General Surgepath Fellowships

[byungwooy]

These days General Surgepath Felloships are not highly sought after but I would like to do one year of surgepath fellowship in a busy academic place before I look for a job.

I am thinking about MGH and WashU. Both have pretty good reputation for gen surgepath fellowships. Can anyone provide some information on MGH fellowship ? number of positions, how they rotate etc ? Any other places that I should consider ?

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[cluecells]

M.D. Anderson would be a good choice

 

[yaah]

Surgpath fellowships are fairly popular, especially now that many smaller programs do not have any and yet many people still want to do fellowship training. Many academic fellowships are looking to train academics, although that is not that uniform.

You can find a lot of information about specifics of fellowships on the programs' websites.

 

[Logos']

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[LADoc00]

I don't know what part of the country you are in byungwooy, but in San Francisco, general surgical pathology fellowship spots are very much in demand. At UCSF we have 7 spots per year and all have been taken by internal candidates (selected by Linda Ferrell), at least since I have been here (I think we are taking one outside person next year).

There is probably an even split between fellows who want to go into private practice and those who prefer academics. The typical route for the latter group is a surg path fellowship, then an assistant professorship, during which the department sends you to spend a few months with someone specialized in your area of interest, eg Colby, Epstein, etc.

At UCSF the rotation is 2 months of hot seat, 2 months of outside consults, 2 months of confirmation consults, 2 months gross room supervisor, 2 months surg path, 1 month dermpath, 1 month cyto. Fellows are paid to take call.

UCSF has a solid fellowship set up by Noel Wiedner and is essentially ripped from playbook of WashU/Stanford.

The problem is none of that is really unique/special or standout enough to me to spend a year on it. 2months of gross room duty is a waste IMO. 2 months of what essentially is senior resident sign out in surg path at SF General is also wasted. Thats a quarter of the fellowship being a glorified resident...when your "competitor" is doing a year of heme/derm/cyto that is leading to a certificate.

Surg path fellowships need to seriously be retooled with the change in ABP credentialing.

WashU has to be the most intense surgpath fellow experience there is..and I didnt do it (being objective here). WashU surgpath is almost like a Special Forces designation and alot of people respect it as such in private practice.

I strongly (and I know this has controversy) advise against "niche" surgpath years at MDA, MSKCC or Mayo.

 

[yaah]

A lot of general surg path fellowships are basically another year of residency. If that's what you're looking for, fine. Many will be general with a focus in something, which is different from a pure subspecialty fellowship and I don't know if people doing hiring for jobs treat these latter two much differently.

If you train at a good program you should be able to sign out most everything general on your own without a fellowship, although the fellowship may help your confidence, particularly if your residency was less intense. I have heard a couple of attendings say that residents who do general surg path fellowships do tend to be more confident. Take it for what it's worth - personally I am treating my fourth year somewhat like a mini surg path fellowship. I still have a couple of CP rotations to finish but I am doing a few different AP electives as well as covering frozens for a couple of months, etc.

 

[caffeinegirl]

Hello! Long time no post

The MGH Surg Path fellowship is of course a non-ACGME fellowship which allows for independent sign out responsibilities in various subspecialized areas of surg path. For the past couple of years, we've taken mostly internal candidates, but this has changed. Actually, we had a table at the fellowship fair at USCAP this year.

The fellowship allows for time for research as well...you won't be signing out all the time. For the first two weeks that you sign out a subspecialty, you see the cases with a resident (unless the service is resident-free that week), and then have them co-signed with faculty. After those first couple of weeks, you sign out the cases. If you need back-up, you can always show faculty before signing it out (and put in a note that you showed it to them..!!).

As a fellow, you'll also serve on the "back-up" list for frozens. At MGH, the senior resident reads the frozen after 5pm, and rarely they call the fellow who's on for help.

The rest of the time is open for projects/research..usually the clinical/translational sort.

The advantage of the fellowship is that it allows you to have that "buffer" year before you're out on your own, by giving you that graduated responsibility. All the stresses of signing out something on your own and having your name on the bottom line occur during this fellowship, and you're more confident in your abilities when you're out in ther real world...so I've heard

PM me if you have any ?'s! Also check out
http://www.massgeneral.org/pathology/train/fellowships.htm#SURGICALPATH

 

[sleeping beauty]

I am not a resident yet. what's the difference between these two? why do we need the accreditation at first place? Is there any difference between doing non-ACGME fellowship and ACGME fellowship in job hunting? thanks.

 

[LADoc00]

Lets take a sec to explain to younger folks that surg path fellowships were an invention of the way ABP credentialing used to be structured.

Once upon a time, you had to do a general transitional type year for pathology. They got rid of that but added a general credentialing year that took into account the fact pathologists werent benefitting from a year spent as a glorified medical student. Some pgy-5s did research but most places created "surg path" years (although to be honest they had been around since the 50s at some places). Fast forward to today where Pathology has been reduced to a 4 year training program, which eliminates: the need to do a surg path year AND any real impetus to do a post soph fellowship (if you know you are doing path).

Now someone will come an argue those are still valid experiences, I wont disagree. BUT, in doing any real cost:benefit ratio, assuming you reasonably paid attention in residency, they arent worth it. Which is why we are starting to see places like MGH have tables to attract residents. Some are even employing real marketing people to get applicants. Being an intelligent person, one would ask WHY they would be so eager to get fellows in their program. The answer to that ? would money. See, if they had to employee junior faculty instead of fellows, that would be over a 300K/yr negative cash flow (price of jr. faculty+benefits-monies not received by ACGME for a fellowship slot). For places with 5+ surg path fellowship slots, that is real money.
End of story.

 

[caffeinegirl]

I agree with the cost-benefit ratio analysis, and that having a fellow makes economic sense to the department.

However, on the flip side, having sign-out responsibility before going out in the "real world" does increase your marketability, doesn't it? It pretty much counts as an "almost" year of job experience.

And in this day and age, it just seems that the jobs out there almost require an extra year of fellowship.

Just some thoughts...

 

[sleeping beauty]

LADoc00, your answers did not answer my questions:

what's the difference between these two? why do we need the accreditation at first place? Is there any difference between doing non-ACGME fellowship and ACGME fellowship in job hunting?

 

[yaah]

ACGME accredited fellowships have board exams and you get subspecialty certification. In some eyes this is preferable, because it means the fellowships are more regulated and uniform. A non-accredited fellowship (like say a GI fellowship) is completely open and could be anything. You can call anything a "GI fellowship" even if you make the person do general surg path, I suppose.

Does it make a difference in job hunting? Probably not, since many of the non-accredited fellowships are equally competitive (GI, GU, maybe Breast) and even more rare and in demand. But doing an accredited fellowship gives you that extra certification (which may or may not help your individual situation, but is unlikely to hurt).

We need accreditation (cynical answer) because specialists in that specialty want their field less open to others and more stringently regulated so that their niche is preserved. And also, they can charge money for a board exam and make people jump through hoops. The non-cynical answer is to make sure the fellowships ARE regulated and legitimate and are educational, because otherwise many places would probably establish "fellowships" which consist of dumping tons of work on you without a ton of real education. That does happen in many non-accredited fellowships or in the second year of an accredited fellowship (like 2nd year of dermpath at some places that do a second year).

Surg path is unlikely to ever be a boarded fellowship because the training overlaps with general residency training. Surg path subspecialty potentially could be boarded fellowships, but not in the near future (again, overlap).

As it is now, many private groups are looking for "fellowship trained" GI or GU or breast path residents, but what defines one of these fellowships, as I said, varies. Many of these fellowships are mostly research anyway.

As I said, general surg path fellowships are nice, and give you extra experience, but if you work hard and use your elective time appropriately and you are at a sufficiently large institution it is probably unnecessary to do that extra year.

 

[LADoc00]

LADoc00, your answers did not answer my questions:

what's the difference between these two? why do we need the accreditation at first place? Is there any difference between doing non-ACGME fellowship and ACGME fellowship in job hunting?

ACGME accreditated fellowship=certificate filed with the ABMS(american board of medical specialities) IF you pass a cert examination admin. by the ABP

Non-ACGME fellowship=no ABMS notation, no cert exam.

as far as I know, only Pathology has a real issue with non vs. approved ACGME. MOST if not all other residencies track trainees thru approved cert fellowships.

That is a BIG red flag to utter mess that Pathology training is today.