dermatopathology

[TIGER STYLE]

Can a pathologist specializes in dermpath? And if so, can he or she sees patients and do biopsies and treatments? Thanks guys....

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[joedogma]

I am pretty sure that only pathologists can specialize in dermpath (please correct me if I am wrong.) I am not so sure about the amount of patient contact they have though...I would imagine that taking biopsies and treatment are left to the dermatologists but I am sure that the diagnosis provided by the dermpath doc tells the dermatologist how to treat...

 

[ny skindoc]

Dermatopathology is a fellowship which can be done after a dermatology or pathology residency.There are dermatologists who do dermpath part time as well as clinical dermatology.A pathologist who does a dermpath fellowship spends his/her time reading path slides,not in clinical medicine doing biopsies or treating patients.The fellowship is focused on reading dermpath slides.There is a little exposure to clinical derm so that pathologists can get some first hand idea of the diseases they are exposed to but its not designed to teach clinical derm.

 

[TIGER STYLE]

Thanks joedogma for the response. I'm asking b/c someone told me that dermpath was a fellowship of dermatology...so a question I have is...is Dermpath a subspecialty/fellowship of pathology also? Thanks...

 

[TIGER STYLE]

Thanks ny skindoc for replying so fast. I guess we are all on this thread at the same time. ny skindoc...technically can a dermatopathologist sees patients and do biopsies and treatment if he/she knows how and is comfortable with it? Also, how competitive is a dermpath fellowship for pathologists? Thanks so much

 

[ny skindoc]

Dermpath is a very highly competitive fellowship for pathologists to get into.Many applicants for few spots.Can a pathologist practice clinical derm? I believe that theoretically this is possible.I doubt a dermpath fellowship would be sufficient training.There are medico-legal issues that would need to be resolved.Why would you want this? Dermatopathology is so lucrative.. most pathologists would be happy to be busy with it and avoid all the potential pitfalls of treating patients.

 

[joedogma]

Thanks for the info ny skindoc, I didn't know that. Dermpath fellowships are probably the hardest fellowships to land after completing a pathology residency but I don't think fellowships are as hard to get in general when compared to other fields such as medicine. That said, I would imagine that landing a dermpath fellowship is A LOT easier than landing a position in a dermatology residency. Keep in mind, anything can happen in five years, who knows what the competition will be like...

 

[yaah]

I don't know of any pathologists who see derm patients after a derm path fellowship. There are definitely dermatologists who read biopsies after a derm path fellowship. Some will read their own biopsy slides, some will spend some days a week reading path slides that aren't their own patients. When I did my PSF, the dermpathologist read the derm path 4 days a week. On wednesday, the dermatologist who did a dermpath fellowship came in and read all the skin cases from that day, whether they were her cases or not (although she usually chose not to make diagnoses on her own cases).

Most pathology fellowship programs have spots for people coming from both dermatology backgrounds as well as pathology backgrounds. I am not sure if they generally like to hold specific spots for people from both fields, or there is direct competition for the spots. It is getting pretty hard to compete with a dermatologist based on CV, as the field is so tough to get into as it is. So I doubt you would be able to "get in the back door" so to speak and open an office dermatology practice by training as a pathologist and then doing a dermpath fellowship.

That being said, some dermatologists, once they do the fellowship, will focus exclusively on the pathology part of it. It is pretty lucrative, mostly because skin cancer slides are quick and easy diagnoses (A BCC, for example, is nearly an instantaneous diagnosis). Melanomas are tougher.

There are some other threads on this in the archives.

 

[BamaAlum]

I have a question related to this topic. Most of the dermatopathologists that I have encountered in private practice only do dermpath and a lot of the general pathologists who get skin specimens will often send them out for a 2nd opinion by a dermatopathologist if it is remotely atypical. Do you think that it is feasible to do both general path and dermpath within the same practice(50/50 perhaps)? Basically, what I am asking is would you be spreading yourself too thin if you tried to serve as a general pathologist and also served as a dermatopathologist in a consultant role?

 

[yaah]

I think it's feasible. There are a lot of pathologists out there who do both dermpath and general surg path. I encountered two at UMass. In the years I have been at school here, two of the dermpathologists here also served on the general surg path service. The other one does 100% dermpath. Apparently, a lot of jobs out there often require you to do more than just dermpath, whether that is autopsy, general surg path, or whatever. Once you gain enough experience you often have more say.

Private practice people often cover multiple areas, as it is more advantageous to hire someone with expertise in several areas than someone with expertise in one area. Honestly, though, I don't know how common or uncommon it is for someone to do only dermpath.

Basically, the answer is, it can be done. I can't answer for you as to how easily it can be done though.

 

[USMELL]

I think it's feasible. There are a lot of pathologists out there who do both dermpath and general surg path. I encountered two at UMass. In the years I have been at school here, two of the dermpathologists here also served on the general surg path service. The other one does 100% dermpath. Apparently, a lot of jobs out there often require you to do more than just dermpath, whether that is autopsy, general surg path, or whatever. Once you gain enough experience you often have more say.

Private practice people often cover multiple areas, as it is more advantageous to hire someone with expertise in several areas than someone with expertise in one area. Honestly, though, I don't know how common or uncommon it is for someone to do only dermpath.

Basically, the answer is, it can be done. I can't answer for you as to how easily it can be done though.

hello, a friend of mine is interested in dermatopathology. Looking at the archives, it seems the consensus is that must dermpath fellowships go to dermatology residents than pathology residents, my question is, is that still true? Basically, is it pretty much impossible, to get a derm path fellowship. Other than dermpath, what other lucrative and job security fellowships are there in pathology. thanks

 

[Gut Shot]

hello, a friend of mine is interested in dermatopathology. Looking at the archives, it seems the consensus is that must dermpath fellowships go to dermatology residents than pathology residents, my question is, is that still true? Basically, is it pretty much impossible, to get a derm path fellowship. Other than dermpath, what other lucrative and job security fellowships are there in pathology. thanks

 

[yaah]

hello, a friend of mine is interested in dermatopathology. Looking at the archives, it seems the consensus is that must dermpath fellowships go to dermatology residents than pathology residents, my question is, is that still true? Basically, is it pretty much impossible, to get a derm path fellowship. Other than dermpath, what other lucrative and job security fellowships are there in pathology. thanks

Maybe your friend should come post then.

I'm not sure where you got your consensus from. Dermpath is competitive, not impossible. It's impossible if your only qualifications are that you "really want to do dermpath."

 

[docbiohazard]

Is your friend worried they're not going to match into Dermpath and considering a scramble into Pathology as some sort of back door into Dermpath or "another lucrative subspeciality?" because, uh, I wouldn't recommend that plan unless your friend really likes Path to begin with...

Gutshot, you're cracking me up...

 

[Gut Shot]

Is your friend worried they're not going to match into Dermpath and considering a scramble into Pathology as some sort of back door into Dermpath or "another lucrative subspeciality?" because, uh, I wouldn't recommend that plan unless your friend really likes Path to begin with...

You're probably on to something. We had two residents in my program, three years apart, who did path because they couldn't match into derm. One ended up liking path, and did get a dermpath fellowship at, shall we say, a little place in Boston.

The other lasted a month.

Gutshot, you're cracking me up...

That's my (third) job.

 

[Patrick O]

The idea that Dermpath fellowships only go to dermatologists is an incorrect one. Many of the spots go to pathology residents. I don't know the exact statistics but it has to be close to 50/50.

 

[USMELL]

The idea that Dermpath fellowships only go to dermatologists is an incorrect one. Many of the spots go to pathology residents. I don't know the exact statistics but it has to be close to 50/50.

really, do you know where one can get this info. Okay with fellowships does your step 1 and step 2 score matter, or is it how you do in residency? Also is it possible to apply to two residency programs, like dermatology and pathology at the same time, can one get matched twice, ot do you have to pick one for the match? Also what other subspecialties are there in pathology? thanks and sorry for the numerous questions 🙂

 

[yaah]

really, do you know where one can get this info.

Simple experience. That's just the way it is. I don't know the exact numbers either but the point is dermatologists and pathologists can both apply for dermpath, and while some programs favor one over the other, in general there isn't a significant advantage from either field, CVs assumed to be equal.

Okay with fellowships does your step 1 and step 2 score matter, or is it how you do in residency?

They usually don't matter but some programs consider them.

Also is it possible to apply to two residency programs, like dermatology and pathology at the same time, can one get matched twice, ot do you have to pick one for the match?

You can apply to anything you want, but the NRMP will only match you to one program. It depends on how you rank them. See their website, they have more info.

Also what other subspecialties are there in pathology?

Anything to do with pathology has its own subspecialty.

 

[exPCM]

I posted in another thread the links to all the accredited dermpath fellowships.
If you check, you will find that the majority of programs require that USMLE scores be submitted. When you are a pathology resident, you will typically have interviews with faculty members in the dermatology department. The dermatologists are used to seeing applicants with very high board scores. If you do not have high scores, you look poorly by comparison. The idea that candidates with lousy board scores are not handicapped when trying to land dermpath fellowships is comical to me.

 

[Long Dong]

I posted in another thread the links to all the accredited dermpath fellowships.
If you check, you will find that the majority of programs require that USMLE scores be submitted. When you are a pathology resident, you will typically have interviews with faculty members in the dermatology department. The dermatologists are used to seeing applicants with very high board scores. If you do not have high scores, you look poorly by comparison. The idea that candidates with lousy board scores are not handicapped when trying to land dermpath fellowships is comical to me.

Does Step 3 matter? I've heard rumors that it does, I wasn't sure if people where joking on this forum or on the dermboard about it or not. I'm an intern and plan on going into dermpath. Should I try to do really well on this test (ie take some elective and vacation time to study for it)? Or is it more important to just do well during residency? Thanks in advance.

 

[Anfield rd]

Does Step 3 matter? I've heard rumors that it does, I wasn't sure if people where joking on this forum or on the dermboard about it or not. I'm an intern and plan on going into dermpath. Should I try to do really well on this test (ie take some elective and vacation time to study for it)? Or is it more important to just do well during residency? Thanks in advance.

I don't think Step 3 has any bearing whatsoever. (my personal opinion only).

I'm curious, why are you going for dermpath if you're coming from derm side? Do you plan to see patients when you practice?

 

[yaah]

Step III scores are requested by many fellowships. Now, whether they matter much or they are just making sure you passed is another story. Some people believe that they matter, others are more skeptical. I am of the opinion that if a fellowship isn't going to factor step scores into the equation very significantly. Your publication record and references are far more important. I would say it is FAR more important to do well during residency than to ace step III.

Anfield - many people go into dermpath from dermatology residency. Many of the best known dermatopathologists (Ackerman, Headington, most of the current Mayo staff, Elston, among a list of many others) are dermatologists. Careers take many twists and turns. While many dermatologist dermpathers also see patients, many do not.

 

[HCE]

Step III scores are requested by many fellowships. Now, whether they matter much or they are just making sure you passed is another story. Some people believe that they matter, others are more skeptical. I am of the opinion that if a fellowship isn't going to factor step scores into the equation very significantly. Your publication record and references are far more important. I would say it is FAR more important to do well during residency than to ace step III.

Anfield - many people go into dermpath from dermatology residency. Many of the best known dermatopathologists (Ackerman, Headington, most of the current Mayo staff, Elston, among a list of many others) are dermatologists. Careers take many twists and turns. While many dermatologist dermpathers also see patients, many do not.

Yaah, I have much respect for you, but I'm not sold on that new avatar picture...

 

[Anfield rd]

Anfield - many people go into dermpath from dermatology residency. Many of the best known dermatopathologists (Ackerman, Headington, most of the current Mayo staff, Elston, among a list of many others) are dermatologists. Careers take many twists and turns. While many dermatologist dermpathers also see patients, many do not.

Yes, I'm aware of that; I was just wondering what motivation the dermies who choose dermpath have. Going from clinical residency to non-clinical subspecialty is a major switch imo. If a dermatologist chooses to do dermpath even part time, it means substantially less time spent in the clinic... If they like looking at the slides so much, why didn't they do path instead of derm? Rumor has it that currently most graduating dermies gravitate towards procedural fellowships; maybe the trend is changing.

 

[Long Dong]

Yes, I'm aware of that; I was just wondering what motivation the dermies who choose dermpath have. Going from clinical residency to non-clinical subspecialty is a major switch imo. If a dermatologist chooses to do dermpath even part time, it means substantially less time spent in the clinic... If they like looking at the slides so much, why didn't they do path instead of derm? Rumor has it that currently most graduating dermies gravitate towards procedural fellowships; maybe the trend is changing.

Well I've always been interested in path. During the first 2 years of med school I was know as the guy in my class who was going into path and nothing else. During my summer between first and second year I did path research. I've always liked how paths are the experts to the experts and make the final diagnosis. One of the residents I did my research with ended up being the dermpath fellow the next year, and got me started thinking about dermpath. So when 3rd year came around, I remembered why I came to med school for and that was to be a clinician, and I like doing procedures. Doing derm and the path seems like the best of both worlds for me. During derm clinic I'd always say to myself, humm what would that lession look like under the microscopic and how would that affect my treatment of it? I would ultimately want to do half a week of clinic and a half week of slides when I finish. And yes most dermies want the glitz and glam of a procedural fellowship, but me I like path and doing a dermpath fellowship I feel would make me a stronger clinician.

And on top of that I get to be down with all you guys on the path forum, cuz you guys have some of the funniest threads on SDN.

 

[Sean2tall]

And on top of that I get to be down with all you guys on the path forum, cuz you guys have some of the funniest threads on SDN.

Haha. That's the best part. 👍

 

[exPCM]

Step III scores are requested by many fellowships. Now, whether they matter much or they are just making sure you passed is another story. Some people believe that they matter, others are more skeptical. I am of the opinion that if a fellowship isn't going to factor step scores into the equation very significantly. Your publication record and references are far more important. I would say it is FAR more important to do well during residency than to ace step III.

Anfield - many people go into dermpath from dermatology residency. Many of the best known dermatopathologists (Ackerman, Headington, most of the current Mayo staff, Elston, among a list of many others) are dermatologists. Careers take many twists and turns. While many dermatologist dermpathers also see patients, many do not.

A big factor that the ACGME now looks at when accrediting programs is the pass rate on the boards. In the future, programs whose graduates do not pass the boards will likely be at risk of losing their accreditation.
see link: http://www.asahq.org/Newsletters/2007/08-07/resReview08_07.html
If a program takes one fellow per year and if during a five year period they have two fellows not pass the boards then their pass rate of 60% (3/5) will be under the current 70% ACGME threshold. I have also heard talk that the threshold may be increased as part of the push toward tightening control of physician education (as seen by adding Step 2 CS testing, time-limited board certification, maintenance of certification requirements, etc.)
In addition, a program's reputation suffers when their graduates do not pass. Program directors (particularly in dermpath) generally prefer people who have a track record of outstanding performance on standardized tests. These individuals would seem to be more likely to pass a difficult test like the dermpath boards. Failing the boards does not reflect well on training programs and many programs want to have the reputation that their graduates pass the boards. I know that yaah does not agree but I speak as someone who has seen this process as an insider. I consider yaah to be an important contributor to this forum but I believe yaah is going into GI path and I do not know whether yaah has ever been involved in the selection process for dermpath fellows. In GI path, where there is no board exam, my guess is that USMLE scores might in fact be less important. IMHO If the scores did not matter, then there would be no reason to require them as part of the application.
I stand by my previous post in this thread where I stated that "The idea that candidates with lousy board scores are not handicapped when trying to land dermpath fellowships is comical to me".

 

[yaah]

PCM - I am not going into GI path and I have more experience with dermpath and knowledge of the field than you would think, but I understand the criticism. Like I said, I am not totally discounting USMLE scores, but use some common sense - are programs really going to take the person with 99s on all three over someone with an established publication and research record in derm who also has great letters and demonstrates great potential in the field even though they "only" have say an 85 on their USMLE? And the fact remains that many derm programs don't even ask for step scores.

As for the lousy scores comment, I would wager that the scenario of an applicant with lousy board scores (how lousy are we talking here, sub 200?)but otherwise stellar credentials is not incredibly common. Candidates with lousy board scores probably are often handicapped when trying to land fellowships, but board scores are often a proxy for other academic performance. While there are occasional candidates who rock their boards and perform at a very low level in residency training, and a probably slightly greater number who barely pass the boards and become superstar residents, these are outliers. Because remember - most people who are successful at landing dermpath spots are one of two types of people: 1) Superstar residents, 2) Those with enough political connections and skills and/or lucky timing with an internal slot.

Board scores are a good "conspiracy theory" type of fodder for internet forums. If something doesn't go well, blame board scores. If one doesn't get a spot, it's because someone else's board scores were higher. Resident candidates (like premeds with the MCAT) think all their problems can be solved by getting a blowout score on the USMLE. The real world doesn't work that way. Board scores are important but are not the only thing.

My opinion: The most important thing in any fellowship application is a personal relationship with the fellowship director (provided you have demonstrated aptitude and interest in the field directly to them). The second most important is your research/publication background, especially in the field. After that you can rank the other attributes, but I doubt you would find anyone who would put board scores ahead of either of those, or ahead of a good reference letter from a known commodity.


As for my avatar, I change from time to time. Heimlich is perhaps the greatest animated character of the last 15-20 years. I like him for numerous reasons. He is not self conscious about his body image, he in fact embraces it! He is not voiced by a celebrity but instead is voiced by an unknown with actual talent. He says funny things. His role is limited but he shines when he appears. And at the end of the movie he becomes a minor hero and attains his moment in the sun even if most of it is due to the work of others (I'm flying!).

 

[torero]

"The idea that candidates with lousy board scores are not handicapped when trying to land dermpath fellowships is comical to me".

Looks like things have changed quite a bit. I applied to about 12 programs a few years ago and don’t remember any of them asking for USMLE scores. It seems to me that asking for them is similar to asking for MCAT scores for residency applications. It’s ancient history. But you have a point. I probably wouldn’t want someone who has failed a USMEL step; they might also fail the dermpath boards. But overall I’m with yaah on this one:

My opinion: The most important thing in any fellowship application is a personal relationship with the fellowship director (provided you have demonstrated aptitude and interest in the field directly to them). The second most important is your research/publication background, especially in the field. After that you can rank the other attributes, but I doubt you would find anyone who would put board scores ahead of either of those, or ahead of a good reference letter from a known commodity.

 

[106174]

to INCREASE one's chances of getting a dermpath fellowship, it is advisable for one to be the overall star applicant and that includes very good usmle scores. a consistent track record in excellence is very attractive to dermpath fellowship directors, and that includes class standing, publication record, etc. i will say though that only step 1 and 2 really matter. everybody knows that most take step 3 during residency and therefore could not care less other than to pass it.

i agree - not everyone who gets into dermpath has a stellar academic record. some get in because of luck and because they happen to be in the right place at the right time.

 

[Long Dong]

Well I guess if there is any doubt, do the safer thing to cover your arse and do as well as I can on step 3. There goes my vacation time and my idea of just a number 2 pencil for step 3. The politics just increases more and more as the group you are trying to get in with gets smaller and smaller. As soon as I start derm I better start rubbing elbows with the darmpaths and a research project. So how do you guys feel about foreign body reactions to fillers?