Exact difference in pathology practice between community/private and academic

[greencreek]

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Can anyone with real experience kindly tell some of the differences? Much appreciated. I am not sure if I want to stay in academic for ever, so very curious about this. Did search the forum and did not get much info.🙄

 

[deleted314957]

not to generalize but it is "night-and-day". Just use your imagination.
Being in your hospital as a solo medical director in a 170 bed community hospital with out-patient out-reach or being part of a large academic staff at a tertiary medical center. The differences are patent.
maybe you cannot visualize because you have never been out of the academic womb.

 

[BrainPathology]

IF, and as soon as someone on this board gets a job I'm sure they'll be happy to share with you.

Seriously though you imply you are in academics now. Do you have any contacts in your community who would be willing to let you shadow them for a day or two. Private is generally faster, generally more uhm general in the cases you sign out, less bureaucracy (IE people aren't specifically hired to obstruct your job at every turn, in fact in some private practices they actually retrain, reassign or fire people who dont help you get your job done), more direct reward for the work you do in terms of salary etc.

But really it's like asking what the difference between the ocean and land "is". If you don't like the Ocean you can leave but to where? The beach? The desert? The mountains? The forest? etc.

 

[Patho2009]

Academic Practice
You have residents who can gross specimen, do autopsies, and write the reports for you
You have to teach the residents and medical students. Give lectures (make powerpoints) and microscope teaching sessions (e.g. unknown cases)
Research and publishing. In some academic institutions, every attending has to show certain number of papers or academic work every 1-2 years.
Will be assigned academic rank which is promoted based on certain criteria (assistant, associate and then full professor)
Less payment (120-250K)
Have the opportunity to subspecialize and sign out cases belonging to your area of interest only.
Good for people who live to work (if you want pathology to take your whole life..spending time at home working on publications and teaching lectures)
Because of the competition in research, publication and others, the environment is not very friendly.

Private Practice
No residents. You do things on your own with some sort of help from pathology assistants.
No teaching. Just focus on your sign out. Make diagnosis, and write your report. No home preparation for lectures.
No research or publication. Enjoy the weekends and enjoy life!!
No academic ranking. You are (staff pathologist) for ever. In the mid of your career however, you can apply to become a lab director..That's it!
More payment (usually exceeds 200-300K+). The payment can be higher than that when you become lab director.
Less chance to sign out cases of your own interest only but still can develop interest or expertise in one area. Also, you may be required to do CP work besides AP.
Good for people who work to live (sign out and go home…nothing more to worry about).
Usually more friendly and "benign" environment as there is less competition among the staff.


What I listed above is based on my individual experience. Others may share different opinions/experiences. What I posted is not right in all the settings as there are many exceptions. For instance, some community-based hospitals are affiliated with universities and have a very good sense of academia. Some academic centers on the other hand do not have residencies.

My sincere advice is to go for what you have passion for. However, be always prepared for all the options as you will be CONTROLLED with the openings and OFFERS you get at the time you complete your residency/fellowship. If you get an offer for a job with a very tempting payment and in a very nice place/city, go for it regardless of other factors (just my opinion).

My second advice is to work on your diagnostic skills. Don't spend all your time to write papers during your residency (or to let your attendings "use you" to write papers for them!). Nothing like being good on the microscope. If you are not able to write a good report or to sign out simple and difficult cases correctly, I wouldn't care about how many papers you published or in what journals you published...All the research or papers won't help you when fail the Boards, lose your job or get your license suspended because of your questionable diagnostic competency.

The bottom line is to be a good pathologist with decent diagnostic skills and be able to make good reports for your patients, wherever you are...... This is the ONLY way to secure yourself throughout your career.

 

[KCShaw]

In academic practice you're working for a university/school of some description, typically a medical school. With it is typically associated some element of teaching, research, and/or publication. Income is generally salary based.

In private/community practice you're not. You may be working for a private owner, whether they are a pathologist (typical) or simply a businessperson (unusual, unless it's part of a big conglomorate), or working directly for a hospital. Income may be salary based, performance based, or something else.

Basically.

If you want to know what working in those systems are like, I suppose I can't tell you, but you might be able to extrapolate. For any given job, however, it's going to come down to that specific environment. Some private practices may have a very academic feel, or even be contracted to an academic institution. Some academic centers may have no pathology residency and relatively low volume -- or their clinical work contracted out while their academic staff are almost exclusively research/teaching (seen it).

 

[pathstudent]

In academics you improve the lives of thousands to millions by training new academic physicians and by moving medicine forward and changing how it is practiced.

Other than that both jobs have a lot of overlap.

 

[greencreek]

Thanks a lot for all the valuable inputs. I heard that a pathologist at community hospital needs to cover everything including frozen sections, surg path, dermpath, cyto and CP like blood banking, is this true?
It's intimidating when dealing with everything.

A pathologist at acdemic institutions might also cover frozens, surg path and mabybe one more subspecialized area like hemepath or cyto, which is managable.

If that's true, it is more challenging working in a community hospital, is this true?

How about private practice groups? Do they do frozen sections at all? How is the workload divided in private practice?

 

[2121115]

It's intimidating when dealing with everything.

It is this type of attitude that weakens our profession. You've got to learn to do a lot. No one is just going to hand you 500K + per year to sign out tubular adenomas that a medical student can do after one day. The attitude pervasive in academics that you must be uber-subspecialized to contribute anything or even be competent hurts us and weakens the caliber of new graduates that programs produce. Bottom line, if you are still in training approach every rotation as if you are going to have to sign it out after the rotation. There is no "I don't have to sign out X" in a general practice.

If that's true, it is more challenging working in a community hospital, is this true?

IMO, yes actually.

 

[Nilf]

Thanks a lot for all the valuable inputs. I heard that a pathologist at community hospital needs to cover everything including frozen sections, surg path, dermpath, cyto and CP like blood banking, is this true?

Yes, it's true. If you want to succeed as a private practice, community hospital pathologist, you have to be a jack-of-all trades, AND master of 1 or 2. Additionally, you might have to be medical director, which means being responsible for firing and hiring.

 

[deleted314957]

Thanks a lot for all the valuable inputs. I heard that a pathologist at community hospital needs to cover everything including frozen sections, surg path, dermpath, cyto and CP like blood banking, is this true?
It's intimidating when dealing with everything.

A pathologist at acdemic institutions might also cover frozens, surg path and mabybe one more subspecialized area like hemepath or cyto, which is managable.

If that's true, it is more challenging working in a community hospital, is this true?

How about private practice groups? Do they do frozen sections at all? How is the workload divided in private practice?

I do it all, myself, and have for 20+ YEARS and know when to consult.

 

[Pathologee]

Where is that one thread about AP/CP pathologists versus AP only research.

 

[greencreek]

Let's say the majority of the residents will do at least one fellowship, an area they will feel very comfortable signing out cases. Other than that, all the rest of pathology training will be done during residency.

For community hospital jobs, what type of skills do you expect the fresh graduates to possess in order to be competent? Do you expect them to do everything correctly AND cover everyhting at the beginning?

Please also elaborate on the skill requirements for academic jobs.

Aagain, I am talking about fresh graduates just after fellowship.

Thanks!
🙁

 

[deleted314957]

Let's say the majority of the residents will do at least one fellowship, an area they will feel very comfortable signing out cases. Other than that, all the rest of pathology training will be done during residency.

For community hospital jobs, what type of skills do you expect the fresh graduates to possess in order to be competent? Do you expect them to do everything correctly AND cover everyhting at the beginning?

Please also elaborate on the skill requirements for academic jobs.

Aagain, I am talking about fresh graduates just after fellowship.

Thanks!
🙁

you won't like to hear this, and this was in the early 90's when i was in the position to hire people, but in my pp group we generally did not look with preference on people just out of residency or fellowship (which were much less common back then) because they had never been "out of the womb".
we preferred people with experience as a "staff" pathologist who had functioned as a non-trainee. there is nothing like being under the gun by yourself ( meaning no counter sigs, etc.) for a couple years to test your mettle. kind of a catch 22 but that is what we did.
i can't comment about academic jobs but you are with LOTS of folks who can help "carry" you.
I spent some time at the AFIP in the 80's and it was known that there were 2 kinds of folks there. those who were very very good and those who could be "watched" and not cause much of a problem.

 

[KWTRCSI]

Academic Practice
You have residents who can gross and do autopsies, and write the reports for you
You have to teach the residents and medical students. Give lectures (make powerpoints) and microscope teaching sessions (e.g. unknown cases)
Research and publishing. In some academic institutions, every attending has to show certain number of papers or academic work every 1-2 years.
Will be assigned academic rank which is promoted based on certain criteria (assistant, associate and then full professor)
Less payment (120-250K)
Have the opportunity to subspecialize and sign out cases belonging to your field only.
Good for people who live to work (if you want pathology to take your whole life..spending time at home working on publications and teaching lectures)
Because of the competition in research, publication and others, the environment is not very friendly.

Private Practice
No residents. You do things on your own with some sort of help from PAs.
No teaching. Just focus on your sign out. Make correct diagnosis, and write your report. No home preparation for lectures.
No research or publication. Enjoy the weekends and enjoy life!!
No academic rank. You are (staff pathologist) for ever.
More payment (200-300K)
Less chance to sign out cases of your interest only but still can develop interest or expertise in one area.
Good for people who work to live (sign out and go home…nothing more to worry about).
Usually more friendly and "benign" environment as there is less competition among the staff.


What I listed above is based on my experience. Others may share different opinions/experiences. What I posted is not correct in all the settings as there are always exceptions. For instance, some community-based hospitals are affiliated with universities and have a very good sense of academia. Some academic centers on the other hand do not have residencies. My advice is to go for what you have passion for. However, be always prepared for all the options as you will be CONTROLLED with the openings and OFFERS you get at the time you graduate. If you get a job with a very tempting payment and in a very nice place/city, go for it regardless of other factors (just my opinion).

Wow nice words

 

[shan564]

Academic Practice
You have residents who can gross and do autopsies, and write the reports for you
You have to teach the residents and medical students. Give lectures (make powerpoints) and microscope teaching sessions (e.g. unknown cases)
Research and publishing. In some academic institutions, every attending has to show certain number of papers or academic work every 1-2 years.
Will be assigned academic rank which is promoted based on certain criteria (assistant, associate and then full professor)
Less payment (120-250K)
Have the opportunity to subspecialize and sign out cases belonging to your field only.
Good for people who live to work (if you want pathology to take your whole life..spending time at home working on publications and teaching lectures)
Because of the competition in research, publication and others, the environment is not very friendly.

Private Practice
No residents. You do things on your own with some sort of help from PAs.
No teaching. Just focus on your sign out. Make correct diagnosis, and write your report. No home preparation for lectures.
No research or publication. Enjoy the weekends and enjoy life!!
No academic rank. You are (staff pathologist) for ever.
More payment (200-300K)
Less chance to sign out cases of your interest only but still can develop interest or expertise in one area.
Good for people who work to live (sign out and go home…nothing more to worry about).
Usually more friendly and "benign" environment as there is less competition among the staff.


What I listed above is based on my experience. Others may share different opinions/experiences. What I posted is not correct in all the settings as there are always exceptions. For instance, some community-based hospitals are affiliated with universities and have a very good sense of academia. Some academic centers on the other hand do not have residencies. My advice is to go for what you have passion for. However, be always prepared for all the options as you will be CONTROLLED with the openings and OFFERS you get at the time you graduate. If you get a job with a very tempting payment and in a very nice place/city, go for it regardless of other factors (just my opinion).

Thanks for that list - I often reconsider my decision to spend my life at a tertiary teaching facility (that seems to happen immediately after I look at my student loan statements), but it's nice to occasionally see a pros/cons list to remind me that academia is really the place for me.

Now just to find a residency...