will be saturated in the future to the point salaries would drop. I've heard of institutions trying to start up a derm and GI fellowship. Do you think it can get to the point where the market is saturated like in the current market for general pathology?

 

[pathstudent]

I wonder if the dermpath/GI/GU path market will be saturated in the future to the point salaries would drop. I've heard of institutions trying to start up a derm and GI fellowship. Do you think it can get to the point where the market is saturated like in the current market for general pathology?

No. Baby Boomers are getting older and older which means more and more skin, prostate and GI biopsies.

The only thing that can ruin it is if medicare ratchets back rates.

 

[exPCM]

Wow - not often are threads revived almost 7 years later.
I did a double take reading about rotating with Dr. Ackerman - he has been dead for more than a year.

 

[dermpathdoc]

Wow - not often are threads revived almost 7 years later.
I did a double take reading about rotating with Dr. Ackerman - he has been dead for more than a year.

Yeah,
I was reading the posts and going what the heck..never even looked at the dates, then ran into my own reply...then i knew it was a very OLD thread....
usually there is a BUMP warning...
Ah well...I miss Bernie.

 

[pathstudent]

From what I have heard from Dermpaths that didn't train with him is that he was a big pompous jerk-off. Is that true at all?

 

[KeratinPearls]

From what I have heard from Dermpaths that didn't train with him is that he was a big pompous jerk-off. Is that true at all?

True story. Ackerman was giving a talk and someone brought up an issue (cant remember...I think it had to do with him receiving money as an academic), and he basically chewed the guy out in front of everyone and threatened to sue the guy for slander.