Derm or GI?

[PathRes1071]

I'm a path resident with a strong interest in dermpath. I'm doing what I can to create a competitive resume but feel disadvantaged since my residency does not offer a fellowship. I'm still a year away from applying and feel like I should probably have a backup plan in case I am not accepted. Do people apply to two fellowships simultaneously (such as derm and GI) or does that make them seem less dedicated? Also, if I were to apply and not succeed the first time, are my chances lower the second time applying or do programs recognize perseverance?

Thank you!

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[Whiskeyjack]

I'm not sure why Dermpath is still competitive. You realize there are NO jobs out there. I know a few Dermpath fellows still without jobs. And a couple with just surgpath jobs.

 

[pathstudent]

I'm a path resident with a strong interest in dermpath. I'm doing what I can to create a competitive resume but feel disadvantaged since my residency does not offer a fellowship. I'm still a year away from applying and feel like I should probably have a backup plan in case I am not accepted. Do people apply to two fellowships simultaneously (such as derm and GI) or does that make them seem less dedicated? Also, if I were to apply and not succeed the first time, are my chances lower the second time applying or do programs recognize perseverance?

Thank you!

If it was 1995, I would say either one would be the way to go, but now after a decade of pathologists willing to sign out the cases for a quarter on the dollar and the intense competition for the biopsies from the national labs along with the rise of physician groups trying to keep the revenue within their practices, they aren't that advantageous anymore.

 

[icpshootyz]

I'm not sure why Dermpath is still competitive. You realize there are NO jobs out there. I know a few Dermpath fellows still without jobs. And a couple with just surgpath jobs.

People still have dollar signs in their head and imagine themselves opening some huge private dermpath lab and making a killing. Unfortunately they don't realize that the big labs already have all the business, are giving kickbacks under the table, and you won't be able to sway anyone to stop sending to the major labs. But, there's still plenty of money to be made in dermpath since it's biopsy-heavy. Based on this resident's interest in only derm or GI, I'm assuming money is what he's after. Either one will work out fine, but try to actually do something you want to do for 30-40 years, not just what pays the most.

 

[PathRes1071]

I'm trying to sub-specialize in an area that I'm most interested in. My original question was whether I should try to apply for both GI and derm or focus on my top choice. With derm having very limited spots and an intensely competitive applicant pool, is it wise to already begin creating a resume that would work for GI as well?

Also, if I were to eventually work for one the bigger labs, could I still specialize in derm or GI? My goal is to sign-out general cases with an emphasis on my specialty.

 

[deleted314957]

with the way things are going, you will most likely end up doing what you HAVE to do rather than what you WANT to do.

 

[icpshootyz]

I'm trying to sub-specialize in an area that I'm most interested in. My original question was whether I should try to apply for both GI and derm or focus on my top choice. With derm having very limited spots and an intensely competitive applicant pool, is it wise to already begin creating a resume that would work for GI as well?

Also, if I were to eventually work for one the bigger labs, could I still specialize in derm or GI? My goal is to sign-out general cases with an emphasis on my specialty.

I've heard that it doesn't look great to apply to two different fellowships at the same time, but I can't say I know that for sure. Only fellowship directors could really tell you if it affects their decisions. As for the bigger labs, again that really depends. There's plenty of large labs that want people to sign-out derms or GI's all day since that's a large part of the biopsy load at many places. But, like others have mentioned, there's no guarantee of any job you want, especially if you're geographically limited. But both derm and GI are still fine fellowships, and you can certainly still do general path with either of those (I do derm and general).

 

[KCShaw]

Depends on the programs, and whether they know you're also applying to a different subspecialty. The reality seems to be that, for the most part, fellowships are not that hard to get. "Top" fellowships can be though, particularly in certain subspecialties like derm where you're competing with dermatology residents for relatively few spots. But it seems like every academic department with a couple of fellowship trained X's on staff try to set up an X fellowship, so there always seems to be a group of fairly non-competitive positions cropping up out there along with the rest of them. If you show early interest and they don't think you're a goose, unless the fellow match has kicked in across the board your chances are probably better than you think. But that may mean making an early decision.

The market coming out the other end is a different discussion. However many jobs there are or aren't, regardless of your subspecialty(ies) everyone needs to be willing and prepared to mainly do general surg path while only "helping" your group with your subspec.

 

[pathstudent]

I suppose probably derm. Any hack community pathologists thinks she can handle any gi biopsy while he is pretty intimidated by non-neoplastic derm.

 

[pathololology]

If you like them equal, then do GI. You will have more of a chance (and a better understanding) of general surg path since GI is the bread and butter of surg path. Like other posters stated above, I too know several dermpath fellows who recently graduated and can not find a dermpath job (i.e. can't find a job with ANY dermpath). The dermpath only jobs are practically vanishing too, unless you have 3-4 years experience in a high volume dermpath only lab (which if you did, then you probably wouldn't leave) . . .
Those 88305 cuts really stopped things dead in their tracks. . . .

I'm trying to sub-specialize in an area that I'm most interested in. My original question was whether I should try to apply for both GI and derm or focus on my top choice. With derm having very limited spots and an intensely competitive applicant pool, is it wise to already begin creating a resume that would work for GI as well?

Also, if I were to eventually work for one the bigger labs, could I still specialize in derm or GI? My goal is to sign-out general cases with an emphasis on my specialty.

 

[pathrock]

Isn't a little odd to apply both GI and derm? I know many people do surg + cyto/GI/heme/derm

 

[dermpathdoc]

Since there is NO certifying exam inGI why would you to take a fellowships. But I echo those that say there are few jobs now in Dermpath. The high pay jobs are limited to those with many years experience. I did a fellowship with Bernie Ackerman.... I relocated to the PNW for family reasons and I have been unable to find a Dermpath job. They are limited to dematologists wanting to rip off your expertise for minimum wage.

 

[LADoc00]

I would not advise either GI or Derm if it means giving up CP certification.

If you are AP and CP, then I would focus on being able to sign out general surgicals including heme cases. IF you are all good on that, then I would flip a coin on those 2. Derm is probably slightly ahead given there is an actual board cert for it but cherry GI gigs are insane in terms of revenue vs. effort.

I would NEVER advise doing AP+GI or Derm exclusively though, it kills your options and likely sends you done the road of employee rather than employer.

Think Monsieur Madeleine (AP/CP+Derm/GI) vs. Fantine (AP only).

 

[brainsalads]

Do derm and heme, then you will be the master at cutaneous lymphoma mwahaha! Plus they are both boarded subspecialties. Don't think you need to do a GI fellowship to sign out 90% of GI specimens if you came from a decent program (transplant liver biopsies are hard though). But I think you need a dermpath fellowship to be comfortable signing out anything but simple AKs or BCCs. In many programs, dermpath is an elective, so its possibly you may not get much at all and inflammatory derm is no walk in the park.

 

[pathololology]

dermpathdoc. I kindly disagree with this. If we make GI a certifying exam fellowship, then we risk allowing GI docs doing the fellowship and opening their own labs AND READING THEIR OWN SLIDES. At my program there is a neurologist who did a neuropath fellowship and now she does only neuropath and doesn't see patients at all. If you look on pathoutlines there are a ton of jobs in GI that are advertising right now. Just because a group signs out GI all day, means they would love somebody with an expertise in liver or tough GI inflammatory cases in addition to tumors. If you were entering the field RIGHT NOW, you would have a ton more options in jobs in GI vs DP. You do, however, have to like general surg path which some DPs don't like, but more and more, DPs are having to some surg path b/c the glory days of doing DP only are slowly melting away

Since there is NO certifying exam inGI why would you to take a fellowships. But I echo those that say there are few jobs now in Dermpath. The high pay jobs are limited to those with many years experience. I did a fellowship with Bernie Ackerman.... I relocated to the PNW for family reasons and I have been unable to find a Dermpath job. They are limited to dematologists wanting to rip off your expertise for minimum wage.

 

[brainsalads]

Shoot for what you enjoy most. Dermpath is more more competitive so if you work like you're trying to get dermpath then your CV will probably turn out great. If you're just thinking about job market for GI but don't enjoy it so much I think that's a mistake. In addition to advertised GI only fellowships, plenty of Surg Path fellowships can be tailored to your interests. So if you can't get a dermpath fellowship first time around which is frequently the case, you could do a "GI emphasis" surg path fellowship in the interim. In all likelihood though you'll end up signing out one or the other unless you join a small practice or small academic program that hasn't switched over to subspecialty signout.

 

[pathololology]

I only halfway agree. If you can't find a job, then there is something to be said for doing what you love second most. I know derm/dermpaths that couldn't find jobs doing ANY dermpath. I also know path/dermpaths who couldn't find a job doing any dermpath either, and ended up doing general surg path in the hopes that the group could lure more dp their way later . . .which is tough to do . .

I constantly feel like we are trying to balance reality with this "the glass is always half full and things will always be roses no matter what" mentality which is common amongst med students and even younger residents.

Shoot for what you enjoy most. Dermpath is more more competitive so if you work like you're trying to get dermpath then your CV will probably turn out great. If you're just thinking about job market for GI but don't enjoy it so much I think that's a mistake. In addition to advertised GI only fellowships, plenty of Surg Path fellowships can be tailored to your interests. So if you can't get a dermpath fellowship first time around which is frequently the case, you could do a "GI emphasis" surg path fellowship in the interim. In all likelihood though you'll end up signing out one or the other unless you join a small practice or small academic program that hasn't switched over to subspecialty signout.

 

[brainsalads]

That's why I encourage doing two subspecialty fellowships. Widen your areas of expertise outside of general SP and make yourself look as attractive as possible in this market

 

[pathololology]

You can PM me if you would like and I will tell you where they trained. I think you would be very surprised at where they trained. I know your position, and you have no choice but to be glass completely overfull person as I was when I was in your position until you actually start looking for a job. But that is not what people always need to hear when they are med students or residents and making a very important decision about their career.

And by scutty dermpath Dx style places . . . are you inferring that Ackerman Academy is not a good place to train??? B/c as of now, there are only 3 "scutty dermpath dx fellowships" and to state that training under Dirk Elston or A. Bernard Ackerman does not have notoriety, has poor training quality, has little specimen variety and/or no connections is quite naive. DP is a volume driven field. Unless you are seeing a large number of cases during your meager 1 year of training (irregardless of variety), will not allow you to feel competent or comfortable with the really tough everyday cases (which I would argue is more important than seeing some zebra and realizing that you need to send it for consult irregardless of what you want to call it your 1st or 2nd year out) and if your volume isn't high enough you won't see the weird and rare diagnoses either.

That's why I encourage doing two subspecialty fellowships. Widen your areas of expertise outside of general SP and make yourself look as attractive as possible in this crazy job market. Your residency should train you well enough for almost all general SP anyway. I'd be interested to know what dermpath programs your friends trained and how wide a net they cast for jobs. Even in dermpath fellowship there are stratifications in notoriety, training quality, and....connections!! Some are scutty dermpath Dx style places with little specimen variety which I think would be a poor training experience. I'm a glass is all the way full type of delusionally optimistic person, so I'm going to shed a ray of hope and say in a few years things will be a lot better!