How much time per case?

[elperro]

Just wondering how long it takes, on average, to make a diagnosis on a slide once it comes to your desk on a tray (general path, not derm). I mean, there may be special stains to order, new slides to make, looking stuff up in books etc. How much of the time do you just look at it and say AH HA, I know this one!

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[yaah]

The majority of the time the case can be completed in under a minute, to be honest. Most cases are one block (one slide, or two if there is a level). GI, for example, most cases are either various types of polyps or "no significant abnormality" medical biopsies.

Special stains are not ordered very often, but if so, it just delays the case a day or so, doesn't really increase the time otherwise all that much. As residents, we look up lots of stuff while previewing, but attendings, particularly on specialty signout, rarely go to books except for the bizarro cases.

My general gestalt as a 2nd year resident is to look at every case and immediately (within 5 seconds) get an impression, which I then try to confirm or reject based on further examination. It's amazing how often first impressions are right on. But I also spend more time than senior residents or attendings trying to figure out what everything on the slide means, so it isn't that rapid.

 

[LADoc00]

anyone ever sign out more than:
1.) 200 surgicals
or
2.) 40 bone marrows
or
3.) 250 pap smears

in a day??

 

[b&ierstiefel]

anyone ever sign out more than:
1.) 200 surgicals
or
2.) 40 bone marrows
or
3.) 250 pap smears

in a day??

No.

That's insane, man!

 

[deschutes]

anyone ever sign out more than:
1.) 200 surgicals
or
2.) 40 bone marrows
or
3.) 250 pap smears

in a day??

Are those your professional goals?

 

[LADoc00]

Are those your professional goals?

Alleged record (unofficial) for bone marrows with flow cytometry signed out in a single day is 42, done by a fellow at MD Anderson in 1990s. I fell 6 short of that a few years back.

The unofficial endurance sign out record is 1100 surgical cases over 72hours, done at the AFIP by a single faculty member, supposedly he ate while signing out, never left the scope, cat napped and took only 2 hours total of breaks. My personal best is 150 surgicals (not biopsies) signed out in just over 10 hours, nowhere even close to the worlds best.

For a year, supposedly (hearsay, like 3rd hand), a dermatopathologist in Germany signed out over 50,000 biopsies in a 12-month period. I believe that is more than Bernie Ackerman's US record, but Im not sure.

 

[PathOne]

Don't know how many Bernie and his sidekick, Geoffrey Gottlieb, has signed out in a year, but its a lot. I know a couple of (very, very good) dermpaths who routinely sign out 250 cases daily. Conversely, I also know people who sign out 60 on an average day.

 

[PathOne]

oh, and on a similar note: I remember, as a green Resident, that I was very impressed by several attendings that would never employ the slide-holders on their 'scopes, but just put the slide in place, hold it for a couple of seconds, and then provide their verdict. I was amazed, but with experience it's absolutely doable. When you have your morphology down cold, the majority of stuff is pretty easy, as noted by Yaah. Then, of course, there's always the real conundrums, that can be really painful, even to the most experienced pathologists in the world. Essentially, those cases often end up with a dx that's an educated guess.

 

[pathdawg]

Most experienced people can comfortably do a tray of endoscopic biopsies (20 slides per tray) in 20-25 minutes, easy. At most commerial labs, they want 100 slides (not necessarily cases) read in a day (one case can have multiple parts). So, 100 slides=5 trays. This should take less than 2.5 hrs. if you're efficient.

 

[LADoc00]

Most experienced people can comfortably do a tray of endoscopic biopsies (20 slides per tray) in 20-25 minutes, easy. At most commerial labs, they want 100 slides (not necessarily cases) read in a day (one case can have multiple parts). So, 100 slides=5 trays. This should take less than 2.5 hrs. if you're efficient.

The commericial labs I dealt with were more in the 125 cases/day range. In terms of say pure GI or derm biopsies, assuming I had no other attendant duties (which is almost never the case), that would take me about 5 hours, maybe more. But then again I havent done a real fellowship in either.

 

[PathOne]

Daily case load is very much depending on the job function, and not only the speed of the individual pathologist. Obviously, if you only read very specific slides (Derm, GI, Uro, whatever) and can sit at your scope all day, without worrying about training residents/fellows etc., not supervise grossing etc., you can obviously read a lot more than if you have to emulate an octopus and do many different things every day... For some, 100% scope time would be a nightmare. For others it would be fine.

 

[b&ierstiefel]

The commericial labs I dealt with were more in the 125 cases/day range. In terms of say pure GI or derm biopsies, assuming I had no other attendant duties (which is almost never the case), that would take me about 5 hours, maybe more. But then again I havent done a real fellowship in either.

That's not a bad gig but I'm sure you have more stuff to do during the day. How many slides do you have to usually look at in a given day, on average?

Hmm...private practice sounds more and more appealing with every passing moment.

 

[LADoc00]

That's not a bad gig but I'm sure you have more stuff to do during the day. How many slides do you have to usually look at in a given day, on average?

Hmm...private practice sounds more and more appealing with every passing moment.

Right now?? I look at about 4 trays a day which occasionally I can get done in about an hour-90 minutes. I spend another hour or so rereading reports, maybe an 30-60minutes reading WHO books, Wheedon or other such tomes of knowledge. 90 minutes grossing. Maybe 60 minutes dealing with CP/management.

For a total of 5-6 hours of core stuff/day. If I do a bunch of frozens, maybe more. Then the last 2 hours or so are filled up with BSing around coffee, checking emails, IMing with the GF, reading the newspaper, lunch with the med staff and conferences and of course posting here.