CP-only residency

[Sunesis]

Hi,
I really enjoy reading the posts on this forum. Does anyone have any advice on the things to consider when applying to CP-only residency programs? Thanks.

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[yaah]

Find one that will provide you with a lot of mentorship in regards to your research and career goals, if necessary providing you with a junior faculty position after residency completion. CP only is not a great way to make yourself marketable, and you have to know what you are getting into.

 

[gbwillner]

Hi,
I really enjoy reading the posts on this forum. Does anyone have any advice on the things to consider when applying to CP-only residency programs? Thanks.

1. How many CP-only residents are there?
2. What clinical services do they cover? What is call like?
3. What kind of research do they do? Are they strong in your areas of interest?
4. How is their mentoring? How many faculty?

There are problably about 5 good CP programs out there.

 

[Sunesis]

Thanks for the responses so far.
At the risk of fueling controversy, what would you say are the "about 5 good CP programs out there"........and why?

 

[LADoc00]

really at this point the only viable option for CP only is TM or very niche molecular lab directorship. Both these occupations are really "meh" in the modern healthcare landscape.

I cannot advise CP only unless you are balls to wall basic science research tract. Perferably with a strong PhD already too.

 

[Sunesis]

I am an FMG with "a strong PhD", currently doing postdoctoral research in genomics and planning on an academic career (clinical interests: CP-only residency and perhaps a molecular pathology fellowship).
Questions:
1. Is it possible to get a faculty position (post CP-only residency) with responsibilities running a molecular diagnostics lab without doing a molecular pathology fellowship?
2. What are the differences between those who just do a molecular pathology fellowship without residency and those who have both CP and molecular pathology board certification?
3. Would it be right to assume that programs that have fellowships provide better training during rotations in that subspeciality than programs that don't have that subspeciality fellowship? What are the known exceptions, if any?
4. Is it okay to determine how much priority a program places on CP-only training by the fact that they accept at least one CP-only resident every year or is that too stringent a criterion? What else shows that the program really cares about CP-only training?
5. What are the pros and cons of doing CP-only and molecular pathology fellowship sequentially versus sandwiching the fellowship between PGY2 and PGY3 (is that even possible?)? How does it affect board certification?
6. What makes for a "strong CP curriculum"? Is it just didactics or are there other things to watch out for?
7. What programs offer the best opportunity for maximizing research time while providing top-notch CP training? Are those goals more mutually exclusive than interdependent? In the same vein, which programs are relatively more adept at achieving one goal versus the other?

More questions to come..............
Thanks.

 

[yaah]

Yes to #1, because many of these individuals have strong research backgrounds and already know everything anyway. It's probably an individual case situation though. Since it is a boarded fellowship now they might prefer it for people fresh out of training.

I don't understand #2 - as far as I know, you can't do a molecular pathology fellowship without doing a residency and get certified by the ABPath. Part of qualifying for a subspecialty board exam is being certified in AP or CP.

#3 is not necessarily true. If they have a fellowship, all it really means is that they have enough volume and expertise to justify it. This means the material and the research opportunities and the faculty are there. I suspect there is a wide range of teaching exposure that goes on though. In general though it is probably a safe bet to assume that programs with fellowships will have better training in molecular.

#4 I wouldn't go by that. If there are CP only residents there, it means that the program likely is supportive of them. But to be honest, there really aren't a ton of CP only people, and just because a program doesn't have one in a specific year doesn't mean a whole lot. I would get at the answer to this question by simply going on the interview and asking questions about how they support CP only residents. If they do a good job, you will be able to tell.

#5 I don't know. People use to do boarded fellowships in between certain residency years. I think it is possible, you just can't get certified in the subspecialty before you get certified in general CP. I would do the fellowship at the end, that way you go into it with the most knowledge and you can consolidate everything there.

 

[sohsie]

I am an FMG with "a strong PhD", currently doing postdoctoral research in genomics and planning on an academic career (clinical interests: CP-only residency and perhaps a molecular pathology fellowship).
Questions:
1. Is it possible to get a faculty position (post CP-only residency) with responsibilities running a molecular diagnostics lab without doing a molecular pathology fellowship?
2. What are the differences between those who just do a molecular pathology fellowship without residency and those who have both CP and molecular pathology board certification?
3. Would it be right to assume that programs that have fellowships provide better training during rotations in that subspeciality than programs that don't have that subspeciality fellowship? What are the known exceptions, if any?
4. Is it okay to determine how much priority a program places on CP-only training by the fact that they accept at least one CP-only resident every year or is that too stringent a criterion? What else shows that the program really cares about CP-only training?
5. What are the pros and cons of doing CP-only and molecular pathology fellowship sequentially versus sandwiching the fellowship between PGY2 and PGY3 (is that even possible?)? How does it affect board certification?
6. What makes for a "strong CP curriculum"? Is it just didactics or are there other things to watch out for?
7. What programs offer the best opportunity for maximizing research time while providing top-notch CP training? Are those goals more mutually exclusive than interdependent? In the same vein, which programs are relatively more adept at achieving one goal versus the other?

More questions to come..............
Thanks.

There are many programs in this country which will extol the virtues of their wonderful CP training program. Most of them have an agreement with the nearby veterinary research department to develop this program from their bovine gastrointestinal division. (ie they are full of it). Unfortunately, if you aren't already pretty familiar with CP, its hard to know the right questions to ask. However, even asking a few specifics can help you sift out programs.

Ultimately, there is one question to ask to separate the possibly good CP training programs from the pretenders: What is your CP board pass rate?

 

[yaah]

The other question would be, "Where do your CP only graduates end up when they finish residency?" If they all go somewhere else for a fellowship and then the program loses track of them or doesn't hear from them, that's bad. If they know where they are all on staff, that's better.

 

[gbwillner]

I am an FMG with "a strong PhD", currently doing postdoctoral research in genomics and planning on an academic career (clinical interests: CP-only residency and perhaps a molecular pathology fellowship).
Questions:
1. Is it possible to get a faculty position (post CP-only residency) with responsibilities running a molecular diagnostics lab without doing a molecular pathology fellowship?
2. What are the differences between those who just do a molecular pathology fellowship without residency and those who have both CP and molecular pathology board certification?
3. Would it be right to assume that programs that have fellowships provide better training during rotations in that subspeciality than programs that don't have that subspeciality fellowship? What are the known exceptions, if any?
4. Is it okay to determine how much priority a program places on CP-only training by the fact that they accept at least one CP-only resident every year or is that too stringent a criterion? What else shows that the program really cares about CP-only training?
5. What are the pros and cons of doing CP-only and molecular pathology fellowship sequentially versus sandwiching the fellowship between PGY2 and PGY3 (is that even possible?)? How does it affect board certification?
6. What makes for a "strong CP curriculum"? Is it just didactics or are there other things to watch out for?
7. What programs offer the best opportunity for maximizing research time while providing top-notch CP training? Are those goals more mutually exclusive than interdependent? In the same vein, which programs are relatively more adept at achieving one goal versus the other?

More questions to come..............
Thanks.

I will add my 2c...
1. Yes... The molecular path fellowship is extremely new and many current managers are grandfathered in. I'm willing to wager in the future it will be much harder to do this without formal pathology and molecular training.
2. As stated by Yaah you can't. While you can run a lab with a PhD, you can't sign out any tests without the MD and certification... that means you need another MD to come by and sign out all your tests for you. Why, in the future, would any hospital want this arrangement?
3. Not sure
4. I would say this is a fair way to tell programs apart. The programs that are GOOD at CP don't have much problem getting at LEAST 1 CP-only resident yearly... and they take up to 3 per year.
5. This is possible and is probably done frequently. However, for the molecular path fellowship there is not as much sense in doing this as, let's say, dermpath or hemepath. That's because the fellowship is already research-heavy. If the year was entirely clinical, it would make a lot of sense because you could save your PGY3 elective time for research at the end of residency and have continuous research time with the beginning of your post-doc/faculty appointment. Because up to 6 months of the fellowship are probably research anyway, it really doesn't make any difference.
6. This has been covered in other posts- do a search. I would say that its the types of services you are allowed to run, your responsibilities, as well as didactics and faculty commitment.
7. I would say the same programs that offer the best clinical training in CP are also likely the best at maximizing research efficiency with the best faculty...

 

[LADoc00]

Actually you most certainly can sign out tests with proper clinical Phd certification. MD is not required although in many states a MD must be the overseer medical director (although he/she doesnt have to sign out anything at all in such a role).

What Yaah refers to in #2 is a totally separate issue. Its whether you can do a molecular fellowship pathway without doing pathology.

Now here is the kicker: Not only can you be the director of a molecular lab section (barring individual state laws for overall lab directorship which vary) WITHOUT a pathology residency, you can even do one without a MD!

Yep, you can do it with just a PhD too, similar to Clinical Chem, Micro etc.

Therefore, for a molecular path fellowship pathway type program you could be a MD in Peds or IM or even a PhD in biological sciences or chemistry.

 

[LADoc00]

I don't understand #2 - as far as I know, you can't do a molecular pathology fellowship without doing a residency and get certified by the ABPath. Part of qualifying for a subspecialty board exam is being certified in AP or CP.

.

Here is where you departed for fail, there are currently no less than 4 totally separate organizations which certify one for molpath diagnostics. Google it.

 

[pathstudent]

Here is where you departed for fail, there are currently no less than 4 totally separate organizations which certify one for molpath diagnostics. Google it.

Indeed, I believe you can get boarded in molecular path by the APB without an MD. The ABP was slow on claiming molecular pathology as its own and once medical genetics was going to board it for themselves, path got in on it and had to make it available to PhDs as part of the deal.

Also I believe you can get boarded by the ABP in a number of specialties without doing an AP or CP residency and, in a few, without doing an MD.

 

[yaah]

Yes, you can get ABP boarded in hemepath, transfusion med, and dermpath without doing pathology residency. Have to do another qualifying residency though for those, I think. I think the only ones you can get without a residency are probably clinical chem, micro, and I guess molecular, which I didn't know about before this. I am not entirely sure on the whole thing though.

 

[sohsie]

The other question would be, "Where do your CP only graduates end up when they finish residency?" If they all go somewhere else for a fellowship and then the program loses track of them or doesn't hear from them, that's bad. If they know where they are all on staff, that's better.

I like that question too, especially if you are going for a CP only residency

 

[pathstudent]

Maybe you do need an MD



Examination Name: Molecular Genetic Pathology
Examination frequency: Biannually.

Eligibility: Applicants for examination in molecular genetic pathology must hold an M.D. or equivalent medical degree, and be a licensed physician in the United States or Canada. In addition, applicants must hold a primary certificate from the American Board of Pathology or the American Board of Medical Genetics.

Accreditation of training programs in molecular genetic pathology by the Accreditation Council on Graduate Medical Education (ACGME) began in 2002. Until April 6, 2007, candidates may be eligible to take the examination on the basis of experience. This experience can consist of at least 5 years of experience at 25% effort or 2 years of full-time experience in molecular genetic pathology. After this initial "grandfathering" period, applicants will be required to have completed a 1-year fellowship in molecular genetic pathology in an ACGME-approved program. All candidates must provide a case logbook demonstrating experience with at least 150 cases in molecular pathology acquired during the period of experience or training. The cases should demonstrate broad experience in the field.

Scope of examination: Principles, theory, and technologies of molecular biology and molecular genetics as they are used to make or confirm clinical diagnoses of Mendelian genetic disorders, disorders of human development, infectious diseases and malignancies, to assess the natural history of those disorders, and to guide management of those disorders.

Examination format: The examination is a 1-day test consisting of 300 multiple-choice questions. The American Board of Pathology’s test center in Tampa, FL is the examination site.

Certificate duration: The certificate will be valid for 10 years. Details on re-certification are unavailable at the present time.

Contact information: American Board of Pathology, P.O. Box 25915, Tampa, FL 33622-5915, Phone: (813) 286-2444, Fax: (813) 289-5279, Web: www.abpath.org; or American Board of Medical Genetics, 9650 Rockville Pike, Bethesda, MD 20814-3998, Phone: (301) 571-1825, Fax: (301) 571-1895, Web: www.abmg.org.

 

[Sunesis]

really at this point the only viable option for CP only is TM or very niche molecular lab directorship. Both these occupations are really "meh" in the modern healthcare landscape.

I cannot advise CP only unless you are balls to wall basic science research tract. Perferably with a strong PhD already too.

Don't you think molecular diagnostics will thrive in "the modern healthcare landscape"? Afterall the era of personalized medicine is upon us and targeted therapies will likely be hinged, in part, upon genomic data generated, analyzed and interpreted by molecular pathologists!

 

[pathstudent]

really at this point the only viable option for CP only is TM or very niche molecular lab directorship. Both these occupations are really "meh" in the modern healthcare landscape.

I cannot advise CP only unless you are balls to wall basic science research tract. Perferably with a strong PhD already too.

YOu can do CP only then hemepath. That's a viable route for academics, private or reference lab.

 

[KluverB]

Don't you think molecular diagnostics will thrive in "the modern healthcare landscape"? Afterall the era of personalized medicine is upon us and targeted therapies will likely be hinged, in part, upon genomic data generated, analyzed and interpreted by molecular pathologists!

Been hearing that for >10 yrs... still waiting.

 

[Sunesis]

Been hearing that for >10 yrs... still waiting.

Is your skepticism directed at (i) the idea that personalized medicine will become more prominent in healthcare or (ii) the idea that molecular pathology will play an increasingly important role in diagnostics and therapy or (iii) the whole post?

 

[KluverB]

Is your skepticism directed at (i) the idea that personalized medicine will become more prominent in healthcare or (ii) the idea that molecular pathology will play an increasingly important role in diagnostics and therapy or (iii) the whole post?

Actually, I see (i) and (ii) in our future... just not anytime soon for me to worry much about it.

LADoc may have mentioned something similar in another thread not too long ago, but basically, the accepted(?!?) definition of "personalized" medicine varies from one person to another.

Most of medicine is already "personalized". When you go to a dr they w/u and treat you based on your CC, PMHx, Si/Sx, Labs, etc. It's "personalized" to you.

At the other extreme, what's been touted as "personalized" medicine by industry, esp. pharma and biotech, is the idea that your //insert your favorite moniker here//'omics profile will determine your course of treatment. Get a skin scrapping. Run a "chip"! Bam!

However, it's been well over 10 years since the promise of the latter has driven lots of VC money into a lot of innovation, esp. of the technical variety (ie. "DNA" chips, whole-genome sequencing, multiplex PCR, etc.). Sadly, the truth lies somewhere in between, at least for the foreseeable future. Some genetic/molecular testing is popping up here and there. Her-2 probably being the first one to spring to mind, w/ other RTKs coming on-line with their (more or less) specific inhibitors as well as polymorphisms that affect their efficacy. HIV drug resistance. Now clopidogrel. Most of hemepath diagnoses. Etc.

However, as flindophile explains quite clearly, what's the value of a test that most clinicians even though they order it, will still treat the patient based on established guidelines, and use the molecular test simply as a novelty. That is likely to change as more data is collected. But here's the rub... the more patient's you enroll in your trials, the less "personalized" it becomes. In the end, you publish your work in NEJM with some statistics which shows some awesome p-values based on N-number of patients. Recommendations are made based on the "evidence". And we're right back were we started, ie. not-"personalized".

So yes, small steps are being made. But nothing compared to the party line that's been presented since the dot-com and biotech-com boom of the 90s.

But I am hopeful.

 

[LADoc00]

Don't you think molecular diagnostics will thrive in "the modern healthcare landscape"? Afterall the era of personalized medicine is upon us and targeted therapies will likely be hinged, in part, upon genomic data generated, analyzed and interpreted by molecular pathologists!

I think you are confusing a particular industry like say MolDx growing in the future and your personal success....
Will MolDx become more prevalent, likely.
Will you personally profit from this, highly unlikely.

People who will profit have tens of millions of $ in capital assets of MolDx lab equipment, you will be merely an overhead cost to them, a pitiful barrier to further profit they can downsize/rightsize/eliminate/replace when the profits sink.

Welcome, welcome to the USS La Amistad, your voyage will be unpleasant, that much I can guarantee.

 

[Sunesis]

I realize that this forum is AP-heavy, but then so is pathology!
However, as an unrepentant CP-biased individual, I would appreciate input from anyone who can give detailed breakdown of the peculiarities of CP programs (either from your personal experience or remote observation of patterns) in your institution, with similar depth to which several posts have included details on the AP side of things?
What are the pros and cons of particular CP programs that you know about?
Even if these experiences are only the context of AP/CP (and not necessarily CP-only) training, your input would be greatly appreciated as it would still enlighten those of us with affinity for CP-only careers.
Thanks!