Great job offer but atrocious histology...

[dopath]

Really like the people, great location for me, good salary/benefits, partnership track. I want to take the job, but their histology looks like thick, under-processed, overstained turd nuggets on a glass slide, and they don’t do appropriate levels (i.e. two sections on a cervical bx doesn’t cut it in my book). I could not feel comfortable interpreting this material and would be constantly having to order levels/deepers/reprocessing. I would happily go in and troubleshoot processing and staining to get things up to speed. But it’s a sticky wicket. I think if I did this the pathologists and histotechs would likely resent me bc it would be more work for all parties involved. And that’s not a way to start a new job. But as the histology stands right now, it’s a complete deal breaker. Should I just turn it down? Or go for broke and hope maybe they would appreciate a fresh approach?

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[jupiterianvibe]

Really like the people, great location for me, good salary/benefits, partnership track. I want to take the job, but their histology looks like thick, under-processed, overstained turd nuggets on a glass slide, and they don’t do appropriate levels (i.e. two sections on a cervical bx doesn’t cut it in my book). I could not feel comfortable interpreting this material and would be constantly having to order levels/deepers/reprocessing. I would happily go in and troubleshoot processing and staining to get things up to speed. But it’s a sticky wicket. I think if I did this the pathologists and histotechs would likely resent me bc it would be more work for all parties involved. And that’s not a way to start a new job. But as the histology stands right now, it’s a complete deal breaker. Should I just turn it down? Or go for broke and hope maybe they would appreciate a fresh approach?

this is a challenging situation.

i had a similar one, except the location was awful. our histo was similar to what you described, and any attempts to remedy the situation was met with resistance as it would be more work for the tech staff. i lasted a few years before i bounced.

consider that the pathologists who work there might be used to the poor quality slides and therefore will resist improving them.

places have a culture, and the new guy is almost never able to change it unless they are in control of the purse strings. so either live with it, tolerate for long enough until you become partner and then change it, or look for another job.

 

[dopath]

this is a challenging situation.

i had a similar one, except the location was awful. our histo was similar to what you described, and any attempts to remedy the situation was met with resistance as it would be more work for the tech staff. i lasted a few years before i bounced.

consider that the pathologists who work there might be used to the poor quality slides and therefore will resist improving them.

places have a culture, and the new guy is almost never able to change it unless they are in control of the purse strings. so either live with it, tolerate for long enough until you become partner and then change it, or look for another job.

Thanks for the reply, jupiterianvibe. This is proving to be a tough decision. I agree that there would likely be resistance from both histo and the old paths bc “we’ve been doing it this way for x# years.” Sigh.

 

[coroner]

I've had colleagues grumble because I started I requested the histotechs arrange the slides on the tray differently just for me. The techs didn't mind but my colleagues for some reason did even though their slides still came out the way they liked?!? But, I was the new guy and non-partner, so my leverage was next to nil. (I did get my slides to my liking at one place, but not the other, but that colleague who nixed it was a total knob)

What you're asking for them to change is on the order of magnitudes greater than my simple request, so chances of rejection will be high. Even though you said you want the job, you also said, this is a dealbreaker. But, you're still hitting most of the high notes (location, pay, friendly/respectful co-workers). It's hard to get the whole package for most people. Also, I'm assuming you already have the offer, which puts you on a time constraint to find something better as this current place is expecting a reply soon. Given the job market and with all other factors considered, I'd probably take the it. Tough it out for the time being and try and and make gradual changes subtly over an extended period of time so they get used to your ways rather than an complete overhaul of histo as soon as you turn on your microscope.

 

[cmz]

Really like the people, great location for me, good salary/benefits, partnership track. I want to take the job, but their histology looks like thick, under-processed, overstained turd nuggets on a glass slide, and they don’t do appropriate levels (i.e. two sections on a cervical bx doesn’t cut it in my book). I could not feel comfortable interpreting this material and would be constantly having to order levels/deepers/reprocessing. I would happily go in and troubleshoot processing and staining to get things up to speed. But it’s a sticky wicket. I think if I did this the pathologists and histotechs would likely resent me bc it would be more work for all parties involved. And that’s not a way to start a new job. But as the histology stands right now, it’s a complete deal breaker. Should I just turn it down? Or go for broke and hope maybe they would appreciate a fresh approach?

I think you can make change as long as you do it respectfully. I hope this place at least has a lead histotech or a histology admin that you can speak one on one with to re-write protocols/SOPs. Of course, this is something you first need to run by the partners/medical director... if you start acting like a cowboy (even if the changes you are seeking are technically what's best for the lab), you will definitely start off on the wrong foot.

There's nothing wrong with asking for more responsibility. Just make sure you carry the ball correctly and follow through.

 

[LADoc00]

this is a new one, a path resident who has a job offer but the histology is not up to snuff.

I have to say you have officially stumped me. Im fairly certain though once there you could push small incremental improvements with no or minimal headwind.

 

[yaah]

If someone we were interested in said they liked the job but thought the histology could improve, personally I would jump at that and ask them more. It may turn out your ideas are too expensive or unteneable, but I find it hard to imagine you would get significant pushback for wanting to work to improve quality. It's a tough job, many paths don't even want to bother and are ok with results as long as they are "good enough." This would improve your candidacy in my view, provided you handled it appropriately and with an open mind.

 

[Euchromatin]

Tricky. If the job is great otherwise (and you don't have any other competing offers that are as good/better overall), I would probably take it. I agree with suggestions by others that if you carefully suggest incremental changes in a respectful fashion, you can probably get at least some improvement while you are waiting to make partner. For example, if you are bringing expertise to the group in a particular organ system, you might start with that area, or even one particular type of specimen - presumably they would be a bit more willing to listen to new opinions if they are hiring you for that expertise. Not sure if it is feasible given your description of the group thus far, but you could also use the compliment sandwich approach - attempt to alternate or combine suggestions for things that would decrease work and/or costs (perhaps there are some types of specimens which are being oversampled?) with those that require more work (i.e. more levels on x type of specimen). If that goes well maybe you could eventually talk them into some newer, more automated processors/stainers/coverslippers/other equipment that would decrease manual histotech work resulting in improved efficiency/workflow/TATs and/or decrease the number of FTEs needed, saving on labor costs. As you noted, you would likely have to completely take responsibility/ownership of any more sweeping changes to histology processes if you can talk them into it at all.

 

[yaah]

Indeed - lesson #1 from the "How to be a manager" playbook: If someone with less responsibility comes to you with a problem with something under your purview, ask them to help fix it!

So be prepared to be tasked with helping if you bring it up. This is, again, probably a good thing though if you otherwise like the job and want to be there. Taking ownership of problems is an important skill to learn.