...I believe we are having fun? Not sure if that's an insult or a salutation...
Anyway, I have less beef with dermpath trained derms than i do derms in general...the latter attend a holiday inn express equivalent of 'pathology training' and are granted the ability to sign out the glass from the biopsies they perform. Maybe that provides good clinical-pathologic correlation for inflammatory stuff, but for the most part it's just low hanging fruit. BCCs and squams and SebKs are not hard, but neither are HPs and TAs, or most prostate cancers for that matter. The reason GIs and uros don't sign out their own stuff [aside from the lack of holiday inn express training] is two fold: time/money, and liability. And I suppose that's why most derms don't sign out their own stuff, or turf it to a dermpath. But plenty just cherry pick the easy stuff once a week or for an hour after work and pass the buck when the hamster falls off the track, and that's my problem.
There's a reason people spend years in a particular residency and fellowship. I'm sure there would be outcry if, as a product of some clinical & derm rotations in residency, pathologists routinely hired some PAs and set up skin clinics, just telling everyone to put some hydrocortisone/lotrimin/bacitracin/cream du jour on it and follow-up in 3-6 weeks, biopsing every suspicious lesion, and passing all the challenging cases off to real dermatologists. Sounds absurd, i know. Risky and lots of liability...and time consuming......which is why we don't do it [though I know 2 path trained dermpaths that do something similar]...and there's probably some reimbursement obstacles. Point being, there are easier ways to make money in path than skin/biopsy (or FNA) clinics.
For derms, the low hanging fruit of BCCs and SebKs is just easy money, and not very time consuming. I'd probably do it too if I was a dermatologist (which I always dreamed of becoming.....), but I'm not a dermatologist, and hence I stay in my lane and b**ch about other specialties not staying in theirs.
