Hot Pathology Fellowships in the Future?

[Unty]

Which fellowships do you think will be "hot" in the future? You guys think dermpath will still be hot as it is now? Will dermpath be supplanted by another field?

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[Gut Shot]

 

[yaah]

You could probably find an argument out there for every single fellowship as potentially increasing in desirability in the future. It depends on how billing practices change, how health care changes, and how many people graduate from fellowships and start practicing, to name just a few examples. I mean the # of dermpath and GI path fellowships seems to have increased exponentially in the past 5 years - maybe that means there will be a glut. Maybe not. The best advice is to do what you want.

 

[Napoleon1801]

Which fellowships do you think will be "hot" in the future? You guys think dermpath will still be hot as it is now? Will dermpath be supplanted by another field?

I think most of the AP fellowships seem to be "hot" or at least luke-warm in comparison to CP...

 

[windora]

I spoke with a national physician recruiter recently who said that dermpath and gi path fellowships are still the ones he gets the most calls for. Hemepath ranks third but is still highly sought after.

 

[LADoc00]

I wouldve said the best fellowship for path was a MBA followed by a second "fellowship" in IBanking...although now that Ibanking is collapsing I have to retract that.

 

[macrocyte]

Over the next 5 to 10 years this is how I project the demand for fellowships to be:

1)GI,Derm
2)GU
4)GYN, Heme
5)Surg path(general), cyto
6)Not worth doing it(marketability wise)

 

[KeratinPearls]

Over the next 5 to 10 years this is how I project the demand for fellowships to be:

1)GI,Derm
2)GU
4)GYN, Heme
5)Surg path(general), cyto
6)Not worth doing it(marketability wise)

What is your reasoning behind these rankings?

 

[gbwillner]

Over the next 5 to 10 years this is how I project the demand for fellowships to be:

1)GI,Derm
2)GU
4)GYN, Heme
5)Surg path(general), cyto
6)Not worth doing it(marketability wise)

What about PEDS???? I hear there are very few people coming out with that fellowship this year and DOZENS of openings....

 

[yaah]

What about PEDS???? I hear there are very few people coming out with that fellowship this year and DOZENS of openings....

When people use a term like "hot" for something like a pathology fellowship they are implying "fastest route to $$$," in general. At present, private places (labs and hospitals) seem to want GI and dermpath more than anything else (derm has always been desired for these groups, GI has exploded in the past few years). Heme has always been stable also. GU is "hot" at present but is a smaller niche and not as hotly desired by private labs as GI people (perhaps because many of the large megalabs have done such an effective job stealing GU biopsy material).

Therefore pediatric path is not "hot" because it doesn't lend itself to entrepreneurial gouging, cash accumulation, and manipulative billing practices. However, if you wish to refer to it as "hot" because well-trained pediatric pathologists are in demand at many academic centers, then yes it is hot.

In terms of job ads I have seen, what people want are 1) GI, 2) derm 3) heme 4) GU/breast (seems tied) 5) Cyto 6) BB/TM, 7) Gyn, 8) others. Academic med centers seem to be looking for some of everything, perhaps more so in derm and GI. Why? Because as fellowships become "hot" people who are interested in them for superficial reasons start competing for them, and people who go into fellowships to some extent for superficial reasons very rarely go into academics. Please don't misconstrue this as a slam against people going into these fields, it's not. It's just a fact of life - similar to how academic dermatology, gastroenterology, and radiology programs have a relatively more difficult time hiring people than other specialties.

General surg path is always a good thing to do, particularly if you can focus in one area (like pulmonary or breast).

 

[pathstudent]

GI/GU seem hot because we get lots of emails from recruiters looking for "GI/GU pathologists", but it is worth pointing out that many of those jobs are pod jobs. Basically every group of gastroenterologists and urologists are hiring their own pathologist(s) so they can make money off the specimen preparation and taking a cut of the pathologist's professional reimbursement. Those jobs don't seem too hot to me.

 

[Thaitanium]

Where do ppl find out about jobs (other than pathologyoutlines and the CAP website)? Will I receive emails from recruiters when I'm a senior resident? If not, how does one generally go about getting in contact with employers?

 

[Unty]

GI/GU seem hot because we get lots of emails from recruiters looking for "GI/GU pathologists", but it is worth pointing out that many of those jobs are pod jobs. Basically every group of gastroenterologists and urologists are hiring their own pathologist(s) so they can make money off the specimen preparation and taking a cut of the pathologist's professional reimbursement. Those jobs don't seem too hot to me.

It should be made a requirement that anyone looking at pod lab jobs should demand 500K for 40 or less hour work weeks and 4 months of vacation.

 

[Arctic Char]

It should be made a requirement that anyone looking at pod lab jobs should demand 500K for 40 or less hour work weeks and 4 months of vacation.

here here!

 

[Gut Shot]

here here!

That sounds good, but I shudder at the volume required to justify such a salary. I like to spend more than five seconds per prostate core.

 

[yaah]

That sounds good, but I shudder at the volume required to justify such a salary. I like to spend more than five seconds per prostate core.

Based on a pod lab pitch that I heard, the volume is probably not that excessive. If you read out 6-8 prostate biopsy sets (with 12 cores each) per day x 5 day week, probably equates to close to $3-400k per year. That's just a guess though.

Pod labs do not generally hire people for 40 hr week, to my knowledge (unless they are really large pod labs). They hire them as part time and pay by the hour (like $150-200 per hour). Independent contractors, so to speak. I suppose that presumes a certain rate of reading slides/hour. No doubt you would have to pay your own malpractice and things like that.

But yes, GI/GU (and derm also) are hot because of the ability to make money out of volume. That's also why larger private places want people with this training, because then they can compete with the pod lab who says they have a "fellowship trained GI pathologist" for marketing purposes. To some people, it probably doesn't matter if Dr X has been a practicing pathologist for 30 years and knows more GI path than anyone in the area, he didn't do a "fellowship" in GI path.

Personally, I would not recommend working for a pod lab unless you are nearing the end of your career or you can do it part time and your other job does not have some sort of non-compete clause. But unfortunately the prospect of quick $$$ wins people over, even if it may diminish your potential earnings for the future (because your only experience will be in one narrow area).

 

[yaah]

Where do ppl find out about jobs (other than pathologyoutlines and the CAP website)? Will I receive emails from recruiters when I'm a senior resident? If not, how does one generally go about getting in contact with employers?

If you are lucky or train at a good program/fellowship or if you know certain people you will find offers coming to you. We get occasional emails from our program director who gets contacted by certain places looking for people. Depending on what your fellowship is you may also get targeted recruitments (like from places looking for cytologists, for example).

Many people contact places they are interested in (calling or emailing or whatever) to ask if they might have an opening. Others have someone they know (like a well known attending) contact for them or otherwise make it known. Lots of places will contact attendings that they respect and ask if they know of any residents/fellows who might be interested.

Personally, I have gotten direct mailings (often fairly generic), emails both as part of places contacting our PD and people emailing me directly (not sure how some of them found out who I was, but others I had known from previous interactions). Have been asked over the phone when calling back consults. Have had attendings inform me about open/potential positions. Have also contacted a couple of places myself.

 

[Gut Shot]

Based on a pod lab pitch that I heard, the volume is probably not that excessive. If you read out 6-8 prostate biopsy sets (with 12 cores each) per day x 5 day week, probably equates to close to $3-400k per year. That's just a guess though.

Perhaps I'm totally wrong, but my hogwash detector is activated by this scenario. I can see annual billing of 300-400k for 6-8 core sets per day, but not net income.

 

[MirkoCrocop]

i think ocular path easily, number 1, 2, somethin gin that range

 

[yaah]

Perhaps I'm totally wrong, but my hogwash detector is activated by this scenario. I can see annual billing of 300-400k for 6-8 core sets per day, but not net income.

Yes, but with manipulative billing practices, you reduce expenses. I really don't know how it works - but I know there are some urology groups who send their tissue cores to a national lab. National lab processes cores and sends the slides to the urology group, who then hires a pathologist to come in and read the slides. If the urology group pays $100-150k per year for maybe 8-10 or 10-12 core sets per week (which they actually advertise about - these are the ads that say "10-15 hours per week, part time position") then extending that out to 6-8 per day gets you higher.

Now, I don't know how this actually works. Is the urology group billing insurance for the technical component (after negotiating a reduced rate that they pay directly to the national lab) as well as the professional component? This seems to me the only way that such $$ amounts are possible, given that the technical component is reimbursed higher than the professional component, and given that the urology group is most certainly NOT going to be paying the pathologist more money than they take in. Sounds illegal, maybe that's not what happens. Perhaps they are allowed to bill for the TC because they have an office for the pathologist and they can argue that as TC expenses. Maybe they just bill for the PC. I dunno.

 

[Path_Anon]

In terms of job ads I have seen, what people want are 1) GI, 2) derm 3) heme 4) GU/breast (seems tied) 5) Cyto 6) BB/TM, 7) Gyn, 8) others.

I'd generally agree with Mr. Yaah, although I'd rank as follows:

1)GI 2) derm 3) heme 4) gen. surgical 5)cyto 6)GU 7)GYN 8) molecular/other

Again, I'd rank these in what my opinion is most popular right now, not nec. what ought to be done. I'm seriously concerned about the disparaging trend of folks jumping right into subspecialty training (and not doing a surg path fellowship) in lieu of the more traditional route of doing at minimum the SP and THEN a potential subspecialty fellowship.

I found the "GU/breast" an odd combo; I'll have to keep an eye out for these subspecialty training background. Seems cool though, I'd like to be able to consider myself a pathologist with training experience in t*tty-f*cking.

 

[Nilf]

i think ocular path easily, number 1, 2, somethin gin that range

My bets are on hernia sac fellowship.

 

[yaah]

Again, I'd rank these in what my opinion is most popular right now, not nec. what ought to be done. I'm seriously concerned about the disparaging trend of folks jumping right into subspecialty training (and not doing a surg path fellowship) in lieu of the more traditional route of doing at minimum the SP and THEN a potential subspecialty fellowship.

Interestingly, I am more concerned with people who do surg path PLUS a subspecialty surg path, especially when they plan to do this. Many do surg path and then do something else, either they couldn't get it beforehand or their interests developed later. But if you train at a solid program and effectively use your elective time, doing an extra surg path year may give you extra confidence but is it really worth the year? For those training at smaller programs without enough volume or expertise, that changes a bit.

 

[Logos']

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[yaah]

I am not concerned about someone's competence if they do both, I am concerned about why they felt the need to do both (particularly if they planned to do both before even applying for the subspecialty). I do understand that many people just want the extra year of training to feel more comfortable. That's fine, I would certainly never hold that against anyone or say it was a mistake. I just question the rationale. I did not technically do a surg path fellowship. I did about 8 months of extra rotations that surg path fellows do, so it is "close" to equivalent.

But those are good points, interesting that that is the standard. Like I said, a lot of it simply depends on what program you train at, and I guess from what you say on the general expectations of graduates.

 

[Ale]

Now, I don't know how this actually works. Is the urology group billing insurance for the technical component (after negotiating a reduced rate that they pay directly to the national lab) as well as the professional component?.

The TC is billed by the lab doing the processing. The pod lab bills for the professional component. At the end of the week the manager comes and tells you that you are not billing enough. You should order more immunos. So every core with an atypical gland gets 3 immunos: p63, AMACR and 34bE12. Even if you have 6+6 in the other 8 cores. And because you have carcinoma you order a GCDFP-15, ER, PR, Her-2, TTF-1, CD99, CK5-6, and vimentin to rule out metastasis from the breast, lung and maybe ewings because he is 99. Then they send it out for consultation with a note saying "bill the patient not me" becasue all the immunos came back positive

There is a post on the internet about a guy that was complaining that the pod lab was doing cell blocks on the formalin that was left in the bottle of the core bx.

 

[yaah]

Heh, I know of a lab that routinely orders 8 immunostains on every new biopsy dx of lung cancer. Just because they can. And we actually get prostate bx consults where they did the triple stain on every core and then find something weird. So I know what you're talking about.

I just still can't figure out how it's worthwhile for the pod labs to pay a pathologist that level if they aren't getting any of the TC.

 

[Nilf]

The TC is billed by the lab doing the processing. The pod lab bills for the professional component. At the end of the week the manager comes and tells you that you are not billing enough. You should order more immunos. So every core with an atypical gland gets 3 immunos: p63, AMACR and 34bE12. Even if you have 6+6 in the other 8 cores. And because you have carcinoma you order a GCDFP-15, ER, PR, Her-2, TTF-1, CD99, CK5-6, and vimentin to rule out metastasis from the breast, lung and maybe ewings because he is 99. Then they send it out for consultation with a note saying "bill the patient not me" becasue all the immunos came back positive

There is a post on the internet about a guy that was complaining that the pod lab was doing cell blocks on the formalin that was left in the bottle of the core bx.

OMFG...

This is what you get when you mix public with private: the worst of both, with benefit of none.

In a normal supply and demand driven economy, a lab that does what Ale described would survive the market.