If you could re-do your post-residency career path, would you choose the same fellowship(s)?

[ThatSerb]

If you could re-do things with the knowledge you have now, would you pick the same fellowships you chose in the past? Why or why not?

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[WEBB PINKERTON]

I guess I would pick the same fellowship but it was a different era. I wouldn't do a fellowship in cytopathology today. Back a few decades ago, it wasn't a dying field.

 

[icpshootyz]

I'd do dermpath again in a heartbeat. I might have preferred to do my dermpath fellowship somewhere else, but I love what I do every day and couldn't be much happier in my current job.

 

[deleted314957]

for the older folks here, fellowships were not a common thing, particularly
in a non-academic pp setting (for perspective i was a 1977 grad from
med school). and then it was derm , heme, forensic and cyto. LOTS of
people were able to “grandfather” into boards. Just claim appropriate
experience, take and pass the test and, bingo. You could get a slew
of them. i knew folks with 3 and 4 boards beyond AP/CP. All of the chemistry and med micro folks i’ve known got in without a fellowship from the old days. Now they limit the number
of boards one can have.

 

[Unty]

I guess I would pick the same fellowship but it was a different era. I wouldn't do a fellowship in cytopathology today. Back a few decades ago, it wasn't a dying field.

Why is cytopathology a dying field?

I was told that you can learn it on the job and there's no need to do a cytopath fellowship.

 

[Euchromatin]

Not sure that 3 years in practice is really long enough to do a serious retrospective look, but, yes, I would pick the same fellowship again - both the specialty and the institution. I did a "niche" AP organ system, non-boarded fellowship and got a job with a large private practice group with mostly general surg path sign out, which is precisely the practice setting I desired. I also had other interviews (and regularly see/hear about job postings) for those with my expertise from academic centers and occasionally large private groups as well, although certainly not as many postings as the more bread-and-butter fellowships like heme, derm, GI, etc. Place I did my fellowship is probably in the top 2-3 in the country in terms of both clinical and pathology prestige for that specialty (although, to be fair some of the more "niche" fellowships aren't offered at all that many places to begin with). Funnily enough I tend to get more praise/recognition regarding where I trained from surgeons/clinicians I work with than from path colleagues.

Cytopath is dying because pap test volumes are significantly declining due to HPV testing/guidelines recommending less frequent testing and presumably will continue to do so as cervical carcinoma becomes less common due to HPV vaccination (hopefully).

 

[LADoc00]

Cytopath used to part of the big 3: Heme, Derm & Cyto that most groups kinda expected you to have if you werent some surgical path whiz kid who trained at WashU, Stanford or JHU etc. but obviously that changed with Gardasil and the decreased reliance on cytomorphology in favor of molecular assays for HPV directly. Aside from Gyn cyto, the market for thyroid, body fluid, pulmonary and GI cytology is so slim nowadays I dont think it still warrants being part of the Big Three, now the Big Two.

 

[deleted314957]

I don’t know about y’all but I never thought a cyto fellowship
offered anything if one had a good background in residency.
In fact the intervention rads i worked with preferred me
to the cyto trained folks at the local “mecca” and I sure as hell
have never been anywhere near the Karolinska Institute! Certainly
there are cases that demand consultative expertise like anything.
I also think most community hemepath is ( or should be) within the preview of
generalists. However, that was a while ago and when I left it was
getting distinctly less common for folks like me to look at marrows.
Again, consult appropriately.

 

[LADoc00]

Once the Game changed from "What is the diagnosis?" to "What are the actionable mutations?", Cytology as a discipline was doomed. Gone are the days where lung cancer (or any organ system carcinoma) diagnoses could even be entertained solely on the basis of cytology and once that paradigm shift occurred, interventional radiologists made the shift from stat cytologic assessement to submitting core samples with the oncologists waiting on mismatch repair enzyme status, PDL-1, hormone status, ALK-1, RAS etc etc.

As molecular oncology moves forward, cytology dies a little each day. One day it will be filed alongside "Chemical Pathology" in the ABP subpec testing menu.

Students and residents dont realize at one point in our history "Chemical Pathology" was the predominant income source for Pathology groups, hence why it exists as a boarded exam. For many, many groups in the 70s "Chemical Pathology" practice income exceeded the income for ALL anatomic subspecs COMBINED. Times change, reimbursement change and I would guess very few of you have even met someone under 60 who has a cert in "Chemical pathology".