Is there any point to NP?

[dermpathlover]

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I know there is a point to NP, but is there any point for your average resident in learning NP. NP tumors rarely ever metastasize. People with brain tumors go to academic centers to have them treated. Community practice neurosurgeons tend to stick to doing backs as that is where the $$$$$$$$ is (supposedly N-surgs in the middle of nowhere can make 1-2 million a year).
Lastly if a brain tumor does make its way into to community practice, you might as well just send it out. They take forever and you ain't going to make much more than if you were looking a colon biopsy.

So is NP like eye path and oral path where there is really no point in your typical path resident learning it?

 

[LADoc00]

I know there is a point to NP, but is there any point for your average resident in learning NP. NP tumors rarely ever metastasize. People with brain tumors go to academic centers to have them treated. Community practice neurosurgeons tend to stick to doing backs as that is where the $$$$$$$$ is (supposedly N-surgs in the middle of nowhere can make 1-2 million a year).
Lastly if a brain tumor does make its way into to community practice, you might as well just send it out. They take forever and you ain't going to make much more than if you were looking a colon biopsy.

So is NP like eye path and oral path where there is really no point in your typical path resident learning it?

Yes there is a point to learning almost everything. That said, I cherry pick good jobs based on whether the hospital has an active neurosurgical service. NS really really bites for pathologists. They are often of the mindset they want a frozen section on EVERYTHING regardless of whether it modifies their treatment intraoperatively. And for those who have ridden the monster, neurosurgical frozens are as hard as hell. By far my least favorite specimen. I have seen a whole team of pathologists all with >20 years of experience go down like little biotches on neurosurg cases where the edge of an infarct has been biopsied or where there is a rare oddball diagnosis, usually infectious (West Nile comes to mind).

LADOC's to avoid list:
1.) Groups that serve active neurosurgical units, they can add mountains of stress, after hours on call frozen sections and are a source of almost no income. You have to accept you are being bent over simply as a courtesy to the community. On top of that, almost every tumor diagnosis will be sent out for second opinion anyway! That is the true irony, you bust your balls to make the call and the case ends up going to Scheithauer-type at Mayo who cracks your nuts into jelly sauce by nitpicking your diagnosis and comment.
2.) Any sort of high volume trauma center, once again these usually have active NS units as well as being a huge source of after hours on call BS through the transfusion service.
3.) Any place with a transplant unit, once again stressful on call BS to deal with and essentially no pay.

...thats for starters

 

[dermpathlover]

Yes there is a point to learning almost everything. That said, I cherry pick good jobs based on whether the hospital has an active neurosurgical service. NS really really bites for pathologists. They are often of the mindset they want a frozen section on EVERYTHING regardless of whether it modifies their treatment intraoperatively. And for those who have ridden the monster, neurosurgical frozens are as hard as hell. By far my least favorite specimen. I have seen a whole team of pathologists all with >20 years of experience go down like little biotches on neurosurg cases where the edge of an infarct has been biopsied or where there is a rare oddball diagnosis, usually infectious (West Nile comes to mind).

LADOC's to avoid list:
1.) Groups that serve active neurosurgical units, they can add mountains of stress, after hours on call frozen sections and are a source of almost no income. You have to accept you are being bent over simply as a courtesy to the community. On top of that, almost every tumor diagnosis will be sent out for second opinion anyway! That is the true irony, you bust your balls to make the call and the case ends up going to Scheithauer-type at Mayo who cracks your nuts into jelly sauce by nitpicking your diagnosis and comment.
2.) Any sort of high volume trauma center, once again these usually have active NS units as well as being a huge source of after hours on call BS through the transfusion service.
3.) Any place with a transplant unit, once again stressful on call BS to deal with and essentially no pay.

...thats for starters

Now that's real advice.

However, do frozens pay well? I think it would be great to work at a place that has busy ENT where they do 20 frozens on one case. That's ching ching ching ching!

 

[LADoc00]

Now that's real advice.

However, do frozens pay well? I think it would be great to work at a place that has busy ENT where they do 20 frozens on one case. That's ching ching ching ching!

Frozen sections are more stress and less pay than typically biopsies or surgical cases. In the grand scheme of things, unless you seriously GAME it, meaning when you get a frozen you:
1.) Bill for frozen section
2.) Do a cytologic prep and bill for that as well
3.) Bill for specimen
they arent worth it IMO. Best to stick to less risky diagnoses from permenant sections. Realize you need to balance risk vs. reward. In this model, unless the situation is optimal, frozen sections really lose.

The reimbursement for a frozen is so much less, it makes me wonder what a place like Mayo do for billing. Do they bill for both a frozen AND a surgical on every case? Or just one of those?? I cant see insurance companies letting them get away with double billing everything just because its the Mayo way....

 

[yaah]

1.) Groups that serve active neurosurgical units, they can add mountains of stress, after hours on call frozen sections and are a source of almost no income. You have to accept you are being bent over simply as a courtesy to the community. On top of that, almost every tumor diagnosis will be sent out for second opinion anyway! That is the true irony, you bust your balls to make the call and the case ends up going to Scheithauer-type at Mayo who cracks your nuts into jelly sauce by nitpicking your diagnosis and comment.

If that happens, you send it to JHU and Berger because the two of them disagree on everything anyway.