derm pathologist producers

[freeWillieB]

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Are there any pathology residency programs that are known for churning out lots of derm pathologists?

 

[deschutes]

You are not alone.

http://forums.studentdoctor.net/showthread.php?t=237221

 

[yaah]

I hesitate to say this for fear that the "I love skin" hordes will descend, but there is one at michigan too now.

 

[freeWillieB]

Thanks guys. Hope I didn't offend anyone with "the D-word".

 

[yaah]

Thanks guys. Hope I didn't offend anyone with "the D-word".

If you're going for pathology residency I am not offended. I am offended by dermatologists getting dermpath fellowship spots. 😉

Who knows. I do a month of dermpath in may and will probably enjoy it. But I just don't think I could ever bring myself to apply for it and deal with what goes into applying for it.

 

[freeWillieB]

Who knows. I do a month of dermpath in may and will probably enjoy it. But I just don't think I could ever bring myself to apply for it and deal with what goes into applying for it.[/QUOTE]

What's so painful about it? Just curious. I'm a 2nd year and don't know much about these things.

 

[yaah]

What's so painful about it? Just curious. I'm a 2nd year and don't know much about these things.

Dermpath is popular because it is lucrative. And things that are lucrative tend to attract people who then deny that money is their motivation. Obviously there are people interested in dermpath who would be interested regardless of the money or lifestyle, but the amount of people who develop an interest because of the other factors and then proclaim it is their lifelong interest is higher in this field. And a lot of these same individuals double as the ones who have three publications and two patents before they finish high school. Thus, to compete with them is annoying. And to work with them in fellowship would be even more annoying. I don't like the fact that dermatologists can get dermpath fellowship spots - I just feel that the appropriate training for such a thing includes a pathology residency. People disagree with me of course.

 

[fab5]

dermatologists deserve to get dermpath slots because that is all they study - skin - day in and day out. they are extremely good at it! dermpath program directors all over the country would get a derm resident anytime for a fellowship over a path resident. that is not surprising at all - derm residents just know more dermpath than path residents do. having said that though, derm residents usually do not opt to do a dermpath fellowship because they like seeing patients more than passing glass. derm residents who do dermpath fellowships, for the most part, either want an academic career or realize during residency that they would rather pass glass than see patients. in fact, if you survey the derm-trained dermatopathologists all over the country, you will find that they ended up giving up patient care to devote their entire practice to passing glass.

money in dermpath is certainly an attraction for a lot of people, and so is the case for people interested in other lucrative fields such as derm, radiology, anesthesia, plastics, ortho, ophtho, rad onc, and ent. i think it is unfair, however, to think that people aspiring for these fields are in it primarily for the money. we have to give these people the benefit of the doubt - that they are interested in these fields because they want to dedicate their lives to them. i believe that these people are smart enough to realize that no amount of money will ever be enough to buy the happiness you can get from doing what it is that you truly love.

 

[Rael]

Just curious - anyone happen to know what percentage of dermpath fellowship spots go to pathologists versus dermatologists?

So then why can't a heme/onc physician do a heme-path fellowship then?

 

[fab5]

Just curious - anyone happen to know what percentage of dermpath fellowship spots go to pathologists versus dermatologists?

So then why can't a heme/onc physician do a heme-path fellowship then?

i am not aware of the numbers but if you look at the websites of the different dermpath programs, you will be able to tell which programs are under derm and which ones are under path. those under derm typically favor derm applicants and those under path favor path applicants.

dermpath is unique because the gross specimens are not organs or fluids that can be taken out of patients' bodies, delivered to the lab, processed and made into slides, and then analyzed/studied by pathologists. in dermpath, the gross specimens are the patients themselves. a lot of derm diagnoses (specially the dermatoses) cannot be made without adequate clinical histories. because derm residents have the benefit of seeing the patients, they are able to make clinicohistopathologic correlations better. to make up for the lack of clinical training, path-trained dermpath fellows are required to attend derm clinics for 6 months during their fellowship.

derm residents are very well trained in dermpath - it is part of their training everyday. derm cannot stand without dermpath and vice versa. a lot of the understanding we have of the pathophysiology of skin diseases are based on the appearances of the various skin diseases under the microscope.

hemepath people need not see heme-onc patients to be able to diagnose hematologic diseases.

 

[yaah]

dermatologists deserve to get dermpath slots because that is all they study - skin - day in and day out. they are extremely good at it! dermpath program directors all over the country would get a derm resident anytime for a fellowship over a path resident. that is not surprising at all - derm residents just know more dermpath than path residents do. having said that though, derm residents usually do not opt to do a dermpath fellowship because they like seeing patients more than passing glass. derm residents who do dermpath fellowships, for the most part, either want an academic career or realize during residency that they would rather pass glass than see patients. in fact, if you survey the derm-trained dermatopathologists all over the country, you will find that they ended up giving up patient care to devote their entire practice to passing glass.

While many dermatologists may be good at diagnosing cases under glass, to say that derm residents know more dermpath than path residents is ludicrous. Perhaps this is true at your program, but it is not universal. A lot of times, dermpath residents may know a lot of path but they also do not have the references from general pathology that I believe are critical - what is atypia, what is reactive, what is invasion, what is normal, etc etc. At my program, for example, the path residents gross in all the cases, they preview, make preliminary diagnoses, etc. The derm residents come to signout and sit in. They have a passing knowledge of pathology for the most part, with some exceptions. Obviously, with time and experience they will become better and this is the purpose of the fellowship.

The "gross" of seeing the patient is indeed key - I agree path residents can lack this. But the good clinician will list their differential on the requisition anyway which eliminates a lot of this.

As for whether program directors will gladly take derm residents over path residents any day, that is also ludicrous. You are right, there are programs which take derm-trained people preferentially and some which take pathologists, but those taking pathologists are not doing so because they couldn't find a dermatologist.

I find this similar to a CP-only resident doing hemepath and signing out cases.

 

[fab5]

While many dermatologists may be good at diagnosing cases under glass, to say that derm residents know more dermpath than path residents is ludicrous. Perhaps this is true at your program, but it is not universal. A lot of times, dermpath residents may know a lot of path but they also do not have the references from general pathology that I believe are critical - what is atypia, what is reactive, what is invasion, what is normal, etc etc. At my program, for example, the path residents gross in all the cases, they preview, make preliminary diagnoses, etc. The derm residents come to signout and sit in. They have a passing knowledge of pathology for the most part, with some exceptions. Obviously, with time and experience they will become better and this is the purpose of the fellowship.

i am surprised michigan's derm residents are not excellent in dermpath (they have a "passing knowledge"). in any case, i did 4 away dermpath electives at different institutions (count my home program and that's 5 total) and had the same experience - derm residents knew dermpath more than path residents did. derm residents have dermpath conferences at least 2x a week and they look at skin pathology (kodachromes, power point presentations, microscope) all the time. they eat, breath and sleep with skin. who else would know skin more than the derm residents? and at all the programs i went to, derm residents knew the basics of path (as it relates to skin) - benign vs malignant, atypia, extent of invasion, etc. how can you possibly study dermpath without knowing the basics of pathology??? i believe the michigan derm residents are way smarter than that. derm and path residents study the same skin pathology books - from lever to barnhill to weedon to mckee. and the derm residents are expected to master (versus simply having a "passing knowledge") dermpath by the end of their training. in fact, in california (and some other states), dermatologists without a formal dermpath fellowship (just relying on their residency training) sign out their own skin biopsies.

The "gross" of seeing the patient is indeed key - I agree path residents can lack this. But the good clinician will list their differential on the requisition anyway which eliminates a lot of this.

unfortunately, there are more clinicians who are not conscientious enough to write the clinical history, let alone differentials, of the cases they see. more often than not, they just do the biopsy and then let their nurses fill out the requisition forms.

dermatopathologists attend dermatology grand rounds and clinical conferences in order for them to see gross skin diseases and consequently make better histologic diagnoses. hence, a dermatopathologist is boarded both by the american boards of dermatology and pathology. one just cannot stand without the other.

As for whether program directors will gladly take derm residents over path residents any day, that is also ludicrous. You are right, there are programs which take derm-trained people preferentially and some which take pathologists, but those taking pathologists are not doing so because they couldn't find a dermatologist.

i wonder then why dermpath fellowships are extremely hard to get into for path residents (and are easy to get for derm residents)... not only are the spots few but there are the derm residents (who for the most part have more excellent credentials than the average path resident) to compete against...

 

[LADoc00]

Are there any pathology residency programs that are known for churning out lots of derm pathologists?

No such program exists. Trust me. Even places that take 2/yr almost always take an outside path candidate and often a dermatologist, leaving your sorry butt blowing in the wind.

I will say it again, the single biggest mistake of the ABP was allowing dermatologists to sit for dermpath boards with only 1 year of path, even making them do 1 year of gen path + fellowship would cut their numbers back ALOT.....the ABP leadership pretty much has ZERO concern for its members.

 

[tsj]

i wonder then why dermpath fellowships are extremely hard to get into for path residents (and are easy to get for derm residents)... not only are the spots few but there are the derm residents (who for the most part have more excellent credentials than the average path resident) to compete against...

Since there are about 80 spots in the country (at least half of which go to path people) how is it so easy for derm people? As most derm people are mostly interested in opening boutiques and hawking over priced anti-aging creams, maybe the few that are interested in derm path have an easy time as most d-path programs like to split their candidates 1/2 in path and 1/2 from derm.

Also what "more excellent credentials" do they have?

 

[fab5]

As most derm people are mostly interested in opening boutiques and hawking over priced anti-aging creams...

As somebody who I am assuming is a Pathologist, I am surprised you look at dermatologists like lay people (who know nothing about medicine) would. If I had a skin problem, from something as banal as acne to something as serious as melanoma, lupus, or CTCL, I would not entrust my life to anybody other than a dermatologist. I would hope you would have a better appreciation of your dermatology colleagues and the critical role they play in medicine and patient care.

Also what "more excellent credentials" do they have?[/QUOTE]

I believe this question need not even be answered...

 

[tsj]

Also what "more excellent credentials" do they have?

I believe this question need not even be answered...[/QUOTE]

No please answer it, and be specific.

 

[fab5]

I believe this question need not even be answered...

No please answer it, and be specific.[/QUOTE]


i said that because we all know that MOST of the people who did very well in medical school - board scores above 240, AOA, top 10% of the class, etc. - chose to go to the most competitive specialties like derm, rads, ophtho, ortho, rad onc, etc.

 

[tsj]

As most derm people are mostly interested in opening boutiques and hawking over priced anti-aging creams...

As somebody who I am assuming is a Pathologist, I am surprised you look at dermatologists like lay people (who know nothing about medicine) would. If I had a skin problem, from something as banal as acne to something as serious as melanoma, lupus, or CTCL, I would not entrust my life to anybody other than a dermatologist. I would hope you would have a better appreciation of your dermatology colleagues and the critical role they play in medicine and patient care.

And a pathologist will determine the course of action for 1000s of other serious (or not serious) ailments you might one day have. Including melanoma, lupus, gvhd etc....

 

[yaah]

i wonder then why dermpath fellowships are extremely hard to get into for path residents (and are easy to get for derm residents)... not only are the spots few but there are the derm residents (who for the most part have more excellent credentials than the average path resident) to compete against...

The problem is that dermpath is a big part of private practice (and some academic programs) for general pathologists. Private practice people look to hire someone who can do dermpath, but they want someone who can do general path PLUS dermpath. This is the big part of the problem. If every specialty area of path was its own little world and that is all you saw, I doubt anyone could complain, because those who wanted to do derm could do derm, etc. But there will be very few private practice path places that would look to hire a dermatologist over a pathologist because they are not boarded in path.

As to your question above, a lot of it comes down to credentials. A path resident has to train in general pathology and cannot simply focus on skin. When it comes to publications, research, etc, what do you think a dermatologist is going to be focusing on? A pathology resident can have varied interest. And in regards to your point about the credentials - when applying for fellowship your med school ranking and step I and II scores are pretty irrelevant.

So we get this straight, I am not badmouthing dermatologists who want to do dermpath. And I am sure the residents here have a good knowledge of dermpath. I am just saying there is a big difference between having this knowledge and going to lots of conferences and actually sitting down with slides and making diagnoses on the tough cases. After one week of residency, the majority of path residents can make the diagnosis on 90% of derm biopsies and resections because they are pretty much the easiest diagnoses out there. It is the other 10% which are more critical. This is also where the private practices want expertise. They don't want to send all their melanomas and atypical nevi out for consultation. LADoc is right - the ABP does a disservice by allowing so many dermatologists to train in dermpath.

 

[fab5]

i rest my case...

just thought i would chime in and share some of my thoughts on dermpath... the readers, i hope, learned something, one way or the other, from our discussions. thank you yaah and tsj for your thoughts.

a co-resident of mine introduced this site to me not too long ago. i am a 3rd year path resident and i recently got a dermpath fellowship spot...

i think this forum is a wonderful resource for all Pathologists, aspiring-to-be, in training, or otherwise... i wish i knew about this site when i was applying as a medical student...

thanks again!

 

[Rael]

Correct me if I'm wrong, fab5, but didn't you state earlier that you are a 1st year path resident. Now you say that you're a 3rd year and going into dermpath. I'm confused, which is it?

Forgive me if I'm mistaken, but that's what I gathered from you previous posts.

 

[fab5]

Correct me if I'm wrong, fab5, but didn't you state earlier that you are a 1st year path resident. Now you say that you're a 3rd year and going into dermpath. I'm confused, which is it?

Forgive me if I'm mistaken, but that's what I gathered from you previous posts.

Thank you Rael for bringing that up. I most likely will get crucified for this but I did lie 👎 about my PGY level. My original post was on a very delicate topic - Gay Pathology - so I decided to conceal my identity by saying I was a PGY-1 resident. Yes, I am gay and I was paranoid.

I've since then just been reading the posts on here but when the Dermpath topic came to fore, I was not able to keep myself from sharing my thoughts - and I let my guard down and revealed more than I should have about my identity.

I do apologize for that detail I lied about... 🙁

 

[Rael]

Thank you Rael for bringing that up. I most likely will get crucified for this but I did lie 👎 about my PGY level. My original post was on a very delicate topic - Gay Pathology - so I decided to conceal my identity by saying I was a PGY-1 resident. Yes, I am gay and I was paranoid.

I've since then just been reading the posts on here but when the Dermpath topic came to fore, I was not able to keep myself from sharing my thoughts - and I let my guard down and revealed more than I should have about my identity.

I do apologize for that detail I lied about... 🙁

I hope I didn't make you uncomfortable by bringing that up...just wondered about it...but I understand your reasons and hope you don't hesitate to post here in the future because of that. I hope your identity hasn't been compromised. I, for one, still have no idea who you are...so it's all good. 🙂

 

[torero]

A bit late in the discussion but… I just reviewed a case signed-out at an outside institution where a dermatology trained dermatopathologist grossly overestimated the thickness of a melanoma because she failed to notice/take into account the fact that the biopsy not embedded properly and cut tangentially. This may be only an anecdote, but I think it is telling of the strengths and weaknesses of derm vs path trained dermatopathologists. Derm residents have an uncanny ability to diagnose things like epidermolytic acanthoma, but give them a scar and they’ll swear it’s a dermatofibroma. During residency they definitely have a more thorough understanding of dermatologic disease than a pathology resident, but path residents have more experience reading slides. Every now and then I have a hard time explaining derm residents (and not only first year, mind you) simple concepts such as what a deeper section means. After being out in practice though, these differences level out, for the most part, anyway.

 

[torero]

Just curious - anyone happen to know what percentage of dermpath fellowship spots go to pathologists versus dermatologists?

So then why can't a heme/onc physician do a heme-path fellowship then?

Actually, not only hem/onc fellowship trained physicians, but even internal medicine trained docs are eligible for ABPath certification in hemepath after completing a two year hemepath fellowship.

 

[Mrbojangles]

Actually, not only hem/onc fellowship trained physicians, but even internal medicine trained docs are eligible for ABPath certification in hemepath after completing a two year hemepath fellowship.

Also aren't neuropath fellowships open to neurologists? I would imagine there are very few heme/onc internists or neurologists who do a path fellowship.

 

[tsj]

At one time anyone could take the path boards (I think). I met one old-timer who did residency in Int. Med., studied for and then took the path boards, passed them and became a pathologist. He still is.

 

[yaah]

At one time anyone could take the path boards (I think). I met one old-timer who did residency in Int. Med., studied for and then took the path boards, passed them and became a pathologist. He still is.

This would be the way to go with some subspecialty boards - that way we could all just take the dermpath boards and be done with it.

 

[Mrbojangles]

What about a one year obligatory internship in pathology for any clinicians thinking about a subspecialty pathology fellowship? That would certainly turn most of them away. How can a clinician all of the sudden be expected to read slides and master their subspecialty especially for a one year fellowship. Dental school graduates who want to do dental path have to do a one year internship in anatomic pathology at my institution.

 

[weaseldom]

If you're going for pathology residency I am not offended. I am offended by dermatologists getting dermpath fellowship spots. 😉

Who knows. I do a month of dermpath in may and will probably enjoy it. But I just don't think I could ever bring myself to apply for it and deal with what goes into applying for it.

what do you mean by, "all that goes into applying for it."?

and yes, btw ~ I am a pending PGYI in path at one of the above listed schools, so I have some 'reasons' for such an inquiry (if any is truly needed)

 

[PathOne]

I'm sorry to say so, but there's quite a lot of misconceptions in this thread. Allow me to give my insights to just a couple.

1) Derms vs. Pathologists as dermpaths: Each bring something special to the table (or microscope, as it were). In very general terms, Derms are probably initially better at clinical correlations/differentials, while Paths have more experience looking at morphology. That is distinct advantages and disadvantages for each group. However, to claim that Derms shouldn't be able to be/become dermpaths simply doesn't wash. The preeminent (although controversial) father of modern dermpath is Bernie Ackerman - a Dermatologist by training. The simple fact is, that either initial training field can produce great Dermpaths.

2) People only want Dermpath for the money and the lifestyle. Certainly, certain people are drawn to a specialty/subspecialty for the money, lifestyle, status or other reasons. And yes, a lot of dx'es are fairly straightforward (for a large part explaining why it's a fairly lucrative franchise). However, it's also a field with some fairly mind-numbing challenges sometimes. While knowing that malignant melanoma is not only one of the fastest growing forms of cancer, but also frequently one of the most aggressive, try differentiating between a malignant melanoma and a totally benign Spitz nevus. Believe me, I've seen some of the best people in the world having a real struggle coming up with the correct diagnosis. Add to that, the fact that technology so far hasn't really been helpful so far in Dermpath. You can stain all you want with stuff like S-100, but it doesn't really help you. And despite the search for that easy and dependable molecular diagnostic marker, we're still essentially nowhere, and unable to distinguish between a totally benign nevi and nasty cancer at the molecular level. So there's plenty of challenges out there.

Oh, and there's of course that one great big advantage to Dermpath: NEVER to have to gross again...!

But to the OP: No, there isn't a university or hospital which has a special leg up on getting you a Dermpath fellowship. However, training in a hospital with a fairly solid Dermpath program, such as UCSF or NYU (to name one on each coast) would certainly be helpful. Also, Dermpath is probably more academically inclined than your average path program, so training at a center known for academic excellence would probably be helpful too.

 

[yaah]

Thanks for your post - the main problem I still have though is that dermpath is so important to private practice general pathology, and there simply aren't enough fellowships to train to fill the demand. I am all for training dermatologists as dermpathologists, but there is a shortage of pathologists who are qualified in this area and the american board of path should be addressing this.

Maybe I'm wrong, there isn't a shortage. But every single job posting for private practice path I see mentions dermpath.

 

[LADoc00]

Thanks for your post - the main problem I still have though is that dermpath is so important to private practice general pathology, and there simply aren't enough fellowships to train to fill the demand. I am all for training dermatologists as dermpathologists, but there is a shortage of pathologists who are qualified in this area and the american board of path should be addressing this.

Maybe I'm wrong, there isn't a shortage. But every single job posting for private practice path I see mentions dermpath.

Allowing dermies to sit for boards with 1 friggin single year of path training was INSANE. Freakin insane. They had to have been either A.) getting bribed by the Amer Board of Dermatology B.) Temporarily gone completely ******ed. That single motion, that single act took millions away from community pathologists. People went bankrupt as a result and that sure as hell had nothing to with "quality healthcare" it had all to do with the almighty dollar and dermies wanted more. I still remember my training, we had a dermy who was doing the fellowship, came in at 9-10 and left about 3pm if he stayed that late. I asked what he did with all the free time...He was working full time in private prac while doing the fellowship!! WTF?!!!!!!! 😡

 

[PathOne]

Thanks for your post - the main problem I still have though is that dermpath is so important to private practice general pathology, and there simply aren't enough fellowships to train to fill the demand. I am all for training dermatologists as dermpathologists, but there is a shortage of pathologists who are qualified in this area and the american board of path should be addressing this.

Maybe I'm wrong, there isn't a shortage. But every single job posting for private practice path I see mentions dermpath.

I definitely agree that there's too few fellowship slots in Dermpath. Which is also a reason why you basically never do general surg path once you've passed the boards.

As regards the Derm-entryway and the length of the fellowship, I'd probably have to concur that one year is on the low side. Both for Derms and Paths, really. Perhaps that's also a reason why the failure rate at the boards is pretty high (abt. 1/3 as far as I recall). Don't really know if there's any data on which side has the most trouble passing the boards.

In Europe, there's currently a huge debate over Dermpath, which so far is only a formal subspecialization in the UK. Most countries are dead-set against Derms reading slides. Personally, I feel that from a purely professional viewpoint many Derms becomes excellent Dermpaths. However, there IS a risk that they may overlook certain things.