Dermatopath Fellowship - What Does It Take To Get In?

[KeratinPearls]

Hi guys,

I am new here. I am looking to apply to pathology residency for 2008.

I am looking to apply for a dermatopathology fellowship. I was wondering how hard is it to get a position? Is it like dermatology-residency hard, where you can score 99s on the steps and still not get in? What is the typical profile of a successful applicant to these fellowships? Numerous publications, great board scores (do Step 1/2 scores matter at this point?), LORs, MD/PhD? Will it be close to impossible for me to land a spot if I do my residency in a program without a dermatopathology fellowship?

Should one be AP/CP boarded or can AP alone suffice? I've seen some programs require an AP or AP/CP. Will an AP make you a less competitive applicant? Well, I have lots of questions, but I thought I'd start with these questions first. Thanks for any help.

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[Gut Shot]

Dermpath is tough, there's not doubt about it. The best ways to hedge your bets are 1.) go to a program that has a dermpath fellowship, 2.) do research with the dermpath folks at your institution (without being a total suck up), and 3.) don't come across as someone who got shot down applying to dermatology, and is therefore just taking the "backdoor" into a derm-related specialty.

I mention #3 because many programs have encountered this type of applicant. The problem with them is that path training is long and challenging. If you're only goal is to land in one tiny sliver of the pathology landscape, there's an excellent chance that you're going to be profoundly unhappy with the rest of it, perhaps enough to quit.

My program has had two residents like this in recent years. One ended up enjoying general pathology more than expected, even though she's still going to a dermpath fellowship at a little place in Boston. The other bailed within a month.

 

[deschutes]

Heard that the dermpath fellowship at UColorado prefers to not take internal candidates, after one grad set up business nearby.

They will however, I am told, go out of their way to get you a dermpath fellowship anywhere else in the country.

 

[yaah]

A lot of it is timing and luck, especially given the way fellowships are run and organized in pathology (everyone has different timelines and many have different requirements). Not all programs take internal candidates but most will consider them more than they would a comparable candidate from the outside (thus, being an internal candidate is often your best shot, and the only interview you may get is your own program).

Thus, timing comes in if there are multiple residents applying each year from your own program. Politics also plays a role, in that "the best candidate" is a subjective thing (even though most programs say they want the best candidate). People who may not even get serious consideration at other programs can get spots because they do outside rotations or "express interest" or whatever.

I would say that publication record (not just "research") is important and you are unlikely to be considered seriously at an outside place if you haven't at least presented a poster or abstract or have a manuscript submitted (unless you're a PhD in which case recent publications might be less important). In addition, recommendation letters are very important in that program directors want to see letters from people they know (thus, a letter from the dermpath director at your program is much more likely to be seen as a good one than one from a new attending).

AP only, meh, I don't know. It gives you one less year to apply and build up your resume, so unless you come in with a strong record you are going to be behind the 8 ball from the beginning.

I don't know if board scores matter. I doubt it makes a big difference.

Bear in mind there are a lot of people in path who have been gunning for dermpath since they came out of the womb. I think many of them actually even enjoy dermpath, although many people gun for it before they even do a rotation in it.

 

[Gut Shot]

I would say that publication record (not just "research")

Well pardon my bellicosity, sir!

 

[Thaitanium]

Does AP vs. AP/CP make you a less competitive applicant because you didnt do the CP portion?

 

[CameronFrye]

Does AP vs. AP/CP make you a less competitive applicant because you didnt do the CP portion?

Not necessarily, but your time on CP is usually your best opportunity to work on projects. A lot of AP months are hard and when you do have the easier months, you usually want to just catch your breath.

One other thought: while a dermpath fellowship insulates you from some of the need to be CP trained to be fully competitive in the private market, if (when?) reimbursements change, you may want to be more than a one trick pony.

 

[b&ierstiefel]

Welcome to the path forum. Dermpath positions are relatively hard to get. Is dermatology-residency hard? The lifestyle in derm residency and the pay in derm is great...it's just hard to get into since a lot of uber-candidates apply to this field, not because they love skin but because they are competitive and they just can. Kinda like why we applied to med school to begin with...cuz we wanna help people and are inherently altruistic? No, cuz we wanna make money and demand respect, although even these incentives are decreasing. Perhaps I'm being too cynical.

Now, path is much easier to get into and dermpath is a great option for pathologists to make a lot of bank. Yes, dermpath can be a viable backdoor for those who weren't competitive enough for derm or were too scared to apply to derm cuz they knew all these gunners at their med school who went into derm. Think of it this way...in pathology residency, it's easier to be a big fish in a little pond. As far as derm residency is considered, you're a little fish in a slightly bigger pond containing sharks with laser beams on their heads. OK, maybe I'm exaggerating a bit

Typical profile of dermpath fellow...don't really know. I know a two people from my program who are or will be in the dermpath fellowship at Harvard. Multiple publications! Both MD/PhD. One had quite a few Cell and Science publications too. I just heard that USMLE scores were not asked for in our application (although other dermpath fellowships wanted to see med school transcripts and board scores). Neither of them are slackers and are strong diagnostically. They networked very effectively with the dermpath attendings early in their residency.

Go to a program that has a dermpath fellowship...not only that, go to a program where the dermpath is run by PATHOLOGY and not DERMATOLOGY. That distinction can (but not always) have a big impact on the politics surrounding who gets preferential treatment.

AP alone will suffice. But AP/CP gives you more options and sure, doing CP gives you time to work on projects as others have mentioned.

Hi guys,

I am new here. I am looking to apply to pathology residency for 2008.

I am looking to apply for a dermatopathology fellowship. I was wondering how hard is it to get a position? Is it like dermatology-residency hard, where you can score 99s on the steps and still not get in? What is the typical profile of a successful applicant to these fellowships? Numerous publications, great board scores (do Step 1/2 scores matter at this point?), LORs, MD/PhD? Will it be close to impossible for me to land a spot if I do my residency in a program without a dermatopathology fellowship?

Should one be AP/CP boarded or can AP alone suffice? I've seen some programs require an AP or AP/CP. Will an AP make you a less competitive applicant? Well, I have lots of questions, but I thought I'd start with these questions first. Thanks for any help.

 

[yaah]

Sometimes I wish dermpath was its own residency. These days it's almost like dermpath : pathology residency is the equivalent to med school : premed in undergrand. Seems like lots of people have an interest when things start (or before they start) but then gradually most people get weeded out. Sometimes it's because they see how competitive it is and they don't want any part of it. Sometimes it's because their stats aren't good enough so they ditch the idea. And then everyone else is residency/undergrad starts to get annoyed with them.

I have yet to meet anyone who was successful in getting a dermpath spot lately who did not have multiple publications or recent poster/abstract presentations/manuscripts submitted. I also have yet to meet anyone who was successful who wasn't a pretty stellar resident.

 

[mlw03]

there's also the obvious issue that you're not just competing for the spot(s) against pathology residents, but also against dermatology residents. bigger applicant pool = more competitive.

 

[SLUsagar]

Hi guys,

I am new here. I am looking to apply to pathology residency for 2008.

I am looking to apply for a dermatopathology fellowship. I was wondering how hard is it to get a position? Is it like dermatology-residency hard, where you can score 99s on the steps and still not get in? What is the typical profile of a successful applicant to these fellowships? Numerous publications, great board scores (do Step 1/2 scores matter at this point?), LORs, MD/PhD? Will it be close to impossible for me to land a spot if I do my residency in a program without a dermatopathology fellowship?

Should one be AP/CP boarded or can AP alone suffice? I've seen some programs require an AP or AP/CP. Will an AP make you a less competitive applicant? Well, I have lots of questions, but I thought I'd start with these questions first. Thanks for any help.

1. Charisma, personality, smarts up the wazoo
2. A great rack (hey come on, occasionally it is true...some folks slide by on stuff like that...LADoc will back me up)
3. Tons of research, w/o coming off like a Hugh Jass Kizzass
4. Ability to make clinicopathological correlation (for many other path fields we often just dump that back on the clinician)
5. Inside, scandelous Bushian/politician-like connections

 

[LADoc00]

I simply employ dermpaths rather than being one. Take your pick.

Biz skillz>>>>>>>>>all.

 

[yaah]

there's also the obvious issue that you're not just competing for the spot(s) against pathology residents, but also against dermatology residents. bigger applicant pool = more competitive.

I actually think that is a relatively minor issue, although obviously it does contribute. What is more important is that many fellowship programs are run by dermatology departments, many of them favor derm trained, many don't. Interestingly, ACGME lists dermpath as a fellowship under dermatology, not under pathology. I find this really odd but it is probably a factor of who the big names were in the past and how things have traditionally been. The real issue is that there are less than 50 total programs (although many have more than one spot) in a field that has a much higher demand.

 

[clemsondermpath]

As someone who recently got a DP fellowship for '08, I can offer my experience. I am at a small, not at all well known path program (via the couples match, both in path) without a DP fellowship. I have only a poster presentation at ASDP and a couple of published non-derm related papers to my name. I am not the schmoozing, kiss-ass, go to meetings and talk your way into a position type at all. The DP faculty here do not really know many people in the field. I got 6 interviews, including some big name places, and was offered by (and accepted at ) a path-run place (and I'm waiting to hear from one of my other interviews). I believe my success in getting a position can be attributed mostly to a combination of my pre-residency academic success (99x2 on Steps, AOA, 3rd in med school class, 1st in college class) and rapport with the faculty at the place that offered. It is very imposing when you consider the competition (especially being from a place that is not particularly well thought of and which does little research) but it's obviously doable and worth it if derm is what you really enjoy.

 

[DarksideAllstar]

Hi guys,

I am new here. I am looking to apply to pathology residency for 2008.

Does this strike anyone else as odd? I realize that everyone has their own interests in things for whatever reason, but isn't this kind of funny that someone is talking fellowship when they haven't started residency yet? Path isn't like internal medicine or surgery where you actually get exposure to subspecialties as a med student, and can say "well, I really enjoyed my cardiology rotation, so I think I'll ultimately do that." I guess if you've done a derm rotation and you like that but hate working the clinic that would be one thing or if you've actually already done a month of dermpath then that would give you an idea of whether you'd enjoy it, but holy ****. I guess when my kid is born I'll hand them a baseball bat and tell them to quit sucking or their mom's tit and get out in the yard for some batting practice so they can make dad some $. Seems like this planning ahead stuff has gotten way out of hand.

To the OP- I'm not bashing you, but it just seems way premature (unless you've already had significant dermpath, then I will retract my statements).

 

[schrute]

As someone who recently got a DP fellowship for '08, I can offer my experience. I am at a small, not at all well known path program (via the couples match, both in path) without a DP fellowship. I have only a poster presentation at ASDP and a couple of published non-derm related papers to my name. I am not the schmoozing, kiss-ass, go to meetings and talk your way into a position type at all. The DP faculty here do not really know many people in the field. I got 6 interviews, including some big name places, and was offered by (and accepted at ) a path-run place (and I'm waiting to hear from one of my other interviews). I believe my success in getting a position can be attributed mostly to a combination of my pre-residency academic success (99x2 on Steps, AOA, 3rd in med school class, 1st in college class) and rapport with the faculty at the place that offered. It is very imposing when you consider the competition (especially being from a place that is not particularly well thought of and which does little research) but it's obviously doable and worth it if derm is what you really enjoy.

Ok, no offense, but "obviously doable" and "99x2 on Steps, AOA, 3rd in med school class, 1st in college class" don't exactly belong in the same sentence.

The general trend on SDN is that of high-achievers painting the picture that pathology residencies (along with fellowships and most other non-FP fields) are dominated by gunners that apply to MGH, BWH, Stanford, JH...and other coastal schools.

I'm not trying to state the obvious, just that landing a derm path fellowship isn't 100% dependant on you being Virchow incarnate unless you plan on applying to a top program. There are 47 derm path fellowships.

 

[LADoc00]

the people that somehow think having a dermpath fellowship will magically make them wealthly are in for a VERY big shock. A vast majority of the DP trainees from path, Im talking 90%+, enter general path groups making *maybe* 10 grand more than someone with cyto the first year and become partner on the exact same time schedule as everyone else. A rare person does outpatient only business, but that is getting less frequent aside from pod labs. A more likely scenario is you get hired by a group of dermatologists for a salary, you go to work for Kaiser or head back to academia.

There has to be more to you than just DP. Much more. Im laughing to myself seeing all this DP=mad bank and knowing the reality.

Funny, DP is sought after because the training numbers are being kept artificially low. If DP trained as many people as say Forensics, then it wouldnt be special. All of pathology could benefit from having only 100-200 spots/year open.

 

[triguy]

Seems like lots of people have an interest when things start (or before they start) but then gradually most people get weeded out.

Let me take a crack at this one: As a med student, you liked the visual aspect of derm (likely the reason why you went into path), so it holds a warm place in your heart. But once you get into path, you will realize that there are much better organ systems out there (like GI), and you too will leave the dermpath fellowship behind for greener pastures. Besides, it is hard to walk in all the manure wearing clicky high heels.

 

[deschutes]

Besides, it is hard to walk in all the manure wearing clicky high heels.

But some prefer wearing clicky high heels to walking in all that manure.

Haven't you heard? Chicks are creeped out by pathologists.

 

[yaah]

the people that somehow think having a dermpath fellowship will magically make them wealthly are in for a VERY big shock. A vast majority of the DP trainees from path, Im talking 90%+, entire general path groups making *maybe* 10 grand more than someone with cyto the first year and become partner on the exact same time schedule as everyone else. A rare person does outpatient only business, but that is getting less frequent aside from pod labs. A more likely scenario is you get hired by a group of dermatologists for a salary, you go to work for Kaiser or head back to academia.

There has to be more to you than just DP. Much more. Im laughing to myself seeing all this DP=mad bank and knowing the reality.

Funny, DP is sought after because the training numbers are being kept artificially low. If DP trained as many people as say Forensics, then it wouldnt be special. All of pathology could benefit from having only 100-200 spots/year open.

I think people see all those job opportunities and assume it means mad bank. As the other thread said, the thing that employers are looking for above all is not dermpath, it's communication skills and common sense, and the ability to do a good job. A good general pathologist can probably sign out 98% of derm without having to involve any consultant (and dermpath boarded people are also going to consult on many of those cases), you don't have to be dermpath boarded to sign out dermpath. You have to be dermpath boarded to get an academic dermpath job, though!

The whole obsession with declaring fellowship interest before legitimate exposure to the field irritates me. It's not just residents and med students doing it though, when program directors invite candidates they ask them what areas they are interested in, and some will look confused if you say you aren't sure what area you like yet.

 

[CameronFrye]

A good general pathologist can probably sign out 98% of derm without having to involve any consultant (and dermpath boarded people are also going to consult on many of those cases)

Absolutely. One of our dermpath faculty (Mark Wick) is path trained and has a fellowship in blood banking. He is a staunch proponent of general pathologists signing out derm and he is always telling us to take every opportunity during residency to learn dermpath.

 

[106174]

Absolutely. One of our dermpath faculty (Mark Wick) is path trained and has a fellowship in blood banking. He is a staunch proponent of general pathologists signing out derm and he is always telling us to take every opportunity during residency to learn dermpath.

christopher crum came to visit us recently and over dinner, he said that he is all for subspecialization in path. in fact, he believes that ALL of pathology will become subspecialized in the next few years, mainly as a result of clinicians wanting only the "best" pathologists reading their specimens ("best" meaning pathologists who become experts by looking at nothing else but that particular organ system, day in and day out).

 

[LADoc00]

Absolutely. One of our dermpath faculty (Mark Wick) is path trained and has a fellowship in blood banking. He is a staunch proponent of general pathologists signing out derm and he is always telling us to take every opportunity during residency to learn dermpath.

Wick is a dermpath ninja master. I completely agree with that philosophy.

There was a short time when pathologists were allowed to challenge the dermpath exam for certification. I honestly think they should bring this back AND if I ever gain control of the ABP, I will allow every who wants it board cert in Derm.

DP boards=marketing ploy, has nothing to do with mad skillz.

 

[yaah]

christopher crum came to visit us recently and over dinner, he said that he is all for subspecialization in path. in fact, he believes that ALL of pathology will become subspecialized in the next few years, mainly as a result of clinicians wanting only the "best" pathologists reading their specimens ("best" meaning pathologists who become experts by looking at nothing else but that particular organ system, day in and day out).

That probably is the way things are going. For a time, there will be general pathologists who see everything though, and that will likely be the case for the foreseeable future. At academic centers and large enough private places, subspecialty will definitely be important though. Clinicians here always seem to want one of the "experts" to see most of the cases, even if the non expert who signed it out is a great pathologist who was entirely correct (a lot of it is based on stylistic things like language, templates, which pertinent findings you mention, etc).

So I'm not so sure about "in the next few years" apart from large institutions. There simply aren't enough subspecialists to read all biopsies.

 

[CameronFrye]

christopher crum came to visit us recently and over dinner, he said that he is all for subspecialization in path. in fact, he believes that ALL of pathology will become subspecialized in the next few years, mainly as a result of clinicians wanting only the "best" pathologists reading their specimens ("best" meaning pathologists who become experts by looking at nothing else but that particular organ system, day in and day out).

Crum's awesome (and a fellow triple-Wahoo!), but I can't completely agree with that belief. While it may become more true at academic institutions, I just can't see a majority of community practices going to that level of super-specialization where one person would see only gyn, another person would only see GI, etc. (of course, path groups will continue to have people who have different areas of expertise). Honestly, pathology would lose a lot of it's appeal to me if everything became completely sub-specialized. I like being in a specialty where I basically have to know everything that can go wrong with the human body. I also think it's very possible to be a general pathologist and still be one of the "best" and my program has multiple examples of that. Dr. Mills is considered an expert and receives consults in things as diverse as head and neck, bone, and prostate. Dr. Wick has written books on a wide variety of entities including derm and pulm (talk about an unusual combination).

All that being said, even though we have general signout, most cases do get reviewed by a "sub-specialist" for tumor boards and such. That satisfies the clinician's desire to have an "expert" look at the case and it also serves the added benefit of quality control by having a second pair of experienced eyes examine a case.

 

[b&ierstiefel]

All I can say is that I really respect those pathologists who are expert general diagnosticians. It takes a lot of dedication, practice, and effort to get to that level of expertise. Personally, I choose to subspecialize since I think I'm too stupid and simple-minded to be a general surgical pathologist.

 

[CornellDerm]

It's very hard to get a derm fellowship.

I graduated from an Ivy League undergrad university, went to a state med school where I graduated in the top 5% of my class and was AOA, had over 250 on both steps 1 and 2 (not quite as high on step 3).

I am doing my residency at Cornell. I applied to roughly 15 derm fellowships, did 4 interviews, and had 2 offers.

It's hard but worth a shot if you are competitive.

Good luck.

 

[l&usibari]

It's very hard to get a derm fellowship.

I graduated from an Ivy League undergrad university, went to a state med school where I graduated in the top 5% of my class and was AOA, had over 250 on both steps 1 and 2 (not quite as high on step 3).

I am doing my residency at Cornell. I applied to roughly 15 derm fellowships, did 4 interviews, and had 2 offers.

It's hard but worth a shot if you are competitive.

Good luck.

What percentage of dermatopathology fellowships asked for USMLE scores? Just curious. So far I've only seen a handful of Notbloodbankology programs that asked for board scores, and having high scores doesn't help if the fellowship doesn't ask for them, so you have to be competitive in other ways, like publications.

 

[CornellDerm]

If I recall correctly, almost every application asked for all 3 step scores--although they probably aren't all that important.

Some programs emphasize research experience and publications (and having a PhD will help at some places). In my opinion, this is over-emphasized. How many dermpath people will even go into academia? And how many of the publications in the literature amount to something clinically usefu, anyway?

I also think having strong letters of recommendation from someone well known (preferably a dermatologist or dermatopathologist) is helpful-- if what is said in the letter is genuine.

Also, I recommend doing an elective (for a month) at the place you want to train. This will give you a chance to shine.