CA programs

[sweetymd]

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Does anyone have any input on CA programs-particularly working environment for residents, esp in terms of workload/hrs?

Looking into stanford, ucdavis, ucsd, ucla, uci, ucsf

thanks!

 

[vr4nut]

I am also curious to hear people's input into this one. Basically everyone I ask says Stanford's the top, but what about all the others? I have interviews scheduled with 7 other CA programs (6 in LA) and I need to narrow it down quite a bit.

If nobody wants to try to rank them, are there any that stand out as superior? Any stand out with deficiencies? Are any of them community programs?

Thanks for any input, I know somebody has to know, 10% of the US population lives on the CA coast...

 

[LADoc00]

I hate threads like this because the posters always already have a rank list in mind and are merely looking for support of their opinion and not honest feedback.

Ranking pathology programs is really immaterial. To be fair to programs, I would have to know what the heck your career goals are be they academic, research, community, private groups, corporations, HMOs etc.

I have a real love-hate relationship with California training, on one hand the schools train some solid "scope" pathologists, on the other hand I feel strongly no one is teaching the essential business skills to allow trainees to actually be successful in the marketplace.

Overall, pathology GME is currently a dismal failure, so much so that the very business model that has existed since WWII (with some noteable alterations by insurance and HMO introduction) is being reshaped and not to our benefit.

There is no program, Stanford or otherwise that will get you a guaranteed KO8/RO1 funding track, nor is there one who will have a high success rate of landing you a job in my corporation or other private ones like it (regardless of training includ. derm).

Of course other states and even some CA programs dont even produce solid scope pathologists, so essentially they are 360 degree failures but that is rare. What I have found is the "type" of pathologist who succeeds is predetermined regardless of whether they have cocktails after work at the PF Chang's in the Stanford Mall or the XYZ Bar in SF.

At the end of the day, the program penis measuring is a fruitless exercise from a success focused standpoint.

I will say the bay area programs "attract", and I use that word very loosely, more capitalistic driven residents with Stanford beating out UCSF, but with so much year to year variation I really dont care. Yes Stanford is a whole lot closer to Sand Hill Rd venture capitalists but the alum network of UCSF, a far older and more established program, is much bigger.

Im not mentioning the remainder of California programs because frankly I could write essays on each one.... and Im currently on the beach in Kaanapali. Each program has had a wonderkid resident who due to circumstances was in the right place at the right time with the right set of skills and landed a killer job (see the pathology group in Pebble Beach Ca or SLO).

 

[gbwillner]

Thanks LADoc, let's take a step back.
You state that no program will give you a "guaranteed KO8/RO1 funding track". This certainly happens at other institutions that I'm applying to (of course, they can't guarantee government funding, but they will fund you out-of-pocket for ~3 years and enable you to have enough data to have a reasonable chance at a K08 and then RO1). I was under the impression that UCSF does have such a program, with guaranteed fellowship and funding.
I did not apply to Stanford because I was told by faculty members that they were having funding issues within the department (making it unlikely that they could fund any projects you are interested in pursuing). As I understand it, most research-heavy programs generate enough revenue within the department to help fund you and put you "on track" for grants and faculty positions.
I would appreciate your feedback.

 

[vr4nut]

I hate threads like this because the posters always already have a rank list in mind and are merely looking for support of their opinion and not honest feedback.

No sir. If I knew enough about any of the programs to make a list in my own mind subject to all of my personal preferences and biases, I would do just that so I would know which interviews to attend. If every single CA program is equal, I will just have to flip a coin to decide which ones I have time/money to visit and which I have to cancel.

If I had 8 invites and only time to do 2-3 interviews, I would certainly hope I could use the interviews on the best programs, since I have no other bias to help me differentiate them.

At this point I may be influenced by anyone's personal bias between the schools, because its better than the coin toss method, especially if someone gives at least one reason to support their bias.

And, LADoc00, even though I am interviewing in LA you don't have to worry about me flooding the market because that climate is overall too cold for me to live in long-term for my personal interests. That said, I realize it is perfect for 99.9% of the rest of the population. And thanks for the info about the research funding- I don't know enough yet to even understand what you are talking about there.

 

[malchik]

Thanks LADoc, let's take a step back.
You state that no program will give you a "guaranteed KO8/RO1 funding track". This certainly happens at other institutions that I'm applying to (of course, they can't guarantee government funding, but they will fund you out-of-pocket for ~3 years and enable you to have enough data to have a reasonable chance at a K08 and then RO1). I was under the impression that UCSF does have such a program, with guaranteed fellowship and funding.

I think what LA means is that, even though you may have funding for basically what amounts to a postdoc, this doesn't guarantee you a successful career in academic pathology. I see a few faculty members at my school who come from these types of programs and fail to get R01 funding. I think the best you can do is look at the track record of a place, and ask what percentage of people who have similar goals to mine were able to attain those goals. And even this is going to have limited value because of so many other variables, like the future of NIH funding, your specific field, your unique talents and interests, etc. I am inclined to agree with LA that where you go in life is much more a function of what kind of person you are than where you trained. That said, don't choose U of Nowhere over UCSF if you want to be a researcher. But even then you could still make it work.

 

[LADoc00]

Thanks LADoc, let's take a step back.
You state that no program will give you a "guaranteed KO8/RO1 funding track". This certainly happens at other institutions that I'm applying to (of course, they can't guarantee government funding, but they will fund you out-of-pocket for ~3 years and enable you to have enough data to have a reasonable chance at a K08 and then RO1). I was under the impression that UCSF does have such a program, with guaranteed fellowship and funding.
I did not apply to Stanford because I was told by faculty members that they were having funding issues within the department (making it unlikely that they could fund any projects you are interested in pursuing). As I understand it, most research-heavy programs generate enough revenue within the department to help fund you and put you "on track" for grants and faculty positions.
I would appreciate your feedback.

No idea where you got your info, Stanford's funding for research is really no different than any similar caliber institution. The clinical side of the operation makes tens of thousands, if not hundreds of thousands of dollars per DAY. The research side has equally impressive revenue streams.

I could expound endlessly on why your thinking at this point is flawed, because frankly I was probably in a fairly similar boat many years ago.

I will be 100% honest, aside from maybe BWH (which may now even be incorrect), Im not terribly impressed with ANY pathology residency program putting people on track for academic basic science research careers. Of the many MDPhDs I have called friends, some with internationally stellar credentials, almost none have stayed in research through training. Those that did were often less socially adept to be able to land "real life" jobs and it became more a boobie prize for years of academic slavery.

I think if you dig deeper you will realize that even in the event which you secure a KO8 grant, the odds of renewal and/or tracking into a RO1 are slim, the odds even then of renewing the RO1 are even slimmer. So I would carefully probe if UCSF has a tradition of trainees moving past the first renewal of the RO1 or equivalent grant. My guess is they can probably count the number who have done this there on one hand in the last 20 years...but that is my guess.

 

[LADoc00]

And, LADoc00, even though I am interviewing in LA you don't have to worry about me flooding the market because that climate is overall too cold for me to live in long-term for my personal interests. That said, I realize it is perfect for 99.9% of the rest of the population. And thanks for the info about the research funding- I don't know enough yet to even understand what you are talking about there.

Pathology has long passed the point of "flooding" the market. The flooding occurred 10+ years ago. LA now is really the flood plains, almost everyone sinks in the dense marshy ****hole of the jobmarket and the only ones that really garner my attention are the few lucky souls who land what I consider a solid job.

 

[mlw03]

Pathology has long passed the point of "flooding" the market. The flooding occurred 10+ years ago. LA now is really the flood plains, almost everyone sinks in the dense marshy ****hole of the jobmarket and the only ones that really garner my attention are the few lucky souls who land what I consider a solid job.

all the more reason that life on the coasts ain't all it's cracked up to be. we've had this discussion before, no need to do it again. vr4nut is just trying to get some info about the various CA programs because he wants the best training possible - period.

 

[b&ierstiefel]

Thanks LADoc, let's take a step back.
You state that no program will give you a "guaranteed KO8/RO1 funding track". This certainly happens at other institutions that I'm applying to (of course, they can't guarantee government funding, but they will fund you out-of-pocket for ~3 years and enable you to have enough data to have a reasonable chance at a K08 and then RO1). I was under the impression that UCSF does have such a program, with guaranteed fellowship and funding.

Abbas does provide generous for UCSF folks desiring to go into the research track. The "3 year" deal was also what I was told when I chatted with him. The intentions are good here...in the not so distant past, people felt rushed to prepare a K08 application within the first year of doing postdoc research. However, back then, one didn't need lots of preliminary data to get a K08 accepted. There was a lot of money at the NIH for this (the good ol' times) and not many people were applying. As long as you were at a reputable institution and working for a PI renowned for mentoring physician-scientists, you could have just a few figures and get your K accepted. However, times are different. People need much more preliminary data and publications help. Funding is tight. Hence, deals like this are a great help for those who can just focus on getting the data rather than worrying about writing an impending K application right away. As for fellowship, I don't think that really impacts things. The fellowship budget is different from a postdoc budget.

I did not apply to Stanford because I was told by faculty members that they were having funding issues within the department (making it unlikely that they could fund any projects you are interested in pursuing). As I understand it, most research-heavy programs generate enough revenue within the department to help fund you and put you "on track" for grants and faculty positions.
I would appreciate your feedback.

Can't comment on this since I haven't heard anything from the Stanford front for quite a while.

I think what LA means is that, even though you may have funding for basically what amounts to a postdoc, this doesn't guarantee you a successful career in academic pathology. I see a few faculty members at my school who come from these types of programs and fail to get R01 funding. I think the best you can do is look at the track record of a place, and ask what percentage of people who have similar goals to mine were able to attain those goals. And even this is going to have limited value because of so many other variables, like the future of NIH funding, your specific field, your unique talents and interests, etc. I am inclined to agree with LA that where you go in life is much more a function of what kind of person you are than where you trained. That said, don't choose U of Nowhere over UCSF if you want to be a researcher. But even then you could still make it work.

Absolutely! RO1's are much tougher to get and hence represent the true test. The K08 just buys you time. But you have to produce and start developing a track record. Failing to do so can make things tougher for you when it comes down to applying for RO1's. Other than that, there are too many variables that determines success...and many of them you can't control.

 

[b&ierstiefel]

I will be 100% honest, aside from maybe BWH (which may now even be incorrect), Im not terribly impressed with ANY pathology residency program putting people on track for academic basic science research careers. Of the many MDPhDs I have called friends, some with internationally stellar credentials, almost none have stayed in research through training. Those that did were often less socially adept to be able to land "real life" jobs and it became more a boobie prize for years of academic slavery.

I am more convinced now that where you train has little bearing on your chance of success in the basic science research setting. It all rests on you and your ability to maintain motivation to keep on that track during residency training. Speaking from the BWH front here, we are not as homogeneous as things may have been under Cotran's rule back in the day. Some people, I've seen, start to really like diagnostic work and after a few years of AP training, really don't have that burning desire to go back to the lab. Some people realize that during AP training, that they hate clinical work even more and drive themselves into lab. Some people came into residency already having decided that they weren't going to do basic science. To each his/her own.

Anyways, those MD/PhD's who you call friends are very lucky to have the LADoc00 stamp of approval. It's like they get one big collective cookie!

I think if you dig deeper you will realize that even in the event which you secure a KO8 grant, the odds of renewal and/or tracking into a RO1 are slim, the odds even then of renewing the RO1 are even slimmer. So I would carefully probe if UCSF has a tradition of trainees moving past the first renewal of the RO1 or equivalent grant. My guess is they can probably count the number who have done this there on one hand in the last 20 years...but that is my guess.

Indeed...especially in the troublesome funding times we are in now. As for UCSF, Abbas seems to be vigorously building that program. More research-oriented folks and MD/PhD's are joining their residency roster since he assumed the chair of that department. I think time will tell before we can come to any conclusion as to the track record of UCSF path residency grads. Traditionally, the internal medicine folks who have short tracked, though, have done quite well...but my data there is old...it's been half a decade since I've thought of that aspect.

 

[docbiohazard]

This raises a few interesting questions that have come up as I interview. As an MD/PhD interested in academics and research, I've been mulling the following:

1) One person put forth the idea that you need to figure out a way to leverage your MD / clinical skills in your research. His point was something to the effect of, "Why try to compete against PhDs who are working 24/7 in their lab with their basic science driven approach? You need to leverage your clinical skills to do research that they *can't* do because of lack of access / clinical training." This made a lot of sense to me, and was interesting to hear. It contrasted somewhat with the following point:

2) That MD/PhDs interested in research/academia should do either AP or CP only, probably CP only, to free up time to do research in the 4th year and fast track into a research/fellowship position. I am interested in AP/CP because I feel like I want the broader, well rounded training and the skills from both areas for my research. I'm also not certain which direction I ultimately want to go with my career. It seems like the people pushing this mode of thought (specialize in CP, then do research) were also focused on trying to compete with PhDs for research $$$ (doing more basic, less clinically applied research)...

3) I've had at least one interview at an institution that is a private hospital with a research institute. The faculty are excellent, the residents are happy and the institution is flush with cash and eager to support resident research. While this is not a "traditional academic institution", it also seems to me that cash is the life blood of research, and if a place has the financial resources, infrastructure and will, it might make sense to buck the "traditional academic paradigm" ...

Anyone have thoughts on the above 3 points? Apologize in advance if this is a threadjack or one of those "annoying MD/PhD threads" that irritates deschutes... 🙂

BH

 

[BU Pathology]

This raises a few interesting questions that have come up as I interview. As an MD/PhD interested in academics and research, I've been mulling the following:

1) One person put forth the idea that you need to figure out a way to leverage your MD / clinical skills in your research. His point was something to the effect of, "Why try to compete against PhDs who are working 24/7 in their lab with their basic science driven approach? You need to leverage your clinical skills to do research that they *can't* do because of lack of access / clinical training." This made a lot of sense to me, and was interesting to hear. It contrasted somewhat with the following point:

2) That MD/PhDs interested in research/academia should do either AP or CP only, probably CP only, to free up time to do research in the 4th year and fast track into a research/fellowship position. I am interested in AP/CP because I feel like I want the broader, well rounded training and the skills from both areas for my research. I'm also not certain which direction I ultimately want to go with my career. It seems like the people pushing this mode of thought (specialize in CP, then do research) were also focused on trying to compete with PhDs for research $$$ (doing more basic, less clinically applied research)...

3) I've had at least one interview at an institution that is a private hospital with a research institute. The faculty are excellent, the residents are happy and the institution is flush with cash and eager to support resident research. While this is not a "traditional academic institution", it also seems to me that cash is the life blood of research, and if a place has the financial resources, infrastructure and will, it might make sense to buck the "traditional academic paradigm" ...

Anyone have thoughts on the above 3 points? Apologize in advance if this is a threadjack or one of those "annoying MD/PhD threads" that irritates deschutes... 🙂

BH

There are many measures of academic success which make pathology both challenging and confusing.

For some academic pathologists success is an international reputation in diagnostic pathology. You represent the final authority in diagnostic work, one to whom most pathologists would send their difficult material. It is likely that if you are in this category you will not be competing for independent grant support, but may be an important and respected collaborator on grants.

For others, academic success comes in the form of significant grant support primarily from NIH or NCI. In many situations these pathologists are not in the top tier of diagnostic pathologists. In my particular case, I always tell people that if I am the only name on the surgical pathology report, get a second opinion.

Both groups of pathologists would typically receive invitations to present their views on pathology and would be keynote speakers and visiting professors.

The question of AP, CP, or AP/CP training is really an individual choice. I selected programs in the early 1980s which were strong in different areas and did not really care whether they were AP or CP. In the end I trained AP only and then moved quickly into a research intensive career while keeping busy clinically by running an autopsy service. The type of training you as an individual selects should be directed by what you enjoy rather than trying to guess which will be more relevant in the future. However, it is difficult to know what you would enjoy unless you have been fully immersed in the discipline which you only achieve with the residency program.

This has not really answered your questions, but the issue of which training is best for academics comes up frequently. The question of how to measure academic success also comes up frequently. Hopefully this provides a modicum of clarity.

Dan Remick
Chair of Pathology, Boston University

 

[SLUsagar]

I did not apply to Stanford because I was told by faculty members that they were having funding issues within the department (making it unlikely that they could fund any projects you are interested in pursuing). As I understand it, most research-heavy programs generate enough revenue within the department to help fund you and put you "on track" for grants and faculty positions.
I would appreciate your feedback.

As a former chief, frequently involved with our faculty dept chairs/heads, I can tell you that you have been misinformed. There are no funding issues in the dept of pathology at Stanford...rather, I've been shocked when speaking with residents at other programs in terms of how laid-back our dept is about funding resident projects, with some outside people telling me how they've had to resort to getting stipends/grants/scholarships to pay for their stuff.

 

[vr4nut]

I have a very basic question- does anyone know if Harbor-UCLA is a community program? FREIDA doesn't say and I can't find it anywhere, except a friend told me that.

Anyone know how Harbor-UCLA and USC compare for an MD-only applicant who wants to keep the possibility of getting a competetive fellowship (eg dermpath) open? I have to decide between the two pretty soon. BTW, I'm probably going to go into private practice.

Any actual input would be appreciated. 🙂

Thanks

 

[oxygen]

So, After reading all the comments about CA program, I still can't find any answers that I wanted.

Any specific comments on those programs like there strength and weakness?

standford:---
Cedar-Sinai
UCLA
UCSD
USC
UC-Davis
UC-irvine

 

[LADoc00]

So, After reading all the comments about CA program, I still can't find any answers that I wanted.

Any specific comments on those programs like there strength and weakness?

standford:---
Cedar-Sinai
UCLA
UCSD
USC
UC-Davis
UC-irvine

I know most of those programs well. I had a lunch with a former UCD faculty member who said verbatim "I would not hire a single graduate that I was forced to train...I raised red flags but they were ignored"
When this former faculty was asked to select a rank list to match, the said faculty member (Ivy league guy) respectfully wrote the chairman "I cannot, in good conscience, recommend a single applicant you have sent me for graduate training in the field of Pathology"

Now, that being said I really like Davis. May seem paradoxical, yes, but there is a twisted genius/brilliance to being the proverbial one eyed man in the land of the blind. Irvine is probably a tad more 'together' than Davis but the job market in So Cal is far far less forgiving than the area north of Fresno.

Aside from Stanford and UCSF, all the CA programs have a history of training ALOT of FMGs, many of which went down in flames either in training (Davis lost nearly an entire class of residents) or shortly afterward.

BUT, out of these ashes of mediocre pathology training programs, I am personally familiar with graduates who have matched or exceeded the most stellar private practice pathologists from programs within the Harvard system, Hopkins or Stanford.

 

[oxygen]

I know most of those programs well. I had a lunch with a former UCD faculty member who said verbatim "I would not hire a single graduate that I was forced to train...I raised red flags but they were ignored"
When this former faculty was asked to select a rank list to match, the said faculty member (Ivy league guy) respectfully wrote the chairman "I cannot, in good conscience, recommend a single applicant you have sent me for graduate training in the field of Pathology"

Now, that being said I really like Davis. May seem paradoxical, yes, but there is a twisted genius/brilliance to being the proverbial one eyed man in the land of the blind. Irvine is probably a tad more 'together' than Davis but the job market in So Cal is far far less forgiving than the area north of Fresno.

Aside from Stanford and UCSF, all the CA programs have a history of training ALOT of FMGs, many of which went down in flames either in training (Davis lost nearly an entire class of residents) or shortly afterward.

BUT, out of these ashes of mediocre pathology training programs, I am personally familiar with graduates who have matched or exceeded the most stellar private practice pathologists from programs within the Harvard system, Hopkins or Stanford.

Thanks LADoc for the reply. I feel so scared about your info and I can feel the hair standing on my backneck!! I can't find any info about UC Davis and Irvine and I can't even find their current residents from their website. I guess UCSD and UcLA should have some top pathology training sites and although I kind of believe Davis and Irine are not as good as UCSD and standford and UCLA, they still accept 4-5 residents per year. But what happend to those residents? where are they and how can I find any info about their training? they seems all under the radar and unable to locate. WHy did Davis lose their entire class of residents? what happend? I am desperate to know more.😱

 

[mlw03]

oxygen,

as i've discovered over the last month, the best way to get straightforward info is to go somewhere and ask directly. while some programs provide lots of good info online, others simply don't. but that doesn't mean everything is bad. for example, UMd's website stinks, but when i was there everything looked on the up and up. i never could have made this determination without seeing things for myself. so while these trips get very expensive, if you're really interested in a place, there's no substitute for seeing things for yourself.

 

[sohsie]

I'll go ahead and "out" myself, although I think by loooking at my previous posts people could probably tell that I am at UCLA.

I finished my residency last year and am doing the GI fellowship this year. Next year, Im doing dermpath.

AP: We do complete specialty signout here. This means when you are on a surgpath service, you gross, preview, and signout every day in the specialty area that you are in. There are 7 areas: 1)GI/Liver (Does not include GI biopsies, which is a separate dedicated rotation) 2) GU/Renal/Peds 3)General/Gyn/Neuro 4) Skin/Frozen section (you are on frozens from 3-6PM every day) 5) Head/Neck/Heart/Lung 6) Breast 7) Bone and Soft Tissue (Done at Santa Monica Hospital). You go through each month twice, although you will likely do a couple of services a third time. Every day, you are responsible for all the cases that come in your area. There are techs to gross the biopsies and some small stuff for you and PAs who help with the bigger specimens (more on that later). Otherwise, you gross those cases, preview slides from cases cut the day before, and sign out cases you previewed the next day.

I have spent a year in another program which did the regular 3 day cycle (gross/biopsies and preview/sign out bigs), so I can compare:

Advantages: You become trained extremely well in those areas by experts in those fields. You see a lot of cases which are relatively uncommon in a general hospital. You have complete control over your grossing so you can fix specimens properly and cut them the next day and not worry about throwing off your schedule. Most biopsies are signed out the day AFTER slides are received so you aren't pressured to look at them quickly so the attending can get their work done early.

Disadvantage: Instead of seeing bread and butter stuff every day (ie GI and GYN biopsies), you get them in concentrated months, followed by not seeing them for a long while. There is a preference for the zebras over the horses.

CP: BB and hemepath are very strong. I didnt realize how strong our BB was until I talked with other people taking the boards. There are stronger BB programs, don't get me wrong, but UCLA is strong in that area. (Plus we just added a super BB guy from Cedars-Sinai) Hemepath is split into "wet heme" (3) and lymphoma months (1). Micro and Chem are more "self-study", although the resources are there and people do teach, but you have to self-motivate. Same for cytogenetics and molecular, but Dr. Grody is a superstar in molecular.

Workday: CP is 8-5 (excepting hemepath, which can be longer), with a lot of free time. AP is 8-6:30 at a minimum, although there is downtime too, especially if you are efficient. There are very busy services, but the PAs have made life much easier, and there probably will be more PA help in the future. I did a Gen/Gyn/Neuro rotation one year ago, and with the PAs help along with being efficient, I almost always had an 8-6:30 day.

There is a complete committment to being under 80 hours along with having the 10 hour required rest between workdays. However, you will work hard on AP, much harder than some (but not all) programs in SoCal.

Boards: Everyone from UCLA who took boards this past spring passed(5 who did residency at UCLA, 3 fellows who did residency elsewhere).

Call: You don't do call until second year (except for cutting call). Its about 3-5 weekends a year, and 1-2 call days per month.

If you have more specific questions, you can PM me.

 

[oxygen]

mlw03, thanks for the reply.
sohsie, that's extremly helpful.

I hope residents or fellows from other CA programs can provide such helpful post in the future.👍

 

[LADoc00]

one advantage UCLA has is it does have a derm fellowship. Think outside of UCI, which may be closed now, it is the only one in Southern California, which as a demographic region of control is insane. No other region of the country is so densely populated with so few dermpath trainees afaik.

 

[sohsie]

Addendum to UCLA post:

UCLA has the following fellows this year:
Cytology (Boarded): 2
Hemepath (Boarded): 2
Cardiovascular: 1
GI: 2
Dermpath (Boarded): 3
Surgpath: 5
Blood bank (Boarded): 1
Women's Health (GYN and Breast): 1
Bone/Soft Tissue: 1

Also, I think there is a boarded molecular fellowship available. In the past, someone constructed their own "Lung and Renal" fellowship.

I will let others (ie LADoc) expound on the relative pros and cons of these types of fellowships

 

[LADoc00]

Addendum to UCLA post:

UCLA has the following fellows this year:
Cytology (Boarded): 2
Hemepath (Boarded): 2
Cardiovascular: 1
GI: 2
Dermpath (Boarded): 3
Surgpath: 5
Blood bank (Boarded): 1
Women's Health (GYN and Breast): 1
Bone/Soft Tissue: 1

Also, I think there is a boarded molecular fellowship available. In the past, someone constructed their own "Lung and Renal" fellowship.

I will let others (ie LADoc) expound on the relative pros and cons of these types of fellowships

Cardio, Womens, Bone/ST are worthless for anyone outside a massive referral hospital. 3 Derm spots is huge though. That is nice. They could grab an outside person, one derm trained person and still have a slot for an internal candidate. IIRC, places like Stanford and UCSF cannot say that.

 

[AnnaLee]

I suppose I am in a position to add something to this discussion, as I did my med school at Davis and am now at Stanford.

As I think I have posted before, I am not really sure why Davis's program isn't stronger than it is. Sacramento has been growing and I think there is a good variety of cases to learn from, including the bread and butter and the weirdo stuff. The faculty are generally interested in teaching (at least in my experience), and the overall workload is pretty light, giving plenty of reading time if that is how you learn. I think the lack of exposure to quality consult cases is probably a drawback, and living in Sacramento isn't for everyone. I also know there are a few ex-faculty members who are very vocal about their dislike for Davis. I think everyone is entitled to their opinion, I guess.

As for Stanford, I think it is an amazing program with a lot of strengths that have probably been detailed at length by other posters. In terms of drawbacks, I think we work harder than some other programs while on AP (for sure more that Davis, prob comparable to UCSF), and the surg path fellowship is amazing but entails very long hours. If you are someone that learns by doing and likes hands-on training (like me), then I don't see the hard work as a drawback. About a year or so ago, the program directors instituted a case "cap" while on surg path to put an end to the nightmare 80 case signouts that can really be crippling when you first start. I think the cap has reduced the number of hours worked while on surg path, and the residents all seem happy with the change.

So this is a really long post, and anyone who has more specific questions can PM me. Just my 2 cents!

 

[oxygen]

one advantage UCLA has is it does have a derm fellowship. Think outside of UCI, which may be closed now, it is the only one in Southern California, which as a demographic region of control is insane. No other region of the country is so densely populated with so few dermpath trainees afaik.

I may visit UCI on Janurary, any comments about UCI program? How about their attendings and residents?

 

[LADoc00]

I suppose I am in a position to add something to this discussion, as I did my med school at Davis and am now at Stanford.

As I think I have posted before, I am not really sure why Davis's program isn't stronger than it is. Sacramento has been growing and I think there is a good variety of cases to learn from, including the bread and butter and the weirdo stuff. The faculty are generally interested in teaching (at least in my experience), and the overall workload is pretty light, giving plenty of reading time if that is how you learn. I think the lack of exposure to quality consult cases is probably a drawback, and living in Sacramento isn't for everyone. I also know there are a few ex-faculty members who are very vocal about their dislike for Davis. I think everyone is entitled to their opinion, I guess.

As for Stanford, I think it is an amazing program with a lot of strengths that have probably been detailed at length by other posters. In terms of drawbacks, I think we work harder than some other programs while on AP (for sure more that Davis, prob comparable to UCSF), and the surg path fellowship is amazing but entails very long hours. If you are someone that learns by doing and likes hands-on training (like me), then I don't see the hard work as a drawback. About a year or so ago, the program directors instituted a case "cap" while on surg path to put an end to the nightmare 80 case signouts that can really be crippling when you first start. I think the cap has reduced the number of hours worked while on surg path, and the residents all seem happy with the change.

So this is a really long post, and anyone who has more specific questions can PM me. Just my 2 cents!

Davis isnt stronger because simply put the head honcho from UCSF who was on the path of leading Davis to glory left running the department after he had a sudden health issue. This sent the department spinning out of control years ago which has never really stabilized.

There was also a push by socialists within the med school to de-emphasize speciality care in the 1980s-90s. This caused alot of unintended consequences that has decimated the dept. the least of which was derm basically jacking pathology big time.

As for Stanford's case cap, bad idea IMO. And I can elaborate for pages why it is bad, but needless to say it is a step in the wrong direction.

IMO Stanford needs to move to speciality sign outs with subspeciality experts in GU and GI. Maybe medical lung too.

 

[piyomonsta]

As for Stanford's case cap, bad idea IMO. And I can elaborate for pages why it is bad, but needless to say it is a step in the wrong direction.

IMO Stanford needs to move to speciality sign outs with subspeciality experts in GU and GI. Maybe medical lung too.

Just curious. Why do you think Stanford's case cap's bad?

 

[SLUsagar]

As for Stanford's case cap, bad idea IMO. And I can elaborate for pages why it is bad, but needless to say it is a step in the wrong direction.

IMO Stanford needs to move to speciality sign outs with subspeciality experts in GU and GI. Maybe medical lung too.

Case cap came into play ~2 years ago b/c we were getting many outreach cases (basically junk) which were cluttering up our trays, our time, and our energy. While we still get some of the bread and butter cases, it's now more high yield, quality cases. Although when I was on AP we had no cap and saw everything, we didn't have as much time to read. I think overall it's better now b/c you can actually read up on your cases, ddx, etc. instead of just flying through them. [note: our surgpath fellows still see all cases coming through...yet another reason why I love our hotseat system].

I've seen the change reflected in resident level of understand, where some of the newbies are talking about their cool pancreas case tossing out intricate ddx's including solid pseudopap tumor vs. serous cystadenoma vs. adrenal cortical vs. etc...hell, when I was a 1st year I was just trying to learn picking up regular ol' invasive ductal ca on a core!

Yes, we do general s/o here at Stanford, but I think it works here ONLY b/c of our open door policy about showing cases...we'll often show a case to a particualr organ/tumor expert even when the attending signing out the case feels comfortable of the diagnosis just to have the resident get detailed learning experience for him/her, also for fine tuning actual dx [i.e. we're not scutting around showing cases for no damn reason]. I think for a new path resident starting, it's nice to be able to see a bit o'everything, perhaps for fellowship subspec. may be better, but you could always do a surgpath fellowship +/- individ. organ/tissue subspec. Granted there are some places out there that are much better suited for subsp. s/o, but I don't forsee Stanford moving in that direction anytime soon. We've def. kept the Kempson-like attitude of being knowledgeable in just about everything and not locking yourself into 1 area (I can't tell you freaking baffled I am how the man, Kempson that is, just ROCKS on things you wouldn't expect him to know the first thing about...i.e. derm, liver, etc.). I think this broad-based knowledge (while spending time in particular areas to make yourself a half-way decent expert) stems from his Ackerman (LV Ackerman that is...) hardcore trained attitude. Overall, being trained this way seems like for private practice this would be a great deal of help, and for academics makes you not-pigeonholed in your spectrum of education.

 

[LADoc00]

SLU, Im not going to go off you right now because I have love in my heart for STL but I dont think you have a clue as to what "high yield" cases are. Go do 5-10 mindless mastectomy and colectomy specimens while others learn from your supposedly innumerable "outreach" GI, GU and skin cases.

You really proved my point, academic centers are fundamentally disenfranchised from what is going on in the community and in healthcare in general. At young age you are taught that the routine outreach stuff is trash much to your financial detriment later in life.

I dont want to hire associates who fight for pancreatic resections, I want someone who will scrap over prostate biopsies, tubular adenomas and moles....

 

[oxygen]

Guess either nobody knows anything about UCI or nobody likes to talk about it.

 

[LADoc00]

Guess either nobody knows anything about UCI or nobody likes to talk about it.

I wouldnt go to UCI over the other options you have in the area like UCLA or SD. I like some of their new faculty though. Irvine gets alot of flak in general but I think it is a relatively enjoyable place to live.

If hot Asian girls are your thing, UCI might even be no.1 nationwide.

 

[SLUsagar]

SLU, Im not going to go off you right now because I have love in my heart for STL but I dont think you have a clue as to what "high yield" cases are. Go do 5-10 mindless mastectomy and colectomy specimens while others learn from your supposedly innumerable "outreach" GI, GU and skin cases.

You really proved my point, academic centers are fundamentally disenfranchised from what is going on in the community and in healthcare in general. At young age you are taught that the routine outreach stuff is trash much to your financial detriment later in life.

I dont want to hire associates who fight for pancreatic resections, I want someone who will scrap over prostate biopsies, tubular adenomas and moles....

no no, i agree, it's the HG dysplasia in the so'called "trash/routine TA" that you blow off or miss is what will put you in court, and is what's key to the real world. I was just saying that for overall resident learning, managing your caseload is helpful to read/learn in an appropriate manner (of course, we still are working tons of hours, as you can attest to).
I do understand the outreach situation..even the newer powerpath versions are now gearing toward the routine/outreach type cases with pretty graphic pictures showing you where on the bunny-shaped prostate cartoon the cancer is, etc. We have to compete with these *@*!& pod labs which pump out reports with fancy color pics and whatnot.

 

[clancy81]

Guess either nobody knows anything about UCI or nobody likes to talk about it.

oxygen,

I asked about UCI awhile ago, I think on one of the other CA threads, and someone did respond with a review about their interview experience there last year. You can probably search for the CA threads and find it in the one from spring/summer of this year. I too will be interviewing there in Jan. and have heard little about the program through the grapevine other than the "people are nice." So I guess we'll just have to see what it's like when we get there.