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Is a fellowship in molecular pathology worth it ??

Discussion in 'Pathology' started by ravisingh007, Jul 12, 2017.

Molecular pathology has good future

Poll closed Oct 10, 2017.
  1. yes

    6 vote(s)
  2. no

    8 vote(s)
  1. ravisingh007

    ravisingh007 2+ Year Member

    Mar 7, 2013
    will molecular pathology be a feild that is dominated by phd people as they chrage less or people with pathology degree will be preffered in the future .what are the present pay scales comapred to other fellowships in pathology .

    what do you all think the future would be ?

    if its a waste in your opinion then what other fellowships whould one consider .

    and is it wise to do two fellowships molecular plus one more

    plz help with your valuable opinion .i am very confused

    does fish and pcr still have relevance in light of ngs or will it become obslete in future
    dr.z and VenuSN like this.
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  3. AZpath

    AZpath 5+ Year Member

    Nov 1, 2012
    Unlikely that PCR and FISH will be obsolete.
    PHD's don't understand medicine, you do.

    This likely the biggest growth area in the next thirty years. Those with real training will do well.
    gbwillner likes this.
  4. Path or bust

    Path or bust I like meat 10+ Year Member

    Jan 16, 2008
    It certainly will be minimized by NGS.
  5. coroner

    coroner Peace Sells...but who's buying? Physician 10+ Year Member

    Aug 3, 2007
    22 Acacia Avenue
    Define by what you mean “good” future in your poll? Do you mean testing will be more prevalent? Fellowship training will get you the big bucks? Pathologists will capture a market which may go to PhD’s improving the demand for our field in general? Or patient’s will benefit with meaningful information to give a better clinical profile of their disease process to allow clinicians to provide better tx and prognostic information?

    In regards to reimbursement for molecular tests, the future is uncertain. There are CPT codes out there; however, the rates have yet to be finalized for NGS and other emerging molecular tests as these are still relatively new.

    You can bet reimbursement rates will drive who gets to interpret these like most testing in medicine. Word on the street is that the professional won’t be that high, so don’t be surprised if it goes the way of PhD’s.

    Sales reps are trying to push their equipment e.g. Illumina’s MiSeq into whatever markets they can and hospitals say they don’t have a molecular pathologist to interpret the results, but I’m not so sure a fellowship would be necessary for it. Remember these companies are trying to sell a product. It’s difficult to say how prevalent your average mid-size community hospital will need them in the future.

    That being said, there will be an uptick in the utility and frequency of molecular testing taking place. I don’t think it will be as centralized as EM or flow which have become obsolete at small community hospitals. On the other hand, it won’t be as ubiquitous as IHC either.

    As far as fellowships, I think a combo of heme+molecular would be a home run. Molecular only and heme only will certainly give you opportunities, but the two of them complement each other and gives a pretty unique skillset that few have. Besides, 50% of graduating residents are doing two fellowships anyway, so why not do something that makes you stand out more than…say surg + cyto (still useful though).

    Lastly, FISH and PCR will absolutely be relevant even with the burgeoning molecular field. NGS and molecular arrays are imprecise for detecting balanced translocations and only measure DNA/RNA whereas FISH targets specific chromosomes and can detect balanced translocations more specifically. Think of it like IHC 40 yrs. ago: a lot of people thought histopathology would become obsolete and all these new stains would be the wave of the future. It certainly was a game-changer but it acted as an adjunct to morphology, not a replacement. Much as molecular testing will be used as an adjunct to come up with a patient’s clinical profile; though, and not a replacement either.
    Last edited: Jul 13, 2017
    bauber likes this.
  6. bauber

    bauber Pathology yo 5+ Year Member

    Jun 20, 2011
    I'm doing a molecular fellowship next year and I'm currently in a sub specialty surgpath fellowship. I've been told this is a wise combination and it's also what I want to do because DNA sequencing and DNA science is cool as hell. Heme + molecular is another wise combo as coroner said.

    There is no doubt molecular is growing and will continue to grow. The press talks a lot about 'personalized medicine', which is a somewhat silly term, but targeted therapies are absolutely the way a big part of cancer care is heading. Infectious disease testing already has a molecular component and as prices of these tests go down, adoption will go up. I was at the international AMP meeting in Berlin in April and there is no indication molecular is slowing down. I have limited knowledge on this subject, but reimbursements for molecular tests are not great right now but again volume of testing is only going to increase over time. Major cancer centers will all certainly have some level of molecular testing, but I think it remains to be seen if medium sized and smaller hospitals or even private practice (big groups) will adopt molecular. Costs for building a molecular lab and implementing testing have to go down first for that to happen.

    There will be many research opportunities in molecular in the coming years as well. Whole genome and whole exome sequencing are taking off in that area.

    I don't think the field is going to fizzle out any time soon.
  7. octopusprime

    octopusprime Physician

    May 6, 2016
    Currently unless your volume justifies it, owning a molecular lab is too expensive to overcome...if you're doing enough HPV testing, tumor marker testing, etc, you can probably operate in the black but next gen is what's going to be the money maker in the future, problem is guessing when to jump on board...there's just too few platforms now, they're really expensive, and the data they produce are --currently-- not usually diagnostic but rather prognostic. I think there needs to be a critical mass of disease-altering immunotherapies and drugs on the market to warrant en mass testing, until then it's just going to be PCR and FISH testing, particularly when IHC is being used as adequate means of testing (HER2, PD-L1, ALK, ROS1 etc...) with molecular methods serving as backups or confirmatory only.
  8. LADoc00

    LADoc00 There is no substitute for victory. 10+ Year Member

    Sep 9, 2004
    There is a huge difference between a field with growth potential and a field in which you yourself can make money from being an expert in it.

    1.) yes molecular is a growth field
    2.) no doing a fellowship in it is not good because there is really no way for pathologists to capitalize on this and most consultant type roles in biopharma are total trash gigs unless you also plan on getting an MBA and actually running things
    pathslides likes this.

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