GI Path Fellowship

[LADoc00]

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Going to see Joel Greenson in SF in a few weeks. If he is as good as Appelman, then I will pronounce Mich as no.1 in GI path, supplanting my previous tie between no1s (BWH/Odze vs. Cleveland/Goldblum).

Importantly tho, if residents here do apply to GI fellowship programs, to do some heavy thinking about whether they want to weigh their training towards liver (UCSF, JHU) or true GI.

IMO, GI is and will become the new "Dermpath" along with GU but the value since it is non-credentialed will be in who you train with (i.e.-Bostwick/Epstein/Amin for GU).

 

[yaah]

Well, I think the "who you train with" will be important. But there are some "lesser known" GI and GU fellowships that are just as good in terms of preparing you. And they are certainly respected. The "less respected" fellowships will probably be the ones at the large private labs where your material is almost entirely biopsies without much further correlation. I would say, for example, that all of the GU fellowships listed on pathologyoutlines.com with the exception of Emory (because Amin left and I'm not sure they have a GU fellowship anymore, but someone can correct me) and OSU because it's a combo breast/GU and the private lab fellowship are all excellent and well respected and would not leave you wanting for influence or respect. There are others not listed there like MD Anderson and Cedars Sinai which would also fit the excellent category. I would hesitate to add the Bostwick fellowship to that category for various reasons I won't get into, but I am not that familiar with it.

Greenson is quite impressive, more so even in signout. Appelman and Greenson are very different individuals but share some common characteristics, mainly the interest in teaching and ability to synthesize info. As I have said, after my few months of GI path training I basically feel confident in GI path, mostly due to the teaching received here.

 

[LADoc00]

Here is the key, the names most respected in Pathology are often totally different than those respected/known in clinical Urology, GI and Derm circles.

Bernie Ackerman would the classic example. The aspect of the Mich program is that the Appelman is an incredible public speaker as well as a knowledgeable clinician. Throw that out in with some solid publications and assuming Mich sends their team out to speak on the clinical circuit (which I would assume they do), then having trained with them will bring kudos when you decide to venture out and start a business.

Training with a lesser known entity in a non-cred. subspec like GI is rougher than say derm or heme. I concur training quality might be identical, but marketing yourself will be far tougher.

 

[NKcell]

Here is the key, the names most respected in Pathology are often totally different than those respected/known in clinical Urology, GI and Derm circles.

Bernie Ackerman would the classic example. The aspect of the Mich program is that the Appelman is an incredible public speaker as well as a knowledgeable clinician. Throw that out in with some solid publications and assuming Mich sends their team out to speak on the clinical circuit (which I would assume they do), then having trained them with will bring kudos when you decide to venture out and start a business.

Training with a lesser known entity in a non-cred. subspec like GI is rougher than say derm or heme. I concur training quality might be identical, but marketing yourself will be far tougher.

FYI, Henry Appelman will be speaking at the Los Angeles Society of Pathologists on Dec 11. You going LADoc?

 

[drdvs]

Well, I think the "who you train with" will be important. But there are some "lesser known" GI and GU fellowships that are just as good in terms of preparing you. And they are certainly respected. The "less respected" fellowships will probably be the ones at the large private labs where your material is almost entirely biopsies without much further correlation.

Along those lines, where do you guys think someplace like AmeriPath falls for fellowship? The GI fellow trains with Petras, but the material is essentially all 'tubular GI' and purely biopsy. Does that make you more marketable or well-trained, or less ?

Again this brings in LADoc's point about sub-specialized specialties; tubular GI, vs liver, vs combination thereof. I suppose it depends a lot on your goals.

 

[LADoc00]

FYI, Henry Appelman will be speaking at the Los Angeles Society of Pathologists on Dec 11. You going LADoc?

I would but will be in SF during that time to see the OTHER Mich guy speaking. All the sudden Mich has a launched a "Coming to Jesus" in GI Path speaking tour.

 

[raider]

GI path is soooooooooooooooo easy. Only thing you need to know really is the pancreatobiliary tract.

 

[trent05]

I think any GI fellowship will make you more marketable, at least any listed on the GIPS website. The academic ones with big names will obviously be even more impressive, but I think the big thing is having done a one year fellowship at an academic institution. The Ameripath fellowship and the other similar lab fellowships might be less respected, but I'm not 100% sure about that. The interesting thing will be to see what happens when GI path becomes boarded, which I think many people expect will happen soon.

 

[trent05]

It is unlikely that GI will ever be like Derm.

There are many more experts than LADoc mentioned...
Montgomery
Hurbin
Jass
Crawford
Klimstra
West
Petras
Hamilton

Funny. At least 3 of these experts that you list are already out of academia and at commercial labs, namely Ameripath. I think GI path already is a lot like D-path in terms of marketability and I say that only from seeing the GI fellows experience in looking for jobs at my own institution. With the current number of GI biopsies and the future estimated number, it is unlikely that we will see a surplus of GI fellowed pathologists. With 20-30 spots per year I think it is quite the opposite.

 

[Matte Kudesai]

Funny. At least 3 of these experts that you list are already out of academia and at commercial labs, namely Ameripath. I think GI path already is a lot like D-path in terms of marketability and I say that only from seeing the GI fellows experience in looking for jobs at my own institution. With the current number of GI biopsies and the future estimated number, it is unlikely that we will see a surplus of GI fellowed pathologists. With 20-30 spots per year I think it is quite the opposite.

If you are thinking of Petras he still does quite a bit of academic teaching and preaching.... Also West just became AP director of a yet unnamed program.

Who else in the at least three do you know.

Crawford is a chair
Hurban at JHU
Montgomery is at JHU
not sure who else is going to commercial labs and if that even matters. These people still publis and move the field.
anyway... you may correct about the future of GI but I seriously doubt it.

 

[trent05]

If you are thinking of Petras he still does quite a bit of academic teaching and preaching.... Also West just became AP director of a yet unnamed program.

Who else in the at least three do you know.

Crawford is a chair
Hurban at JHU
Montgomery is at JHU
not sure who else is going to commercial labs and if that even matters. These people still publis and move the field.
anyway... you may correct about the future of GI but I seriously doubt it.

Sure about west? Even Fenoglio is at Ameripath now. Only the future will tell.

 

[SLUsagar]

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[path19]

So, for those of us interested in doing a GI fellowship, what are everyone's thoughts regarding the need to train at programs with huge names and with big-wig GI pathologists. Given that there are only 20-30 programs, is it really not good enough to train with one of the top 20 academic GI pathologists? Will only the fellows of Odze, Goldblum and Appelman get multiple offers for good jobs? This can't be the case IMO, especially given the apparent demand for GI fellowship-trained pathologists in the community (i.e. look at any job board and plenty of places are looking to hire). Although admittedly biased, I have to agree with trent05 that GI will continue to be a marketable subspecialty given that so few training programs exist, even less than the # of dermpath programs!

 

[pathstudent]

given the continued proliferation of GI pod labs and the diminishment of biopsy specimens from private practice is GI *really* a good specialty given the ****tiness of those jobs?

GI is still a fantastic specialy for academics though.

 

[b&ierstiefel]

So, for those of us interested in doing a GI fellowship, what are everyone's thoughts regarding the need to train at programs with huge names and with big-wig GI pathologists. Given that there are only 20-30 programs, is it really not good enough to train with one of the top 20 academic GI pathologists? Will only the fellows of Odze, Goldblum and Appelman get multiple offers for good jobs? This can't be the case IMO, especially given the apparent demand for GI fellowship-trained pathologists in the community (i.e. look at any job board and plenty of places are looking to hire). Although admittedly biased, I have to agree with trent05 that GI will continue to be a marketable subspecialty given that so few training programs exist, even less than the # of dermpath programs!

As long as the demand for GI fellowship trained pathologists, I don't think it is paramount to train with the bigwigs necessarily. Training with the bigwigs will be beneficial for you in terms of learning GI, and not necessarily for jobs (?) because the bigwigs will see the difficult consults and your repertoire of knowledge in GI pathology will expand. Maybe GI is like Dermpath then where the main focus is doing a fellowship SOMEWHERE rather than doing it at the BEST PLACE. As soon as the demand for these pathologists decreases, then you have a bottleneck phenomenon where your connections/pedigree may be of more importance (i.e., the tiebreaker principle). That being said, I think a strong pedigree can only help you and you're better off having it than not. You don't wanna look back and wonder "what could I have gotten if I had done that instead?"

 

[Matte Kudesai]

As long as the demand for GI fellowship trained pathologists, I don't think it is paramount to train with the bigwigs necessarily. Training with the bigwigs will be beneficial for you in terms of learning GI, and not necessarily for jobs (?) because the bigwigs will see the difficult consults and your repertoire of knowledge in GI pathology will expand. Maybe GI is like Dermpath then where the main focus is doing a fellowship SOMEWHERE rather than doing it at the BEST PLACE. As soon as the demand for these pathologists decreases, then you have a bottleneck phenomenon where your connections/pedigree may be of more importance (i.e., the tiebreaker principle). That being said, I think a strong pedigree can only help you and you're better off having it than not. You don't wanna look back and wonder "what could I have gotten if I had done that instead?"

Do you peeps think that GI will ever have a board like derm. Who knows maybe after the surgical pathology fellowship dies at most institutions and subspecialization becomes the norm, EVERYONE will have a GI path fellowship. Heck why not. Most places have the material and will probably have someone willing to stick their neck out signing out GI specimen and teaching others to do likewise. It will likely never result in a blood curdling cremasteric reflex (and total sphincter puckering) like trying to sign out a tough melanocytic lesion in thirty something year old mother of three. But then again maybe gastroenterologists will be biopsying like crazy and the boomers will march to drink GOLITELY..... Boom boom boom.

 

[b&ierstiefel]

Do you peeps think that GI will ever have a board like derm. Who knows maybe after the surgical pathology fellowship dies at most institutions and subspecialization becomes the norm, EVERYONE will have a GI path fellowship. Heck why not. Most places have the material and will probably have someone willing to stick their neck out signing out GI specimen and teaching others to do likewise. It will likely never result in a blood curdling cremasteric reflex (and total sphincter puckering) like trying to sign out a tough melanocytic lesion in thirty something year old mother of three. But then again maybe gastroenterologists will be biopsying like crazy and the boomers will march to drink GOLITELY..... Boom boom boom.

But that's the key variable...I would imagine that litigation risk is a lot higher for melanocytic lesions. This linked with board certification of a subspecialty is a perfect setup for monopolization of knowledge. Dermpath easily pulls this off because few will stick their necks out diagnosing a melanocytic lesion, like you said...the risk is too high. Plus, if you stick your neck out and you get it wrong, the prosecution will certainly ask you if you are board certified in dermpath. The risk is probably higher (at least more publicized) in the context of dermpath over GI path.

That being said, if enough people show interest in GI path so that the supply exceeds demand, sure, make a board exam. It'll be a money-making scheme enterprise similar to the hoax we call Step 2 CS.

 

[yaah]

I think that's the key, moneymaking. The thing about GI path is that a lot of the knowledge that would be tested on boards falls under the rubric of general surgical path. The main reason to do the fellowship (IMHO) is not primarily to learn about rare entities but to know how to deal with judgment calls and difficult diagnoses (i.e. Barrett's dysplasia and UC-associated dysplasia). You can't test that on a board exam very well, apart from general characteristics of dysplasia (which as many studies have shown are very open to interpretation). Dermpath has enough variety and clinical correlation (like hemepath does) to be very much open to a board exam situation.

Volkan Adsay is running the GU path fellowship? Odd. He is mainly GI and HEENT. He didn't do much GU at Wayne St, as far as I know, apart from general signout.

 

[SLUsagar]

I think that's the key, moneymaking. The thing about GI path is that a lot of the knowledge that would be tested on boards falls under the rubric of general surgical path. The main reason to do the fellowship (IMHO) is not primarily to learn about rare entities but to know how to deal with judgment calls and difficult diagnoses (i.e. Barrett's dysplasia and UC-associated dysplasia). You can't test that on a board exam very well, apart from general characteristics of dysplasia (which as many studies have shown are very open to interpretation). Dermpath has enough variety and clinical correlation (like hemepath does) to be very much open to a board exam situation.

Volkan Adsay is running the GU path fellowship? Odd. He is mainly GI and HEENT. He didn't do much GU at Wayne St, as far as I know, apart from general signout.

my bad, you're right he's not running it. but he's indeed vice chair there at emory.

 

[mcfaddens]

I think that's the key, moneymaking. The thing about GI path is that a lot of the knowledge that would be tested on boards falls under the rubric of general surgical path. The main reason to do the fellowship (IMHO) is not primarily to learn about rare entities but to know how to deal with judgment calls and difficult diagnoses (i.e. Barrett's dysplasia and UC-associated dysplasia). You can't test that on a board exam very well, apart from general characteristics of dysplasia (which as many studies have shown are very open to interpretation). Dermpath has enough variety and clinical correlation (like hemepath does) to be very much open to a board exam situation.QUOTE]

Do you think if one was to do an elective lets say 1 or 2 months with a "big wig" would be enough to learn the rare entities instead of an entire year? Considering you would not title yourself as a GI pathologist but for the purpose of pure learning.

 

[b&ierstiefel]

I think that's the key, moneymaking. The thing about GI path is that a lot of the knowledge that would be tested on boards falls under the rubric of general surgical path. The main reason to do the fellowship (IMHO) is not primarily to learn about rare entities but to know how to deal with judgment calls and difficult diagnoses (i.e. Barrett's dysplasia and UC-associated dysplasia). You can't test that on a board exam very well, apart from general characteristics of dysplasia (which as many studies have shown are very open to interpretation). Dermpath has enough variety and clinical correlation (like hemepath does) to be very much open to a board exam situation.QUOTE]

Do you think if one was to do an elective lets say 1 or 2 months with a "big wig" would be enough to learn the rare entities instead of an entire year? Considering you would not title yourself as a GI pathologist but for the purpose of pure learning.

Probably not...1-2 months is too short.