career in GYN

[sleeping beauty]

---

Members don't see this ad.

Gyn surgpath volume is huge. but it does not appear a favorite for many. can anyone tell me why?

 

[mlw03]

for one, i don't believe it's a boarded fellowship. also, i get the impression most pathologists are pretty comfortable signing out gyn cases anyway.

 

[sleeping beauty]

for one, i don't believe it's a boarded fellowship. also, i get the impression most pathologists are pretty comfortable signing out gyn cases anyway.

but i believe most pathologists are more comfortable signing out GI and GU than Gyn.

 

[b&ierstiefel]

but i believe most pathologists are more comfortable signing out GI and GU than Gyn.

None of the 3 are boarded subspecialties...yet.

As any pathologist can signout colon polyps, prostate cores, any pathologists can do the same for let's say cervical/endometrial biopsies.

I don't know why GYN isn't as popular. Maybe people just don't like reading cervical biopsies, for example. I know several people who think cervical biopsies are really boring...kinda how some people think reading pap smears are boring.

I think the demand for GYN is significantly lower in the community setting. I see significantly more job ads for GI than GU and GYN combined. Maybe it has to do with volume, but I really don't know.

 

[Ale]

None of the 3 are boarded subspecialties...yet.

As any pathologist can signout colon polyps, prostate cores, any pathologists can do the same for let's say cervical/endometrial biopsies.

I don't know why GYN isn't as popular. Maybe people just don't like reading cervical biopsies, for example. I know several people who think cervical biopsies are really boring...kinda how some people think reading pap smears are boring.

I think the demand for GYN is significantly lower in the community setting. I see significantly more job ads for GI than GU and GYN combined. Maybe it has to do with volume, but I really don't know.

This is how I see it:

GYN pathology has not changed much in the last 20 years (except for EIN and BRACA prophylaxis, maybe), no volume increase, etc.

In GI, almost everyone gets colon cancer screening after age 50, MSI for younger patients with CA, sessile serrated polyps are not hyperplasic polyps anymore, etc. All of these were things that were not widely known 15-20 years ago.

In GU it's similar; we are doing 12 bx of the prostate as opposed to 2 or 6. ASAP and PIN exist; things that 15-20 years ago you would have called it normal prostate.

As new diagnoses come out, people that were not trained to recognize them don't feel comfortable signing them out, thus the need for subspecialty. Hopefully, ten years from now all the residents will know all of these and we won't need subspecialty training (unless we come up with more new diagnosis, and they will).

 

[yaah]

I've always been surprised to not see GYN being more popular too. I think part of the reason GU is popular is that there are so many fine points to it. Gleason grading is subjective but vitally important, and experience matters. Bladder biopsies are similar in terms of subjectiveness and how many factors are becoming important to know about. So volume is important but not as critical as it is in GI. GI is important simply because of volume - there are difficult areas as well (dysplasia) but a lot of GI is very simple, it just seems to becoming popular for private practice groups to be able to say that they have some one who is "GI fellowship trained" and thus they can use this to attract business. If you were a client gastroenterologist, wouldn't you rather send your biopsies to a place where someone was GI fellowship trained? It may make very little difference in quality of diagnosis compared to good private practices, but it's the marketing aspect.

Breast is getting more complicated too. Part of it seems to be litigation based, but there are also lots of fine points in that area for which it is helpful for a lab to say they have a fellowship trained person on board.

For GYN, these factors are, as of now, less important. The volume is there but the perception that having a fellowship trained person there is important is not, apart from academic centers.

 

[b&ierstiefel]

yaah and Ale, I think you hit the nail on the head. I've thought about why other fellowships are in higher demand but didn't think of why GYN really wasn't...the latter didn't bother me too much since I really enjoy GYN cases...it may bother me in the near future when it comes time to get jobs 🙂

Anyways, there are increasing refinement of diagnoses and substratification of precursor lesions in GU, GI, and especially breast. I don't think the litigation issues have really been of a detriment to these subspecialties as much as it as affected Derm. As these fields have become increasingly complex, I think general pathologists will encounter more problems and issues with these hence the greater demand for these subspecialty pathologists.

Increasing diagnostic complexity and confusion is a great way to enhance the "importance" of a certain subspecialty. GYN hasn't done this as much so we're not in the position yet to really monopolize knowledge. The entity of EIN does need more clarification at times and perhaps EIN will be subdivided into different categories but I don't see this happening anytime soon. Even if that issue became more complex, that would be only just one thing leading contributing to increased complexity of GYN and hence increased demand for GYN specialty folks.

 

[sleeping beauty]

why Gyn is not popular? bias.

many ppl, particularly surgeons, tend to think all Gyn organs are not that useful after reproduction years (except vagina ). they are just trouble makers. ovaries and uterus locate in a corner without much connection with others. they are easy to remove. the removal does't affect anything, particularlly cosmetically. therefore surgeons remove all when they just need to remove one organ. Once for all.

do you remember surgeons always remove appendix as long as they open a patient's abdomen? they think ovaries and uterus are appendices too.

this is bias.

 

[exPCM]

why Gyn is not popular? bias.

many ppl, particularly surgeons, tend to think all Gyn organs are not that useful after reproduction years (except vagina ). they are just trouble makers. ovaries and uterus locate in a corner without much connection with others. they are easy to remove. the removal does't affect anything, particularlly cosmetically. therefore surgeons remove all when they just need to remove one organ. Once for all.

do you remember surgeons always remove appendix as long as they open a patient's abdomen? they think ovaries and uterus are appendices too.

this is bias.

Since the majority of gyn surgery is now done by OB/GYN doctors and the majority of OB/GYN doctors are women, are you saying that these women physicians are biased?

 

[sleeping beauty]

the OBGyn docs i know are all men. women can have bias too. they are trained in the same way.

 

[b&ierstiefel]

why Gyn is not popular? bias.

many ppl, particularly surgeons, tend to think all Gyn organs are not that useful after reproduction years (except vagina ). they are just trouble makers. ovaries and uterus locate in a corner without much connection with others. they are easy to remove. the removal does't affect anything, particularlly cosmetically. therefore surgeons remove all when they just need to remove one organ. Once for all.

do you remember surgeons always remove appendix as long as they open a patient's abdomen? they think ovaries and uterus are appendices too.

this is bias.

I don't see why this would decrease the popularity of GYN pathology though. Are you implying that the ease of removal of these organs diminishes the importance of evaluating these specimens? I agree that after in postmenopausal patients, ovaries and uteri are simply troublemakers. But GYN pathology doesn't only involve specimens from postmenopausal folks. I think your reasoning is a gross oversimplification of why GYN pathology isn't as popular.

 

[docbiohazard]

Additionally, I thought the random removal of appendices had fallen out of favor due to the risks inherent with violating the bowel (ie. it's not a no-risk proposition)... at least I had a burns surgeon tell me that once...

BH