First days

[levels x3]

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From prior posts, there seemed to be a fair number of us who started jobs in July and August. How's it going? Has it been easier, harder, different, or exactly what you expected?

My first day was today. For frame reference, I joined a 4 (I'm number 5) person private group in a small-medium sized community hospital in the Northeast. We have a fairly average case mix, nothing too crazy, but not boring either. Being day 1, I was scheduled to gross and do frozens. About an hour into the morning my first frozen arrived. Upper arm mass, older woman, no other history. A few seconds of scanning the slide and I think, s*%t, it's a freaking carcinoma (adeno, lung most likely). So fine, I'm perfectly capable of having the "yup it's a malignant epithelial neoplam, but I don't know where it's coming from" conversation with the surgeon, but why couldn't I have gotten a parathyroid to warm up on? In residency I would have then up-front ordered 5-10 immunos to work up this case. But today I stopped myself and just ordered unstained slides wondering if shot-gunning IHCs is kosher outside the ivory tower.

I could go on, but I'm sure others have some early job experiences to share.

 

[MirkoCrocop]

Grats on starting a real job! You made it!

Sounds like fun, a little scary... maybe a lot scary!

I guess everyone starts out apprehensive - to be expected really, and in time, we gain more confidence...

 

[yaah]

I have had some stressful moments my first few weeks - like having to call EUS FNAs positive based on 4 cells, things like that. It has been pretty much what I expected, except a little more heme than I thought. I am doing non-gyn cyto which is ok but I didn't do a fellowship, so it's a bit of a confidence issue in terms of the different specimens I am seeing. Showing a lot of those cases around.

 

[dodobird13]

yeah i agree the nongyn cyto is kind of a bitch... especially since in general i find cytology to be only a couple steps up from a magic 8-ball.

i think the weirdest part now is having been in one place long enough to see the results from your previous diagnoses coming in, e.g. wide excisions of skins you called positive or LEEPS from cervical biopsies... you look back at the previous report, see your name on it, and go oh crap, hope i was right. it's just different. the first three weeks were hell.

 

[levels x3]

Third on the non-gyn cyto being a pain. I also did no fellowship and so am lacking in confidence there.

Another adjustment, and some advice to residents; don't get too used to how things are done at your program because when you leave it will be different. My group formats its reports very differently and I don't like the way they do it, but I'm stuck. Our fixation and staining is very different as well, so there's a learning curve there.

One happy thing though (for me anyway) is that I'm getting a lot more derm than I expected. I like derm and I came from a very derm heavy residency so I feel pretty comfortable with it.

 

[2121115]

Third on the non-gyn cyto being a pain. I also did no fellowship and so am lacking in confidence there.

Levels, does that mean that you did not do a fellowship? Or that you did not do a cytopathology fellowship?

If you did not do a fellowship, I'm curious what your job search was like, if you wouldn't mind sharing.

 

[ImmaculateTurd]

like having to call EUS FNAs positive based on 4 cells,

You had to? Was it the endoscopist putting pressure on you?

 

[levels x3]

I was specifically referencing a cytology fellowship leading to a slight lack of confidence with some non-gyn cytology. So I too am showing those cases around a lot.

To further answer your question though, I didn't do any other fellowship either. My job search wasn't much of a search though, so I might not be much help. I was actively recruited by this group beginning at the end of my first year of residency. I rotated through their lab early in my fourth year of medical school and they actually convinced me to go into pathology (I was doing medicine as a default at that time). Though the hospital is located in a suburban area in the northeast that is basically like every other suburban area in the northeast, has a low cost of living, good public schools, and a major university; specialists are difficult for the area to recruit. The job was my ideal as well; private group with a good partnership track, happy partners with very low turn-over, varied case-load, good compensation...etc. There was some negotiating along the way, they checked in with my program to see if I was doing well, but the rest as they say, is history.

Most of my decision making process was not whether or not to join that group, but whether or not to do a fellowship at all. The group left it up to me, but the job would be there either way. This might be a topic for a different thread, but I do not believe that everyone needs to do a fellowship. I think you should do one if it fits your career goals. I am especially skeptical of general surg path fellowships as a sole fellowship, outside of those at a small number of big name centers.

It gets said over and over again, but Pathology is a small world. Most jobs aren't advertised...I know, people don't like to hear these comments. There's little actionable advice in them, but maintain connections no matter how old, be a good resident, and don't be geographically limited. And obviously there's a "right place, right time" aspect to my story, so good luck as well.

 

[KeratinPearls]

I was specifically referencing a cytology fellowship leading to a slight lack of confidence with some non-gyn cytology. So I too am showing those cases around a lot.

To further answer your question though, I didn't do any other fellowship either. My job search wasn't much of a search though, so I might not be much help. I was actively recruited by this group beginning at the end of my first year of residency. I rotated through their lab early in my fourth year of medical school and they actually convinced me to go into pathology (I was doing medicine as a default at that time). Though the hospital is located in a suburban area in the northeast that is basically like every other suburban area in the northeast, has a low cost of living, good public schools, and a major university; specialists are difficult for the area to recruit. The job was my ideal as well; private group with a good partnership track, happy partners with very low turn-over, varied case-load, good compensation...etc. There was some negotiating along the way, they checked in with my program to see if I was doing well, but the rest as they say, is history.

Most of my decision making process was not whether or not to join that group, but whether or not to do a fellowship at all. The group left it up to me, but the job would be there either way. This might be a topic for a different thread, but I do not believe that everyone needs to do a fellowship. I think you should do one if it fits your career goals. I am especially skeptical of general surg path fellowships as a sole fellowship, outside of those at a small number of big name centers.

It gets said over and over again, but Pathology is a small world. Most jobs aren't advertised...I know, people don't like to hear these comments. There's little actionable advice in them, but maintain connections no matter how old, be a good resident, and don't be geographically limited. And obviously there's a "right place, right time" aspect to my story, so good luck as well.

Holy moly...recruited for a job at the end of first year? What did you do to impresss them?

 

[levels x3]

Holy moly...recruited for a job at the end of first year? What did you do to impresss them?

Nothing so fantastic. It's really much more of a "right place at the right time" scenario. They were an aging group looking to plan for the future and I fit right in.

Now if I can just survive my first few weeks, I'll still be around for the future...

 

[mcfaddens]

I was specifically referencing a cytology fellowship leading to a slight lack of confidence with some non-gyn cytology. So I too am showing those cases around a lot.

To further answer your question though, I didn't do any other fellowship either. My job search wasn't much of a search though, so I might not be much help. I was actively recruited by this group beginning at the end of my first year of residency. I rotated through their lab early in my fourth year of medical school and they actually convinced me to go into pathology (I was doing medicine as a default at that time). Though the hospital is located in a suburban area in the northeast that is basically like every other suburban area in the northeast, has a low cost of living, good public schools, and a major university; specialists are difficult for the area to recruit. The job was my ideal as well; private group with a good partnership track, happy partners with very low turn-over, varied case-load, good compensation...etc. There was some negotiating along the way, they checked in with my program to see if I was doing well, but the rest as they say, is history.

Most of my decision making process was not whether or not to join that group, but whether or not to do a fellowship at all. The group left it up to me, but the job would be there either way. This might be a topic for a different thread, but I do not believe that everyone needs to do a fellowship. I think you should do one if it fits your career goals. I am especially skeptical of general surg path fellowships as a sole fellowship, outside of those at a small number of big name centers.

It gets said over and over again, but Pathology is a small world. Most jobs aren't advertised...I know, people don't like to hear these comments. There's little actionable advice in them, but maintain connections no matter how old, be a good resident, and don't be geographically limited. And obviously there's a "right place, right time" aspect to my story, so good luck as well.

Whoa Thats pretty crazy! I had almost the exact same experience that you did just in another part of the country. My first case was a difficult one as well, keep it up and good luck

 

[yaah]

You had to? Was it the endoscopist putting pressure on you?

That, and they were pretty ugly cells.

 

[gungho]

it's been interesting reading everyone's experiences of first experiences in practice. last week was my first week and it was incredibly stressful. on top of learning new site-specific procedures and computer systems and getting things organized, finally putting my name on the sign-out was daunting. even though i had a surg path fellowship at a big-name institution with sign-out responsibilities, there was still a "safety net" and we were encouraged to show anything we had any doubt about. i can still show stuff to my partner, but i feel i'm supposed to be a "big boy" now. was routinely looking at 400-600 slides on a sign out day during fellowship that had been previewed by a resident, now struggling with 150-200 slides because i'm looking at every last cell. and i haven't started looking at cytology or bone marrows or doing much CP stuff yet.

remember after my 3 yr FP residency i was delivering babies, doing scopes, taking care of MI's and other ICU patients (things not quite as complex back then) and felt comfortable, but still having high anxiety after 4 yr of AP/CP residency and intense surg path fellowship. hopefully things will settle down. i have no clue how the guy i joined did this by himself for 12-13 yr.

 

[coomasie blue]

Cheers to everyone who just started....

Newbie at signing out myself and I agree it is amazing to release cases with your name as the final.

Cyto trained and pretty comfortable with nongyns but still feeling the pressure.

Hopefully this will get easier ... Have always heard that on the job learning is the best way to become a great pathologist and first year out you really start to learn pathology.

best to all and don't be afraid to show stuff around. Don't let surgeons push you around and stick to your guns....

peace