Fast track

Discussion in 'Pathology' started by Matte Kudesai, May 12, 2008.

  1. Matte Kudesai

    Matte Kudesai Senior Member
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    Why not consider and/or give serious thought to a fast-track system in pathology?

    I know that AP only followed by certain surgical pathology sub specialties exists... however these are not that formalized.

    If increased specialization is the future of pathology.. how about offering a system that puts you in your subspecialty area after a year of general pathology training.

    Can this be done at least for individuals who are sure they want to do surgical pathology?

    Trainees seem to include CP as part of their AP/CP training because of heme or historically better private practice job opportunities.


    Fast track to GU... work with a GU group, learn GU stuff, and sign out GU.

    How much money will this save the system?

    Think about it... rather than wasting months in chemistry, micro, transfusion medicine etc... you are ready to sign out in your fast tracked specialty in 3 years.

    What percentage of newer trainees are working in environments that require the "training" two full years of CP provides?
     
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  2. mlw03

    mlw03 Senior Member
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    as long as i hear that to be eligible for private practice jobs i need to be CP trained, i would never consider this fast track. to say nothing of the fact that the broad base of knowledge all pathologists share is part of what keeps us together as a specialty. while one pathologist may be a forensic pathologist working in rural Kansas and another a flow cytometry expert in Manhattan, both had the same core of knowledge, thus allowing them to communicate at a fairly high level as colleagues. i don't think abandoning this in the name of getting people out a year or two faster is in the best interest of pathology as a field.
     
  3. Matte Kudesai

    Matte Kudesai Senior Member
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    I agree that the dogma about getting a good PP job is having AP/CP training. But why has this become the reality?
    What high level communications become necessary? What kind of broth you need for what kind of bug? Can't you just call the micro specialist?:laugh:
    Not sure what you mean by high level. You will find that this high level communication thing becomes more fantasy than reality as things get
    increasingly complex.
    I am talking about reality. Compared to most other residencies, pathology has an inordinate amount of BS time.

    This is expensive and inefficient. Most people don't care because they don't mind dicking around on rotations that THEY WILL NEVER DO in life. There was a time when you needed to know all the CP... Now med techs do it and they are superspecialized.

    Unless you are doing a one man show at a podunk hospital general pathologists are a dying breed. You will not want to cover apheresis call as a GI pathologist. You will not be able to communicate at a high level about forensics with a forensic pathologist or chemistry, or micro after the two month rotations. That is the reality.

    In the past few years.. training has gone from 5 to 4 years.
    The board will be retested every decade and the trend is that almost everyone does sub specialty training.

    At the same time large labs (and many PP groups) are covering specific subspecialties and advertising and hiring individuals with a specific subspecialty expertise.

    This may indicate the need to trim the excess baggage of training.. streamline and get people to be able to signout faster.

    Make a curriculum that exposes residents in an efficient way to areas of interest and let them move to that system early in training.
     
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  4. jux

    jux
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    I think you might be overestimating the efficiency of other residencies.

    Also, can you please trim 3rd and/or 4th year of med school?
     
  5. Matte Kudesai

    Matte Kudesai Senior Member
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    touche.....

    Messing around a bit but also a bit serious. I thought surgeons and primary care docs at least earn their pay (that's what I hear at least).

    CP training is an interesting phenom... It is excruciatingly inconsistent.

    There are programs that make you gross all day to justify your pay even when you are on CP. Other programs spring ya and expect you to read and reread Henry's or whatever without any real clinical duties in the hospital.

    Meanwhile surgery residents are doing and redoing procedures that will be their livelihood by second year at the latest.

    Many programs literally pay pathology residents to watch technicians do what they will NEVER do in the real world.

    AP/GU
    AP/derm
    AP/GI
    AP/cyto
    AP/heme
    AP/GU

    Maybe Petras and Bostwick should start offering these options by partnering with a residency program.

    Fast track baby...
    come on its not that crazy of an idea...:rolleyes:
     
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  6. LADoc00

    LADoc00 Gen X, the last great generation
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    Why does it seem like every year we go over the same topics....

    You will not make as much doing AP/GU as AP/CP. AP/CP is the base.

    There is no "fast track" by doing AP+GU unless it is the fast track to idiocy.

    There was no better ROI than my 18 months in CP. CP allows one to bill for a pro fee of every lab test while doing minimal managerial work, why would you give that up?
     
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  7. Matte Kudesai

    Matte Kudesai Senior Member
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    You are billing in your own business correct?

    You have already trained and are now actually doing the hiring in a multi service type PP.

    When you hire a person for your group that has a subspecialty expertise and want them to signout only GI or whatever, does their CP board help you?

    How does it help you? What lab tests are you billing for that involves the GI person?
     
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  8. LADoc00

    LADoc00 Gen X, the last great generation
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    here is the rub: you couldnt even get a job in the hospital where I am because the medical staff bylaws require dual AP/CP certification for anyone taking any call...

    we are not on the same page and you arent understanding the crux of what Im saying...AP+CP+???---->PROFIT.
     
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  9. Matte Kudesai

    Matte Kudesai Senior Member
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    Gotcha. I thought you had your own practice.
    Are straight biopsy gigs set up the same way?

    Positions with no call, no autopsy, no frozen, just fast high volume biopsies in a specific subspecialty area.
     
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  10. levels x3

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    What LADoc describes is still the vast majority of pathology practices. Private practice, partnership groups still need to be privileged within a particular hospital system and to do that AP/CP is almost always a prerequisite. It doesn't really matter who owns the practice. If you want to work in most environments, CP is a must.

    Again, take a look outside the ivory tower of our training programs. We are being horribly trained for the real world by our AP-only, MD PhD attendings. Most of us don't have a clue what an 88305 brings in.

    By the way, no call, no autopsy, no frozen, high volume biopsy sounds suspicously like Ameripath to me....
     
  11. Matte Kudesai

    Matte Kudesai Senior Member
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    Precisely....

    What type of person works for Ameripath?

    Anyone on this forum work for Ameripath? What is it like?

    Do you think your business model will continue to grow?
     
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  12. Arctic Char

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    couldn't you say the same thing about a number of internal medicine subspecialties? even some surgical specialties as well. i mean, do you really need to learn how to take call every 3rd night on an internal ward in order to spend the rest of your career doing colonoscopies? no.

    but as long as medicine remains a self-governing body, i think pride of the profession will keep us doing things the long way. it makes us "better doctors" . . . irrespective of the efficiency of our services. its stubborn righteousness, yes . . . but, the flip side is that if we had everyone sub-sub-specialize, we'd all be technicians and there would no longer be a "doctor in the house". i don't want to be a slide reader, i'd rather be a doctor with a microscope. i know that sounds kitchy, but i can't deny that i see it this way

    i look forward to it all. but i agree that it seems inefficient in the big picture. i wish i could do AP only, but i just get nothing but AP/CP recommended to me
     
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  13. yaah

    yaah Boring
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    I dunno, I think you sort of see the drawback to this approach if you sign out in a subspecialty-based program. What do you do about the cases that are outliers? A knowledge of other specialties, at least a moderate amount, is crucial. Personally, I learned stuff on all my rotations that helped me on all the other ones. I didn't like micro, but I'm glad I learned the stuff, even if it is mostly basic concepts.

    I agree, if there is something to eliminate it should be part of the last 2 years of med school. What a colossal waste of time.
     
  14. Matte Kudesai

    Matte Kudesai Senior Member
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    As Spalding would say "double turds".

    On every CP rotation try and answer the question posed by Bob and Bob.. "What exactly is it that you do here"?

    I agree.. stuff can be learned on every rotation. I personally like CP. However it seems that many trainees add CP for heme and the black box of billable tests in a future PP gig.

    Who knows if this is an efficient use of the money allocated to pay for resident salaries.

    As the Bob and Bobs start to squeeze the system... and large labs offer residencies (they already offer fellowships)... please continue to "Fight the Power".
     
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  15. Matte Kudesai

    Matte Kudesai Senior Member
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    Why do you wish you could do AP only?

    Not sure you can make the analogy with IM and surgery because they seem to be able to answer the Bob and Bob question during their training. They are admitting patients, covering the SICU, or doing procedures.

    You will see that this is not the case in the majority of CP rotations.
     
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  16. Master Chief

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    Why does everybody keep talking about these jobs? I would get bored doing just high volume subspecialty biopsies (and I say this as a subspecialist). Call and frozens are not that bad. Autopsies are not going to push you over the edge either. I can understand when people are uncomfortable with CP because training is usually pretty weak. I personally don't like CP (because I am not good at it), and luckily I am in the position not to do alot. However, I won't let my CP boards expire, as I am in the unfortunate first class that has to recertify. I will emphasize the fact that almost EVERYBODY should do AP/CP. AP only tracks should only exist for the rare AP/NP academic. And I have no idea what the CP only track is about, again save the rare super academic person.
     
  17. levels x3

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    We had 2 recent CP-only graduates. One did a TMS fellowship and just wants to be a blood banker. The other...nobody knows what she's going to do...she's by no means a super academic either...

    These, however, are rare and completely inadvisable models to follow. Their future job prospects are limited to say the least. AP/CP gives you flexibility. You shouldn't just be planning for your first job, but for your second (and possibly third). Being well rounded and AP/CP boarded affords more mobility from job to job.
     
  18. paleman

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    have to give different opinion. i have CP and don't use it. APDP is still a killer private practice combo. don't know what will happen when codes change in the future so having CP i guess is some kind of a backup but i gotta tell you folks i actually tell employers at interviews that i am good at DP and refuse to do CP because i quite simply cannot handle that c**p (MHO) - leave the CP to PhDs i say.
     
  19. mcfaddens

    mcfaddens Member
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    Are you DP boarded? Because thats a pretty bold statement to make during a job interview to someone who dosent know you. First impression "red flag" kind of seems like a statement like that would come off very cocky MHO. (not saying that you are)
     
  20. Arctic Char

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    AP just seems more up my alley so far as i can tell right now, and the opportunity cost of one extra year of training weighs heavily toward a fast track residency. but, naturally, i have a lot to learn between now and then, so i may end up liking aspects of CP after all. and i don't really mind the extra year, in the big picture. i suppose i will mind, though, if it does indeed become a huge waste of time. but i would think that that has everything to do with me and my approach to the experience.
     
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  21. paleman

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    Yip. hold on there.. i don't think i am cocky. i am simply saying that DP has allowed me to waive CP responsibility in the jobs i have had so far.. maybe CP will be useful to me years down the track (i currently know zero CP - in 10 years it will be less than zero). maybe i will never need CP. ever. (thank the good lord for that)
     
  22. LADoc00

    LADoc00 Gen X, the last great generation
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    well...lets say you have a 60% non Medicare payor mix, of that 50% recognize CP pro fees (which isnt unusual) on the order of 10% of the total lab fee.

    then lets say you have a lab which generates 20 million in charges, which isnt unusual...

    20,000,000x(0.1)x(.60)x(.50)=600,000/year.

    You dont leave 60 stacks of high society on the table ever. EVER.

    [​IMG]
     
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  23. Matte Kudesai

    Matte Kudesai Senior Member
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    When you say "you have a lab" what do you mean?

    How is a dermatopathologist billing for a lab fee unless they have their own business and their own lab. If you are working for a PP signing out only derm, how are you (as an individual) generating a lab fee? Are you not a salaried employee that just moves the mountains of glass?

    You are a small business owner.. right? When you hire a dermatopatholgist and you want them to only sign out derm biopsies.... quickly, efficiently, and accurately...

    Will you give a rats testicle about their CP status?

    Please explain the structure of private practice groups that hire individuals that have a subspecialty expertise. Are they looking for someone to only signout GI or do you want cross coverage?

    What if the individual did a big name GI fellowship. If they are the definitive GI dx for your group... why waste their time doing other BS if they don't want to?
     
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  24. Gyric

    Gyric Junior Member
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    I have never really understood the level of CP bashing on this board. True, it is not generally as interesting as AP, but it still defines a core skill set for a pathologist that will make you better at whatever area you specialize in.

    Maybe it is just the strength of my CP training (I did not “watch techs” or “read Henry’s,” rather I learned how to consult with clinicians wanting to utilize the laboratory, how to manage a large laboratory staff and ensure accurate results, and was at least introduced as to how best to get reimbursed); I would never take an AP only job, I think diversification is key in the coming medicare **** storm.

    The medical establishment supports the concept that “diagnosis” requires a medical license. If you start allowing PhDs to sign off on CP diagnoses (electrophoresis etc), then you will open the door to erosion of AP as well (eg microarray based tissue diagnosis).
    Having a PhD myself I can say that it would not be appropriate for me to render a diagnosis without medical training,

    DPs are not so hard to come by that you can not hire an AP/CP/DP over an AP/DP. Now if you are only interested in DP and are just going to a dermpath mill, there are probably better ways to spend those 18 months.
     
  25. LADoc00

    LADoc00 Gen X, the last great generation
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    Young cricket, you have much to learn on road to ninja master.
    [​IMG]
     
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  26. Matte Kudesai

    Matte Kudesai Senior Member
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    What Oh Master is the straightest road to Cashshshshshs?:D
     
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  27. Arctic Char

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    wow, props on the ultra-condescending reply.:laugh:
     
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  28. docbiohazard

    docbiohazard Highly ranked amateur
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    The straightest road is that which has the most curves... :cool:

    BH
     
  29. paleman

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    High society? 20 million in charges for 600,000/year?? the amount of political maneuvering/ brown-nosing/ swindling you'd have to do, not to mention the call you'd have to take and the fact you'd have to be CP uptodate? you got kids? sure you could get some other schmuck to do most of it for you after a while but only after years.

    I don't know but if i was to define high society it would = 9-5 easy easy pp owned by yourself dp. just my opinion and obv would be different if i liked CP one tiny little bit.
     
  30. Matte Kudesai

    Matte Kudesai Senior Member
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    Do you mean the crooked road..... What about the straight and narrow?;)
     
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  31. Matte Kudesai

    Matte Kudesai Senior Member
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    I know.... Too low to even be a grasshopper.

    Wow... The ninja pathologist strikes again....

    For some reason I think of LA more like this or should I say BH Ninja
    [​IMG]
    (Beverly Hills Ninja)
     
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  32. Matte Kudesai

    Matte Kudesai Senior Member
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    [​IMG]
     
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  33. docbiohazard

    docbiohazard Highly ranked amateur
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    The straight and narrow is the crookedest road of all... :D

    BH
     
  34. jayman

    jayman Member
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    Just switched to CP-only, dudes! Rock on.
     
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  35. Matte Kudesai

    Matte Kudesai Senior Member
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    So what will you be doing?

    Coag?

    BB?

    Molecular?

    Micro?

    Heme?


    Sweet.
     
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