Grossing Load

[ElementMD]

Hello SDN Path,
I am a pathology resident in an NYC program. We are grossing a lot.
I am sure among residencies there is a spectrum from an inordinate amount to almost none ( I know of one NY program in particular that barely grosses). I suspect we are somewhere near the high end.
What is a reasonable amount of grossing per day/week?
Does ACGME have any position on this?
I know there is a push with ACGME toward more oversight and standardization of path residencies.
On surg path we gross about 8 days a month and 20-30 specimens each shift. About half or more of these are large specimens (colon, mastectomy, nephrectomy, orchi, head and neck).
TYIA

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[Unty]

Hello SDN Path,
I am a pathology resident in an NYC program. We are grossing a lot.
I am sure among residencies there is a spectrum from an inordinate amount to almost none ( I know of one NY program in particular that barely grosses). I suspect we are somewhere near the high end.
What is a reasonable amount of grossing per day/week?
Does ACGME have any position on this?
I know there is a push with ACGME toward more oversight and standardization of path residencies.
On surg path we gross about 8 days a month and 20-30 specimens each shift. About half or more of these are large specimens (colon, mastectomy, nephrectomy, orchi, head and neck).
TYIA

That’s a lot of complex specimens for each day but you are only grossing 8 days per month.

Welcome to Pathology where you will be an indentured grossing slave until you finish residency or don’t gross at all and become incompetent at grossing when you need to in your job.

8 days a month isn’t bad but having to gross that many large specimens a day is a form of hard labor. How long are you in the hospital on these days? I’m guessing 12-16 hours? There are ACGME rules regarding work hours. I believe it is a requirement you are a certain number of hours away from work after one workday.

Are you previewing the cases you Gross? If not then you are truly cheap labor.

Another reason why you shouldn’t go to a crap program. Grossing is important but excessive grossing without previewing your cases is just a form of hard labor if you ask me. Even worse grossing biopsies is cheap labor at its finest. Taking advantage of residents to save your institution money from hiring a PA or paying a PA more to Gross biopsies.

I know of a world renowned institution where resident gross until late. There is nothing wrong with grossing late as long as you get to preview the cases you Gross.

ACGME sucks in regards to overseeing pathology training programs. No grossing at all? lol!!! What do residents do during surgpath. Just look at slides? Sounds nice but when you look for work I’m guessing they will go for those no grossing jobs.

Too many programs ACGME! Programs with very low volume, programs with excessive grossing without being able to preview your cases, or even better no previewing at all.

Subpar FMG residents at Lower tier programs who got a spot because they said they “wanted to be a pathologist.”

You wonder why some people have problems finding a job or why some employers don’t advertise their jobs? Because there’s a lot of crap out there.

I would make a mention of this in your anonymous ACGME evaluation at the end of the year. Have the residents tried to get together and bring it up to your program director. Please don’t tell me your PD is a vicious person who will black ball you if you complain.

Maybe try to ask to somehow distribute the workload more evenly throughout the month among residents instead of 8 days.

 

[deleted642280]

Your grossing does seem excessive. I trained in NYC and did not gross nearly that much, and we were given designated time for previewing and 1:1 signout with our attendings. Also, the NY state GME office has more stringent requirements than GME national (they do not allow for averaging of duty hours for example when counting days off), so you have some protection there:

New York State Council on Graduate Medical Education (NYS COGME)

graduate medical education main page

www.health.ny.gov

 

[univlad]

In the mid 2000's at my program, we grossed on SP either every third or fourth day, depending on how many residents there were that month, usually 3. Day 1: Gross and frozen until noon. Day 2: Read out non-biopsy cases (most of which you would have grossed the day before) Day 3: Read out biopsy cases and cover frozen sections after noon. If there were 4 people, the fourth person covered frozen all day and caught up on other cases.

We had a PA that did most of the biopsies She left at 3, so at the end of day we had to do about 10-20 min of biopsy grossing. The last tissue processor started at 6 but we were usually finished by 5 or 5:30. Our PA would also do non-biopsy cases too if the grossing load was high for the day. I think were well trained--in private practice now, if our PA is on vacation one of pathologists grosses alone and it is a busy day--longer hours than when I was a resident. Thankfully we each only have to do it a handful of times each year.

 

[Med Director New England]

Hello SDN Path,
I am a pathology resident in an NYC program. We are grossing a lot.
I am sure among residencies there is a spectrum from an inordinate amount to almost none ( I know of one NY program in particular that barely grosses). I suspect we are somewhere near the high end.
What is a reasonable amount of grossing per day/week?
Does ACGME have any position on this?
I know there is a push with ACGME toward more oversight and standardization of path residencies.
On surg path we gross about 8 days a month and 20-30 specimens each shift. About half or more of these are large specimens (colon, mastectomy, nephrectomy, orchi, head and neck).
TYIA

Are you grossing specimens that you don’t preview / sign out?

Is your dept phasing out specimen types for grossing once you are competent? If senior levels are still grossing things like biopsies that is a problem imo.

Is their enough support for your dept to function without your residents for a few days For grossing and cutting frozens?

 

[Unty]

There are surgical path fellowships which have you Gross for 6 months to a year. Cheap labor.....

 

[rirriri]

Hello SDN Path,
I am a pathology resident in an NYC program. We are grossing a lot.
I am sure among residencies there is a spectrum from an inordinate amount to almost none ( I know of one NY program in particular that barely grosses). I suspect we are somewhere near the high end.
What is a reasonable amount of grossing per day/week?
Does ACGME have any position on this?
I know there is a push with ACGME toward more oversight and standardization of path residencies.
On surg path we gross about 8 days a month and 20-30 specimens each shift. About half or more of these are large specimens (colon, mastectomy, nephrectomy, orchi, head and neck).
TYIA

thIs generation is so soft!!

In the 2000s we grossed 12-15x a month including weekends. 20-30 was considered a light day. Pretty sure this schedule was much worse in the 80s and 90s.

To complain you need a unified front talking to your PD and mention your complaints in your resident surveys.

now the main reason programs get nicked for grossing is if you are grossing and NOT seeing the cases you grossed. That is considered ‘scut’ work in Pathology. Anything you gross you must be seeing the slides for—-so if you aren’t then that’s your strategy.

 

[rirriri]

That’s a lot of complex specimens for each day but you are only grossing 8 days per month.

Welcome to Pathology where you will be an indentured grossing slave until you finish residency or don’t gross at all and become incompetent at grossing when you need to in your job.

8 days a month isn’t bad but having to gross that many large specimens a day is a form of hard labor. How long are you in the hospital on these days? I’m guessing 12-16 hours? There are ACGME rules regarding work hours. I believe it is a requirement you are a certain number of hours away from work after one workday.

Are you previewing the cases you Gross? If not then you are truly cheap labor.

Another reason why you shouldn’t go to a crap program. Grossing is important but excessive grossing without previewing your cases is just a form of hard labor if you ask me. Even worse grossing biopsies is cheap labor at its finest. Taking advantage of residents to save your institution money from hiring a PA or paying a PA more to Gross biopsies.

I know of a world renowned institution where resident gross until late. There is nothing wrong with grossing late as long as you get to preview the cases you Gross.

ACGME sucks in regards to overseeing pathology training programs. No grossing at all? lol!!! What do residents do during surgpath. Just look at slides? Sounds nice but when you look for work I’m guessing they will go for those no grossing jobs.

Too many programs ACGME! Programs with very low volume, programs with excessive grossing without being able to preview your cases, or even better no previewing at all.

Subpar FMG residents at Lower tier programs who got a spot because they said they “wanted to be a pathologist.”

You wonder why some people have problems finding a job or why some employers don’t advertise their jobs? Because there’s a lot of crap out there.

I would make a mention of this in your anonymous ACGME evaluation at the end of the year. Have the residents tried to get together and bring it up to your program director. Please don’t tell me your PD is a vicious person who will black ball you if you complain.

Maybe try to ask to somehow distribute the workload more evenly throughout the month among residents instead of 8 days.

do you insist on taking every topic into a totally off topic rant against pathology? Your views are such crass generalizations and are repetitive in every thread.

Top tip #1: if you are unhappy spend less time ranting about and spend more time doing something about it.

 

[CDX-2]

I am currently grossing 5 days / week, ie ~20-22X / Month. My co-registrar (co-resident) and I do cut-up and biopsy transfers for 4.5 - 6 hrs / day. I personally do anywhere from 20 - 60 cases/day, depending on what proportion are biopsy transfers. The largest number of "large" specimens I've had to do in a day was 5 (breasts, bowels, thyroids).

Together we total ~150-200 blocks / day. If we didn't have to cut any skin ellipses (we get lots of oriented and unoriented skins), our blockload could probably decrease by up to ~50%...

 

[LADoc00]

Hold it...hold it. Am I understanding the original post correctly?? You are complaining/"inquiring around" because you gross 20-30 specimens 8 days PER MONTH?

Like somehow that is our biggest obstacle/concern? I hope to the dear Lord this is a gag post.

This is about as absurd as someone in the Armenian genocide complaining they missed a post breakfast snack on the first day of the death march into the Syrian desert...dude, if you think that is bad, just wait for it.

Element, I am very unsure you are cut out to survive this one big guy. Sorry to be the bearer of this news.

PS- Someone else actually responded this "seems excessive"..Im at a loss. We are doomed. Im going to now go watch the Promise and drink myself into a stupor.

 

[CDX-2]

Hold it...hold it. Am I understanding the original post correctly?? You are complaining/"inquiring around" because you gross 20-30 specimens 8 days PER MONTH?

Like somehow that is our biggest obstacle/concern? I hope to the dear Lord this is a gag post.

This is about as absurd as someone in the Armenian genocide complaining they missed a post breakfast snack on the first day of the death march into the Syrian desert...dude, if you think that is bad, just wait for it.

Element, I am very unsure you are cut out to survive this one big guy. Sorry to be the bearer of this news.

PS- Someone else actually responded this "seems excessive"..Im at a loss. We are doomed. Im going to now go watch the Promise and drink myself into a stupor.

I initially Lol'ed at the original post too, but to give the benefit of the doubt, perhaps OP is concerned about cutting so many big specimens (10-15) on his grossing days. I'd probably take 12 Hrs just to do the big Specimens alone (assuming all of the big specimens are tumour/cancer cases)...

Perhaps they can arrange to have 2 residents do grossing with double the cut-up sessions (16X / Month)?

 

[yaah]

Hold it...hold it. Am I understanding the original post correctly?? You are complaining/"inquiring around" because you gross 20-30 specimens 8 days PER MONTH?

Like somehow that is our biggest obstacle/concern? I hope to the dear Lord this is a gag post.

This is about as absurd as someone in the Armenian genocide complaining they missed a post breakfast snack on the first day of the death march into the Syrian desert...dude, if you think that is bad, just wait for it.

Element, I am very unsure you are cut out to survive this one big guy. Sorry to be the bearer of this news.

PS- Someone else actually responded this "seems excessive"..Im at a loss. We are doomed. Im going to now go watch the Promise and drink myself into a stupor.

No. This impression is accurate. It's insane. I didn't train that long ago - when I was on a surg path rotation I grossed every day. Now it's like a 3 day cycle and only one of those is grossing, and you only see a third of the specimens at most. I don't get what everyone is doing with their time, but they are definitely still complaining about being overworked. Academic centers have hired tons of PAs - that trend was starting when I was in training - at the time I started my training my program had 1 PA. When I finished I think there were 4, and now I think there are like 7-8.

Not to be the old man here, I mean I know it's not that productive to gross your 15th colectomy of the week, but it seems like it swung so far in the other direction I'm not sure gross path training is adequate any more. There are like checklists now, you grossed your 4 Whipples, you're all done for the rest of your training now!

 

[LADoc00]

I don't get what everyone is doing with their time


View attachment 283528

Youporn, Has to be youporn. I refuse to believe path trainees are staring at endless cat videos on youtube.

 

[gbwillner]

Grossing is fairly low yield for training, IMHO. It's important, but not as important as other things. I think the line is that you should not be grossing anything you are not then previewing and signing out. Also, with some exceptions, grossing biopsies is a waste of time and should be limited to first year residents.

 

[Path-Anon]

Grossing is fairly low yield for training, IMHO. It's important, but not as important as other things. I think the line is that you should not be grossing anything you are not then previewing and signing out. Also, with some exceptions, grossing biopsies is a waste of time and should be limited to first year residents.

I agree. I don’t mind grossing if I have time to see the slides, and investigate a diagnosis. Your work will be based on making a diagnosis off of slide review. Where I went for residency, the grossing was every other day where the off day you were on biopsy service or stuck in the frozen section room. The chairman tried to get the PAs to take the junky cases like appendices, hernia sacs, small lipomas, etc., but the PAs balked and complained that the path residents didn’t want to do their jobs. The days when we got the slides back we had to track down missing slides, orphaned paperwork, etc., then we barely got a chance to review them before the attending came wanting to sign all the cases out. We spend sign out sitting at the microscope transcribing whatever the attending dictated while trying to look at what he saw and perhaps ask a question or 2.
Some cases we grossed were never seen by us: we had a busy liver transplant service and grossed all the livers, but never saw a single slide, as it was all signed out in a specialized liver sign out with the liver path fellow. And the path resident on evening frozen was responsible for reading the biopsies for liver transplant!!
What I got from residency training: how to be a glorified PA, and not even help getting a job afterwards (when I joined the program, I was told jobs are word of mouth, the chairman is well known and he just has to pick up a phone for you to secure a position). The bulk of my learning in making a slide diagnosis has been on the job, learning from my senior attending, and going to conferences.

 

[Unty]

I agree. I don’t mind grossing if I have time to see the slides, and investigate a diagnosis. Your work will be based on making a diagnosis off of slide review. Where I went for residency, the grossing was every other day where the off day you were on biopsy service or stuck in the frozen section room. The chairman tried to get the PAs to take the junky cases like appendices, hernia sacs, small lipomas, etc., but the PAs balked and complained that the path residents didn’t want to do their jobs. The days when we got the slides back we had to track down missing slides, orphaned paperwork, etc., then we barely got a chance to review them before the attending came wanting to sign all the cases out. We spend sign out sitting at the microscope transcribing whatever the attending dictated while trying to look at what he saw and perhaps ask a question or 2.
Some cases we grossed were never seen by us: we had a busy liver transplant service and grossed all the livers, but never saw a single slide, as it was all signed out in a specialized liver sign out with the liver path fellow. And the path resident on evening frozen was responsible for reading the biopsies for liver transplant!!
What I got from residency training: how to be a glorified PA, and not even help getting a job afterwards (when I joined the program, I was told jobs are word of mouth, the chairman is well known and he just has to pick up a phone for you to secure a position). The bulk of my learning in making a slide diagnosis has been on the job, learning from my senior attending, and going to conferences.

How many interviews and offers did you get? Are you in private practice?

 

[Path-Anon]

This

How many interviews and offers did you get? Are you in private practice?

This was 15 years ago. The job market SUCKED, PERIOD. I went to the chairman when my surgpath fellowship was over; he told me “why don’t you call Big City Academic Medical Center (I am leaving out names so as not to dox myself). So I did and was told I didn’t have enough experience. So much for him picking up a phone for me. Then I called Quest and Labcorp: same result, you don’t have enough experience. I couldn’t leave the city due to family legal issues. I then went to City North Side Community Hospital and gave my CV, but they never called me back. It turned out that a female fellow got that job after the chairman called and put in a good word about her. I then spent a year at a Medicaid Mill reading glass slides for $5.00/slide for a year just to get the experience. It was either that or go bankrupt. Then I got my first job at City West Side Community Hospital and was there for 10 years until they merged with Big City Academic Medical Center (same place I had first applied!) and all community hospital pathologists were thrown out by Big City’s Path Dept who then staffed it with their own pathologists. I did end up finding another job.

That is Pathology: the only specialty where you can be told that you have no experience when you finish your residency, and where your job is so insecure that you can lose it in a hostile takeover like some boiler room stock broker.

I can’t imagine doing anything else though; but those leaders who care about the future of pathology need to get their acts together for those in the trenches and do less virtue signaling at international and hospital board meetings.

 

[gbwillner]

I agree. I don’t mind grossing if I have time to see the slides, and investigate a diagnosis. Your work will be based on making a diagnosis off of slide review. Where I went for residency, the grossing was every other day where the off day you were on biopsy service or stuck in the frozen section room. The chairman tried to get the PAs to take the junky cases like appendices, hernia sacs, small lipomas, etc., but the PAs balked and complained that the path residents didn’t want to do their jobs. The days when we got the slides back we had to track down missing slides, orphaned paperwork, etc., then we barely got a chance to review them before the attending came wanting to sign all the cases out. We spend sign out sitting at the microscope transcribing whatever the attending dictated while trying to look at what he saw and perhaps ask a question or 2.
Some cases we grossed were never seen by us: we had a busy liver transplant service and grossed all the livers, but never saw a single slide, as it was all signed out in a specialized liver sign out with the liver path fellow. And the path resident on evening frozen was responsible for reading the biopsies for liver transplant!!
What I got from residency training: how to be a glorified PA, and not even help getting a job afterwards (when I joined the program, I was told jobs are word of mouth, the chairman is well known and he just has to pick up a phone for you to secure a position). The bulk of my learning in making a slide diagnosis has been on the job, learning from my senior attending, and going to conferences.

That sounds terrible, sorry. I had a very different experience.

 

[alpinebrook]

At my program, let's say it's a very busy month and you're on surgicals the entire time (i.e., weeks not broken up by cytopathology or lighter grossing services like derm path, renal path, etc.) -- you're grossing 5 days per week, at least 4 hours per day, so that's ~80 hours of grossing over a 4 week period. The grossing list is supposed to be capped at 4 hours but it's often unrealistic. The PAs create the grossing lists and the 4 hours is based on how long they think it should take, not how long it actually takes a less experienced resident to gross a case -- which creates conflict of interest -- they won't hesitate to shorten the time allotted for a specimen in order to fit more specimens on a resident's list. Then it's even longer for those of us who are slower/more meticulous. However, we do get to review every case we gross, and we do not gross small biopsies. Many of the cases, but certainly not all, have educational value. So, from what I'm reading on here, it could have been much, much worse for me...

 

[CDX-2]

At my program, let's say it's a very busy month and you're on surgicals the entire time (i.e., weeks not broken up by cytopathology or lighter grossing services like derm path, renal path, etc.) -- you're grossing 5 days per week, at least 4 hours per day, so that's ~80 hours of grossing over a 4 week period. The grossing list is supposed to be capped at 4 hours but it's often unrealistic. The PAs create the grossing lists and the 4 hours is based on how long they think it should take, not how long it actually takes a less experienced resident to gross a case -- which creates conflict of interest -- they won't hesitate to shorten the time allotted for a specimen in order to fit more specimens on a resident's list. Then it's even longer for those of us who are slower/more meticulous. However, we do get to review every case we gross, and we do not gross small biopsies. Many of the cases, but certainly not all, have educational value. So, from what I'm reading on here, it could have been much, much worse for me...

Interesting that the PAs create the grossing list...

I'm curious as to how much time the PA allocate towards a tumour mastectomy, and a tumour bowel?

I've been told that in order to meet the expected speed in a city / tertiary lab (in Australia),
grossing a tumour mastectomy or a tumour bowel should take no more than 45 minutes.

Obviously all mastectomies and bowels are different in terms of number and size of lesions.

I take ~45-75 minutes to gross a tumour mastectomy. This is if the mastectomy only contains ONE well-circumscribed tumour (NOT post-neoadjuvant chemo, NO attached axillary clearance). If it was a prophylactic mastectomy, I'd take 20-30 minutes.

A breast wide local excision takes me 20-90 minutes depending on the size of the specimen.

I also take ~45-75 minutes to gross a tumour bowel, providing there's only ONE tumour. Finding the 12+ lymph nodes is the time-consuming part.

Am I too slow for PA standards?

 

[yaah]

That is probably too slow. But you will get better as you get more experience.

 

[pathslides]

You are grossing too slow. But soon you will realize important sections and be more efficient. Man, talk to your program director, don’t let the PAs run you guys by gaming the system, that’s bs and call them out on that.

 

[bauber]

I had days in training I grossed from 730-730, mostly large surigicals. It was a 3 day cycle though and I got to see all my cases the next day. One of my fellowship places had a 2 large specimens per day limit for the residents. There's a lot of variation between programs. You really should not be grossing biopsies as a resident and if you are it should be to help out the PAs on an extra busy day. The department can pay a lab tech to transfer biopsies.

 

[Alteran]

Grossing is a fairly low-yield exercise after your 2nd year if you have been trained properly. Every trainee should know how to gross efficiently and correctly to be able to serve as a resource for the PAs they will one day supervise. While my group has 2 PAs, I'm not shy about going into the gross room to re-gross some stuff that either got missed or was complicated and needed some additional sections to complete the case.

There is no issue with a heavy grossing load as long as you get to preview and sign out what you grossed in. Otherwise, there is no value in it.

 

[CDX-2]

This week I managed to gross a "tumour bowel" in 29 minutes!!!

Granted it was a segmental colectomy (large bowel segment was only ~10 cm length) with a large polyp, and I possibly found 12 tiny lymph nodes.

I know it's not a tumour right hemicolectomy (which normally takes me 45 - 75 mins to gross),
but at least I can now say I've grossed at least one "tumour bowel" within 30 minutes!

Having way less mesentery to examine makes it so much quicker...

 

[ElementMD]

Thanks for all the feedback everyone. Sounds some think we are grossing too much, some too little and some just right.
Here is a typical grossing day for me:
I am sure some will say that you used to gross this list in the morning before you even had your breakfast.
But here is a typical day, please let me know what you think.

Grossing day, 3/21/2019
TAH-BSA	4
Colon	4
Colon	4
Whipple	6
Prostate	3
Prostate	3
Testicle	4
Mastectomy	5
Wedge and Lobectomy	4
Parotid and Neck Dissection	4
Lump with margins	4
Wedge, lobe and lymph nodes	4
Brain	1
Breast lump, unoriented	2
Cervical Cone, oriented, with EMC, ECC	2
PTH	1
Lymph node	1
Placenta	1
Placenta	1
TOTAL

 

[ElementMD]

Your grossing does seem excessive. I trained in NYC and did not gross nearly that much, and we were given designated time for previewing and 1:1 signout with our attendings. Also, the NY state GME office has more stringent requirements than GME national (they do not allow for averaging of duty hours for example when counting days off), so you have some protection there:

New York State Council on Graduate Medical Education (NYS COGME)

graduate medical education main page

www.health.ny.gov

Thanks Sarahkeet...
I clicked on that link and I dont see bylaws or guidelines anywhere.
Could you possible send the sublink?

 

[deleted314957]

Thanks for all the feedback everyone. Sounds some think we are grossing too much, some too little and some just right.
Here is a typical grossing day for me:
I am sure some will say that you used to gross this list in the morning before you even had your breakfast.
But here is a typical day, please let me know what you think.

Grossing day, 3/21/2019
TAH-BSA	4
Colon	4
Colon	4
Whipple	6
Prostate	3
Prostate	3
Testicle	4
Mastectomy	5
Wedge and Lobectomy	4
Parotid and Neck Dissection	4
Lump with margins	4
Wedge, lobe and lymph nodes	4
Brain	1
Breast lump, unoriented	2
Cervical Cone, oriented, with EMC, ECC	2
PTH	1
Lymph node	1
Placenta	1
Placenta	1
TOTAL

Guess what my friend? You are a grossing monkey and being taken advantage of.

 

[Med Director New England]

Thanks for all the feedback everyone. Sounds some think we are grossing too much, some too little and some just right.
Here is a typical grossing day for me:
I am sure some will say that you used to gross this list in the morning before you even had your breakfast.
But here is a typical day, please let me know what you think.

Grossing day, 3/21/2019
TAH-BSA	4
Colon	4
Colon	4
Whipple	6
Prostate	3
Prostate	3
Testicle	4
Mastectomy	5
Wedge and Lobectomy	4
Parotid and Neck Dissection	4
Lump with margins	4
Wedge, lobe and lymph nodes	4
Brain	1
Breast lump, unoriented	2
Cervical Cone, oriented, with EMC, ECC	2
PTH	1
Lymph node	1
Placenta	1
Placenta	1
TOTAL

That great if your training to become a PA

 

[MetroPath]

Holy crap that’s a lot especially if they are mostly cancer cases. You can just suck it up and get those 8 days done. You aren’t seeing the slides to those cases then, which amounts to you being a grossing slave.

I don’t know how ACGME does not regulate this. This isn’t good training.

 

[pathslides]

Thanks for all the feedback everyone. Sounds some think we are grossing too much, some too little and some just right.
Here is a typical grossing day for me:
I am sure some will say that you used to gross this list in the morning before you even had your breakfast.
But here is a typical day, please let me know what you think.

Grossing day, 3/21/2019
TAH-BSA	4
Colon	4
Colon	4
Whipple	6
Prostate	3
Prostate	3
Testicle	4
Mastectomy	5
Wedge and Lobectomy	4
Parotid and Neck Dissection	4
Lump with margins	4
Wedge, lobe and lymph nodes	4
Brain	1
Breast lump, unoriented	2
Cervical Cone, oriented, with EMC, ECC	2
PTH	1
Lymph node	1
Placenta	1
Placenta	1
TOTAL

[/
.

Unless you are seeing all that glass and making the reports, you are being used as a PA

 

[deleted642280]

Thanks Sarahkeet...
I clicked on that link and I dont see bylaws or guidelines anywhere.
Could you possible send the sublink?

Sure:

Resident Work Hours and Conditions of Post-Graduate Trainees

Resident Work Hours and Conditions of Post-Graduate Trainees

www.health.ny.gov

https://www.health.ny.gov/facilities/hospital/reports/resident_work_hours/regulations_comparison_guide.pdf

https://www.health.ny.gov/facilities/hospital/reports/resident_work_hours/key_points_and_q_and_a.pdf

 

[CDX-2]

Thanks for all the feedback everyone. Sounds some think we are grossing too much, some too little and some just right.
Here is a typical grossing day for me:
I am sure some will say that you used to gross this list in the morning before you even had your breakfast.
But here is a typical day, please let me know what you think.

Grossing day, 3/21/2019
TAH-BSA	4
Colon	4
Colon	4
Whipple	6
Prostate	3
Prostate	3
Testicle	4
Mastectomy	5
Wedge and Lobectomy	4
Parotid and Neck Dissection	4
Lump with margins	4
Wedge, lobe and lymph nodes	4
Brain	1
Breast lump, unoriented	2
Cervical Cone, oriented, with EMC, ECC	2
PTH	1
Lymph node	1
Placenta	1
Placenta	1
TOTAL

8 bowels, 6 Whipples, 6 radical prostatectomies, 5 mastectomies, plus all the other specimens for a single day?!

I don't think that's a realistic grossing workload.

Even if you were extremely judicious and dexterous, and took only 30 minutes to do each of those specimens (bowel/whipples/prostate/breast), you'd still take 14+ hours to finish all of those specimens you listed!!!

 

[bauber]

**** I would have considered quitting if I had to do 6 whipples/day.

 

[ElementMD]

Thanks for everyones feedback.

There is a paper out of U Penn involving too much grossing and the restructuring process they used to make it more standardized.

Surgical Pathology Resident Rotation Restructuring at a Tertiary Care Academic Center

Changes in the field of pathology and resident education necessitate ongoing evaluation of residency training. Evolutionary change is particularly important for surgical pathology rotations, which form the core of anatomic pathology training programs. ...

www.ncbi.nlm.nih.gov

We are starting a similar project at our instituion. Times have changed.
The field has changed. The grossing load has to evolve with the evolving demands of the specialty,

 

[Euchromatin]

8 bowels, 6 Whipples, 6 radical prostatectomies, 5 mastectomies, plus all the other specimens for a single day?!

**** I would have considered quitting if I had to do 6 whipples/day.

I'm not the poster, but I would assume that the number in the far right column was the difficulty/classification of the specimen (e.g. a placenta is fairly easy to gross so is only "1" but a Whipple, being one of the most complex, is a "6"), not the # of specimens. Also, if it was the number, there would be no point in listing "colon" and "placenta" twice.

Given my assumption about the numbering is correct, I think this load is pretty high for a single day's work, but might not be all that unreasonable IF:
they are only grossing about twice a week (presumably if 8 times a month)
they then are given time to preview all of the slides from these cases AND dictate/generate reports for them the next day BEFORE the attending sees them/signs out
they don't have a bunch of other duties on those grossing days

would also depend a bit on how efficient of a system for dictating/generating gross descriptions there is (i.e. are there good templates for most specimens already), how nice the equipment/grossing stations are, etc.

 

[TrojanRaggy]

Thanks for all the feedback everyone. Sounds some think we are grossing too much, some too little and some just right.
Here is a typical grossing day for me:
I am sure some will say that you used to gross this list in the morning before you even had your breakfast.
But here is a typical day, please let me know what you think.

Grossing day, 3/21/2019
TAH-BSA	4
Colon	4
Colon	4
Whipple	6
Prostate	3
Prostate	3
Testicle	4
Mastectomy	5
Wedge and Lobectomy	4
Parotid and Neck Dissection	4
Lump with margins	4
Wedge, lobe and lymph nodes	4
Brain	1
Breast lump, unoriented	2
Cervical Cone, oriented, with EMC, ECC	2
PTH	1
Lymph node	1
Placenta	1
Placenta	1
TOTAL

That's how much I gross every week in a program with 180K plus surgical pathology specimens despite the fact that we are on a 1 day cycle...

 

[deleted314957]

Thanks for everyones feedback.

There is a paper out of U Penn involving too much grossing and the restructuring process they used to make it more standardized.

Surgical Pathology Resident Rotation Restructuring at a Tertiary Care Academic Center

Changes in the field of pathology and resident education necessitate ongoing evaluation of residency training. Evolutionary change is particularly important for surgical pathology rotations, which form the core of anatomic pathology training programs. ...

www.ncbi.nlm.nih.gov

We are starting a similar project at our instituion. Times have changed.
The field has changed. The grossing load has to evolve with the evolving demands of the specialty,

I can tell you this. The evolving demands of the speciality DO NOT involve grossing.

 

[gbwillner]

I considered grossing load as an important factor in discriminating AP programs. I ruled out any such program where I did not sign-out all the specimens I grossed. There is a little leeway when you rotate off service.

In the end, I preferred programs where you have a 1-day schedule and gross a little every day. I chose a program that had a pretty heavy gross load, but that was only because I signed out a lot of specimens. 2nd year included subspecialty sign-outs, including GI and H&N which were the heaviest grossing loads. 2 colectomies +1 whipple or 2 laryngectomies was about as heavy as it ever got if the gross room was very busy that day (plus a few smaller speciments). We did not do any small routine BXs after 1st year, those went straight to the PAs. In general, you RARELY had to do more than 1 of any type of large specimen- the second would go to the PAs, although you would still sign them out.

The training point of grossing is really to understand what goes into the cassettes, how the sample is arranged, what is adequate or not, how the process works.... how many colons do you have to gross to understand that specimen type? My conservative estimate is that after 20 you probably are not learning anything.

 

[HeyDalaron]

I considered grossing load as an important factor in discriminating AP programs. I ruled out any such program where I did not sign-out all the specimens I grossed. There is a little leeway when you rotate off service.

In the end, I preferred programs where you have a 1-day schedule and gross a little every day. I chose a program that had a pretty heavy gross load, but that was only because I signed out a lot of specimens. 2nd year included subspecialty sign-outs, including GI and H&N which were the heaviest grossing loads. 2 colectomies +1 whipple or 2 laryngectomies was about as heavy as it ever got if the gross room was very busy that day (plus a few smaller speciments). We did not do any small routine BXs after 1st year, those went straight to the PAs. In general, you RARELY had to do more than 1 of any type of large specimen- the second would go to the PAs, although you would still sign them out.

The training point of grossing is really to understand what goes into the cassettes, how the sample is arranged, what is adequate or not, how the process works.... how many colons do you have to gross to understand that specimen type? My conservative estimate is that after 20 you probably are not learning anything.

I agree. I trained at a place which had a generous compliment of PAs, so residents weren't necessary to run the service. Biopsy grossing was never expected of us. Larger specimens were done as much as one thought it were necessary for learning. In the final two years, grossing was a very minimal, if not absent, part of the experience.

There is very little to be learned from grossing after doing a few cases of any particular type of specimen. The law of diminishing returns applies.

I feel kind of incensed at the OP's exploitation.

 

[Dr Faust]

Cheap labor grossing was the bane of our existence and the main parasite of our education.

We were told grossing biopsies was part of service and that service was a required part of our training. What a load of bollocks. Meanwhile, you had senior residents in our program that didn't know how to interpret MMR IHC stains, didn't know what MOC-31 was used for in effusion cytology and couldn't sign out a frozen section on their own if their life depended on it. But we sure did know how to gross a mean biopsy. LOL.

 

[Unty]

You can easily fall through the cracks in certain programs and graduate residency like you mentioned. Service work trumps making sure residents are well trained in some places.

I got off the phone with a pathologist the other day who told me one junior pathologist quit her job because she wanted ALL her cases reviewed. This person had a surgpath fellowship under her belt. She quit after a few months.

Some programs will not give you graduated responsibility. Some places don’t critically assess whether you can practice as an independent pathologist.

 

[deleted314957]

You can easily fall through the cracks in certain programs and graduate residency like you mentioned. Service work trumps making sure residents are well trained in some places.

I got off the phone with a pathologist the other day who told me one junior pathologist quit her job because she wanted ALL her cases reviewed. This person had a surgpath fellowship under her belt. She quit after a few months.

Some programs will not give you graduated responsibility. Some places don’t critically assess whether you can practice as an independent pathologist.

She will find a comfy home in academia and contribute NOTHING to QUALITY resident education. Such people become the butt of jokes in residency. We’ve all seen them.
She may limit her practice to vas deferens.

 

[27G]

You can easily fall through the cracks in certain programs and graduate residency like you mentioned. Service work trumps making sure residents are well trained in some places.

I got off the phone with a pathologist the other day who told me one junior pathologist quit her job because she wanted ALL her cases reviewed. This person had a surgpath fellowship under her belt. She quit after a few months.

Some programs will not give you graduated responsibility. Some places don’t critically assess whether you can practice as an independent pathologist.

I don’t think it’s as simple as giving graduated responsibility. It’s about leadership. Unfortunately sometimes incompetent people become program directors because residents complain and the leaders just want happy residents. This sets up an awful precedent of shuffling people through to graduation and using the only metric of competence as passing the boards. Lots of trainees don’t know how to work, put their cell phones away and look at cases and work them up. Carefully look at lymph nodes, read, digest information, look at cases thoroughly.... use all the resources available including study sets, guidelines.... etc. They want to be spoon fed and blame the system for not learning. Bad program directors don’t really understand what a real job entails because they have been in academics their whole career and get out of service work by doing admin. The best mentor a resident can find is a serious possibly grumpy person that moves mountains of glass accurately and passionately. Stay away from the admin people. Learn how to work, become competent, confident, independent, and a team player. If you are passing the buck in residency and not being called on it you are a disaster for the field.

 

[CDX-2]

You can easily fall through the cracks in certain programs and graduate residency like you mentioned. Service work trumps making sure residents are well trained in some places.

I got off the phone with a pathologist the other day who told me one junior pathologist quit her job because she wanted ALL her cases reviewed. This person had a surgpath fellowship under her belt. She quit after a few months.

I'm curious as to how this junior pathologist will be able to service / pay off her med school debt if she quit after a few months. Will other prospective employers take her?

 

[yaah]

Part of it is gradual shifting of the age of "attaining adulthood" for lack of a better term. It's akin to the general educational tracks in the world where it used to be a high school degree was qualifying for a good job - then it became college, now even college isn't enough.

At one point, med school was the end of your training. Then it became residency. Then it was fellowship. Now apparently for many it's an apprenticeship or junior attending or whatever. And by this point you may be mid 30s. You have to cut the cord at some point. Ideally everyone can get, in their first job, a place where you have autonomy yet are free to ask questions and get mentored for the tough stuff. But there are an awful lot of people who come out of training who just don't seem to be comfortable with anything out of their comfort zone. I do not think at all that this is unique to pathology - part of it stems from older folks not trusting young folks, but part of it also stems from young folks lacking confidence and focusing their training too much to the exclusion of other skills that they need to learn - it can't be all just about boards studying and getting research for your CV.

 

[y2k_free_radical]

You can easily fall through the cracks in certain programs and graduate residency like you mentioned. Service work trumps making sure residents are well trained in some places.

I got off the phone with a pathologist the other day who told me one junior pathologist quit her job because she wanted ALL her cases reviewed. This person had a surgpath fellowship under her belt. She quit after a few months.

Some programs will not give you graduated responsibility. Some places don’t critically assess whether you can practice as an independent pathologist.

I have seen fellow pathologists quit practicing because the responsibility for correct diagnosis finally exhausted their emotional reserve.In my experience this is more common with female pathologists.Perhaps it is because they are more emotionally invested than us males.

 

[Euchromatin]

I have seen fellow pathologists quit practicing because the responsibility for correct diagnosis finally exhausted their emotional reserve.In my experience this is more common with female pathologists.Perhaps it is because they are more emotionally invested than us males.

"exhausted their emotional reserve"??
I have no idea what this is supposed to mean. And the last 2 sentences are pure misogynistic bull****.

I don't find signing out cases (whether the cases are challenging or not) to be remotely "emotional." The only time I have ever heard another pathologist voice "emotions" related to our work are occasional expressions of sympathy for patients when diagnosing cases with particularly severe/terminal diagnoses. We've had a couple of people that we hired out of fellowship not work out for our group because they either couldn't keep up with the workload or their diagnostic skills were too weak. No one I know has ever expressed concern about their own or anyone's else's "emotional reserve."

 

[Vicinal]

Part of it is gradual shifting of the age of "attaining adulthood" for lack of a better term. It's akin to the general educational tracks in the world where it used to be a high school degree was qualifying for a good job - then it became college, now even college isn't enough.

At one point, med school was the end of your training. Then it became residency. Then it was fellowship. Now apparently for many it's an apprenticeship or junior attending or whatever. And by this point you may be mid 30s. You have to cut the cord at some point. Ideally everyone can get, in their first job, a place where you have autonomy yet are free to ask questions and get mentored for the tough stuff. But there are an awful lot of people who come out of training who just don't seem to be comfortable with anything out of their comfort zone. I do not think at all that this is unique to pathology - part of it stems from older folks not trusting young folks, but part of it also stems from young folks lacking confidence and focusing their training too much to the exclusion of other skills that they need to learn - it can't be all just about boards studying and getting research for your CV.

I think subspecialization also has contributed to this. Many practices cannot support pure specialization unless it’s heme or derm or neuro. Doing multiple subspecialty fellowships; especially non boarded ones can be detrimental rather than getting a job and learning to sign out GI, Gyn, Gu. A surgpath fellowship in a great program where you see everything and focus in an area may be a better option. Especially one that may allow you to start signing out by the end or at least have a good hot seat type experience. Unfortunately path does attract the purely lifestyle type folks that want to enter “lifestyle” during residency which is absolutely the wrong time. When you get a job you get paid for generating codes. It’s not rocket science. If you can’t work to generate revenue for the group and are not a team player and require lots of extra “care”.... the group will look for a way to send you off to your next adventure.

 

[Pathopath]

There's as much to learn from grossing all your big specimens as there is from watching slides of your nth case of all the pathology you see frequently...

"exhausted their emotional reserve"??
I have no idea what this is supposed to mean.

This happens to some people; even if you don't know of anyone citing this as their reason for quitting or getting burnt out in their practice, it's not hard to think of this as a possible outcome, specially for some pathologists with poor diagnostic skills, and even for some with average or addequate skills who tend to self doubt themselves too much, or find the burden of uncertainty of diagnoses, specially neoplastic, too difficult to bear. What I can't wrap my head around is you having never heard any colleague complain about or know someone obviously affected from having to deal with uncertainty in diagnosing...