Bone and soft tissue pathology

[FLY1]

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Hi everyone,

I have some questions about Bone and Soft Tissue (BST) pathology and I was hoping you could help me answer them.

1. Is BST completely worthless outside of big academic centers?

2. Why is there less BST jobs on pathoutlines than almost every other subspecialty? Is it because of the low volume? I am surprised because, at least in my institution, most attendings are not comfortable signing out BST cases except the fellowship-trained one. It seems like a very interesting specialty to me but the low demand is kind of pulling me back from doing a fellowship.

3. What are the 3 best BST fellowships in the country?

4. Is BST and GI a weird fellowship combination?

Thank you!

 

[caffeinegirl]

Think about where your specimens come from - from very specialized Orthopedic Oncology surgeons, and the tumors themselves are very rare and require expert resection and multidisciplinary treatment. This can be found in large academic centers as well as healthcare systems (ie. Kaiser). You won't find the need for specialized fellowship trained BST pathologists in private practice - the patients with biopsy+ osteosarcs for example get referred to such academic centers. And, because they are so rare, the private practice pathologist will most likely send it to an academic center for consultation anyway.
If you want to do BST, go to an institution that has such a multidisciplinary team for training. MGH has a great program with lots of volume. Andrew Rosenberg is now at UMiami, and is also a great mentor. Sharon Weiss at Emory, Chris Fletcher at BWH, Steve Billings at Cleveland Clinic are just a few others.
BST and GI is a weird combination - and would only work if you want to work in academics and cover multiple services in a subspecialized environment. A few of the attendings at MGH, for example covered both services.
A common combination is BST (with emphasis on soft tissue) and dermpath. Alex Lazar, Jerad Gardner and Steve Billings are great examples of this combination.

 

[Mint-Berry Crunch]

Hi everyone,

I have some questions about Bone and Soft Tissue (BST) pathology and I was hoping you could help me answer them.

1. Is BST completely worthless outside of big academic centers?

2. Why is there less BST jobs on pathoutlines than almost every other subspecialty? Is it because of the low volume? I am surprised because, at least in my institution, most attendings are not comfortable signing out BST cases except the fellowship-trained one. It seems like a very interesting specialty to me but the low demand is kind of pulling me back from doing a fellowship.

3. What are the 3 best BST fellowships in the country?

4. Is BST and GI a weird fellowship combination?

Thank you!

Current pathology resident and future BST fellow...

1. BST is for the most part worthless outside of big academic centers. However, there are a few larger private practices that see enough volume to employ someone with BST training (but very rare).

2. There just isn't that big of a need for BST trained pathologists. Consider that sarcomas compose ~1% of new cancer diagnoses per year and you will understand why. Interestingly, in my institution, none of the pathologists that sign out BST have done a fellowship in it, but we see enough that they are comfortable signing them out.

3. It is hard to say which is the best, but there are not many choices to begin with. This past year there were only 6 programs with stand-alone BST fellowships: Cleveland Clinic, Mayo Clinic, University of Michigan, MD Anderson, UPMC, and UPENN (U Miami recently opened a fellowship). Traditionally, there are three other programs, Emory, UF, and UW, who have fellowships but last I checked Emory had closed their fellowship since Weiss retired, UF is in Limbo because Dr. Reith left to go to Cleveland Clinic. Not sure about UW's situation. BWH is a pseudo fellowship as you only spend about 3 months with Dr. Fletcher. The orthopedic fellowship at HHS is not a bone and soft tissue fellowship. The majority of the specimens are benign bone diseases and almost no soft tissue, although you do spend 3 months at MSKCC and you may see some there. Other programs with surgical pathology fellowships may allow you to do a subspecialty focus in BST. Although the job market for BST is small and will restrict you to large academic medical centers or referral labs, if you love it I would do it.

4. BST and GI seems like a weird combination, but in my experience it is not uncommon. As stated above, a better combination is BST and dermpath. At least with this combination you have a choice of either academic or private practice setting with many more options.

 

[SunBakedTrash]

Why not just pick one and apply yourself? Become the best pathologist you can be. There is so much to know that you can spend your entire career learning the intricacies of just soft tissue pathology or medical liver pathology. Just do some electives in the other one as part of your residency or fellowship. I understand the job situation sucks but sometimes I think some of you just like pain.

 

[deleted314957]

Look for Jerad Gar(d?)ner. he is a cap/politically connected , young academic who did soft tissue with Weiss and then, i think, derm.


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[FLY1]

Thank you all so much for your replies. I actually already have a GI/Liver fellowship lined up. That is why I was asking about the GI/BST combo.
I do enjoy BST (well, at least the soft tissue part), but I don't want to waste a year of unnecessary training if it's not going to improve my job prospects (especially that I am still not fully decided on PP vs academics).

 

[hurrycane]

IMO BST would not make a tremendous difference job-wise. GI is definitely more marketable.
Gardner for example is more of a derm person, then a BST person.

 

[caffeinegirl]

I would not do a BST fellowship after GI. First figure out where you want to do PP vs academics - that is the most important branch point. Then you can decide about BST. There are also plenty of soft tissue CME courses that you can take at annual meetings (CAP, USCAP, ASDP) or seminars that would increase your expertise without a fellowship. See https://www.pathcme.com/2018hpc_stpath_sch/

Thank you all so much for your replies. I actually already have a GI/Liver fellowship lined up. That is why I was asking about the GI/BST combo.
I do enjoy BST (well, at least the soft tissue part), but I don't want to waste a year of unnecessary training if it's not going to improve my job prospects (especially that I am still not fully decided on PP vs academics).

 

[hoeround]

there are some "famous" pathologists who have GI/ST background - Goldblum, Montgomery, Hornick off the top of my head. That said, agree not a terribly useful combination, even for academics.

 

[alpinebrook]

Vikram Deshpande at MGH does both GI and BST (though he's more of a GI guy).

 

[maxxor]

Vikram Deshpande at MGH does both GI and BST (though he's more of a GI guy).

For context, only G. Petur Nielson at MGH does solely BST. The other 3 have something else they read:
Vikram - GI
Ivan Chebib - Cytopath and has an FNA clinic
Yin Hung - Lung