Mayo Pathology?

[Selectin-Man]

I've always wondered about the Mayo pathology residency program, but I've rarely seen any mention of it on these boards. My older brother did his internal medicine residency at Mayo Rochester, and he seemed to think that their pathology residency might be strong. But that's an opinion based on limited info.

Does anyone have any information or opinions about the Mayo (Rochester) program??

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[LADoc00]

I've always wondered about the Mayo pathology residency program, but I've rarely seen any mention of it on these boards. My older brother did his internal medicine residency at Mayo Rochester, and he seemed to think that their pathology residency might be strong. But that's an opinion based on limited info.

Does anyone have any information or opinions about the Mayo (Rochester) program??

Now, back in the day, aside from consults ALL Mayo pathology was done in a frozen section format. Anyone know what the scoop is now?

I think for the most part people avoid Mayo, but the reasons have always been murky. I know their best pathologists (Colby etc) are NOT at the Rochester lab, so that is one indicator. Overall, my personal slant is that Mayo lost alot of its luster in 90s in general.

 

[Napoleon1801]

Now, back in the day, aside from consults ALL Mayo pathology was done in a frozen section format. Anyone know what the scoop is now?

I think for the most part people avoid Mayo, but the reasons have always been murky. I know their best pathologists (Colby etc) are NOT at the Rochester lab, so that is one indicator. Overall, my personal slant is that Mayo lost alot of its luster in 90s in general.

I was up there this summer and they bragged alot about how they did all frozen section.

 

[yaah]

Now, back in the day, aside from consults ALL Mayo pathology was done in a frozen section format. Anyone know what the scoop is now?

I think for the most part people avoid Mayo, but the reasons have always been murky. I know their best pathologists (Colby etc) are NOT at the Rochester lab, so that is one indicator. Overall, my personal slant is that Mayo lost alot of its luster in 90s in general.

Myers and Visscher left and are now at Michigan too.

We had a lot of discussion on this thread about 2 years ago about Mayo - it shouldn't be that hard using the search function to find the posts. There were discussions about their way of business.

But yes, everything that comes out of the OR is done as a frozen section - different types of frozen section though, they use liquid nitrogen (I think), and cut thicker sections, which are stained with Toluidine Blue only. Everything is signed out that day. Permanent sections come out the next day but they are only really lightly reviewed, just to confirm. The only time diagnoses are changed is if there is a major discrepancy (i.e., permanents show 1/10 lymph nodes positive instead of 0/10).

Mayo has a different way of doing things, and IMHO the residents come out well trained and qualified to practice elsewhere, but at the same time the residents in the program don't have a ton of responsibilities - the fellows have a lot more. Residents barely even take AP call (if any). To me it seems as though your diagnostic skills would suffer a bit, but I suppose that's debatable. They still do see small biopsies, etc, as per the normal routine. Plus, you see lots of transfer cases coming in as every patient seen at mayo has to have their path from prior hospitals reviewed there.

There are a lot of great attendings there (Unni, Lloyd, Smyrk, Cheville, etc) but it's different from a traditional academic center - you seem to have less contact with them.

 

[djmd]

I've always wondered about the Mayo pathology residency program, but I've rarely seen any mention of it on these boards. My older brother did his internal medicine residency at Mayo Rochester, and he seemed to think that their pathology residency might be strong. But that's an opinion based on limited info.

Is it true that they wear Suits all the time instead of a white coat plus shirt and tie?? That would be crazy!

 

[yaah]

Is it true that they wear Suits all the time instead of a white coat plus shirt and tie?? That would be crazy!

Now that is true. Although usually the jacket is hanging on a chair or something. There is some rule at Mayo that you can't be on floors or clinics unless you are wearing scrubs, and if I remember right there are separate hallways, stairways, elevators, etc, for people wearing scrubs as opposed to patients.

 

[LADoc00]

Now that is true. Although usually the jacket is hanging on a chair or something. There is some rule at Mayo that you can't be on floors or clinics unless you are wearing scrubs, and if I remember right there are separate hallways, stairways, elevators, etc, for people wearing scrubs as opposed to patients.

They wear SUITS? Full suits to residency?? B.S., no way. That place is freaky, avoid it at all costs.

I also heard you have make certain sacrifices to Kali to progress to be a PGY-II and of course the legendary "Hot Probe" Rite of Initiation. I heard someone who interviewed there mention "bukakke" but Im not really sure what that means, maybe it was the sushi they served at the interview lunch.

 

[pathstudent]

They wear SUITS? Full suits to residency?? B.S., no way. That place is freaky, avoid it at all costs.

I also heard you have make certain sacrifices to Kali to progress to be a PGY-II and of course the legendary "Hot Probe" Rite of Initiation. I heard someone who interviewed there mention "bukakke" but Im not really sure what that means, maybe it was the sushi they served at the interview lunch.

It is true. All the med students have to wear suits too. What a stupid place. It is not like you are in NYC on the upper east side or Cedars Sinai in Beverly Hills, you are in frickin' nowhere Minnesota.

 

[b&ierstiefel]

They wear SUITS? Full suits to residency?? B.S., no way. That place is freaky, avoid it at all costs.

I also heard you have make certain sacrifices to Kali to progress to be a PGY-II and of course the legendary "Hot Probe" Rite of Initiation. I heard someone who interviewed there mention "bukakke" but Im not really sure what that means, maybe it was the sushi they served at the interview lunch.

Wow! Suits?

BTW, you spelled "bukakke" wrong.

Go eat some eggrolls.

Bye.

 

[djmd]

BTW, you spelled "bukakke" wrong.

Go eat some eggrolls.

Bye.

Bwahahaha... Type of sushi they served at lunch...

Wow I do NOT want to interview there!

 

[MWRTER]

It is true. All the med students have to wear suits too. What a stupid place. It is not like you are in NYC on the upper east side or Cedars Sinai in Beverly Hills, you are in frickin' nowhere Minnesota.

Shirt, tie and sport coat do not equal suit - a suit you cannot or at least should not mix and match - although some of the really old time surgery attendings may wear dark suits all the time - that is not the dress code now. On rounds and clinic - the dress code is a coat and tie instead of white coat and tie - but it is definitely not a suit. I think the patients appreciate the professional attire in clinic. One is allowed to wear scrubs when on call, on the floors post call, and the frozen section suite. I don't understand what is "freaky" about this standard - I think the dress code makes the whole hospital staff appear professional. You guys seem to rag on the Mayo path department based on very limited information - kind of like the Bush adminstration going to war with Iraq on very little and suspect data. The Mayo clinical pathology labs is a nationwide reference lab - they have specific senior techs assigned to teach the residents/rotating students about the laboratory techniques and are very knowledgeable about the underlying theory of the various techniques. The transfusion medicine department is very strong - Mayo collects a large percentage of the blood products from the population of Rochester and are aggressive at recruiting and retaining a stable donor pool. There is a very active plasma exchange component to transfusion medicine as well. They are at the forefront of developing molecular diagnostic tests for microbial pathogens. So if you are at all interested in exploring the CP part of your AP/CP training or are not interested in reading Henry cover to cover, this aspect of Mayo path should be a consideration. The AP service is very busy and one does see a large variety of cases - although a drawback is that everything is frozen - but if you are a resident who likes to read rather than gross to 6,7,8 at night or preview to midnight, having everything signed out at frozen section might be an advantage - at least you get to go home at 5-6 at night (btw, a resident can buy a nice house in Rochester on a resident's salary and still live very comfortably). For the most part - Mayo is very collegial and has a friendly environment that values education over service. Unlike in some institutions, pathologists are still very highly regarded and respected by the clinicians at Mayo. The only really terrible part about Mayo is the city of Rochester - it is a very safe, cold, boring town/city with good schools - nice place to raise a family. The twin cities - 70 miles north is a very liberal/cosmopolitan city. I hope this post gives a more balanced critique of the Mayo program.

 

[LADoc00]

Shirt, tie and sport coat do not equal suit - a suit you cannot or at least should not mix and match - although some of the really old time surgery attendings may wear dark suits all the time - that is not the dress code now. On rounds and clinic - the dress code is a coat and tie instead of white coat and tie - but it is definitely not a suit. I think the patients appreciate the professional attire in clinic. One is allowed to wear scrubs when on call, on the floors post call, and the frozen section suite. I don't understand what is "freaky" about this standard - I think the dress code makes the whole hospital staff appear professional. You guys seem to rag on the Mayo path department based on very limited information - kind of like the Bush adminstration going to war with Iraq on very little and suspect data. The Mayo clinical pathology labs is a nationwide reference lab - they have specific senior techs assigned to teach the residents/rotating students about the laboratory techniques and are very knowledgeable about the underlying theory of the various techniques. The transfusion medicine department is very strong - Mayo collects a large percentage of the blood products from the population of Rochester and are aggressive at recruiting and retaining a stable donor pool. There is a very active plasma exchange component to transfusion medicine as well. They are at the forefront of developing molecular diagnostic tests for microbial pathogens. So if you are at all interested in exploring the CP part of your AP/CP training or are not interested in reading Henry cover to cover, this aspect of Mayo path should be a consideration. The AP service is very busy and one does see a large variety of cases - although a drawback is that everything is frozen - but if you are a resident who likes to read rather than gross to 6,7,8 at night or preview to midnight, having everything signed out at frozen section might be an advantage - at least you get to go home at 5-6 at night (btw, a resident can buy a nice house in Rochester on a residents salary and still live very comforyably). For the most part - Mayo is very collegial and has a friendly environment that values education over service. Unlike in some institutions, pathologists are still very highly regarded and respected by the clinicians at Mayo. The only really terrible part about Mayo is the city of Rochester - it is a very safe, cold, boring town/city with good schools - nice place to raise a family. The twin cities - 70 miles north is a very liberal/cosmopolitan city. I hope this post gives a more balanced critique of the Mayo program.

Uhoh...you arent Dr. Fidler are you??

http://www.mayo.edu/msgme/anatomicpath-r-welcome.html

Mayo is coming after me now!

Yaah use your mod powers to track the IP address of that poster....I suspect its somewhere in Minn....

 

[Selectin-Man]

I'm very curious to find out more about the Mayo pathology residency. I'm a 5th year MD/PhD student, and I'm the type that would prefer to spend more time reading and likely will want to be involved in research--if time permits.

But honestly, I'm a little ignorant about how a path lab operates and why it's such a disadvantage to exclusively do frozen sections. Could someone tell me more about why this is such an issue?

 

[LADoc00]

I'm very curious to find out more about the Mayo pathology residency. I'm a 5th year MD/PhD student, and I'm the type that would prefer to spend more time reading and likely will want to be involved in research--if time permits.

But honestly, I'm a little ignorant about how a path lab operates and why it's such a disadvantage to exclusively do frozen sections. Could someone tell me more about why this is such an issue?

Dont ask Yoda why the force is good, it just is bro. Diagnosing by pure frozens is crazy, doesnt give you time to think about your report and even do much immuno work. I cant possibly believe they are that good on frozen to nail most diagnoses. I bet they sign alot out like "Malignant, could be carcinoma but you know what, we only did a frozen so it could be melanoma."

 

[MWRTER]

I'm very curious to find out more about the Mayo pathology residency. I'm a 5th year MD/PhD student, and I'm the type that would prefer to spend more time reading and likely will want to be involved in research--if time permits.

But honestly, I'm a little ignorant about how a path lab operates and why it's such a disadvantage to exclusively do frozen sections. Could someone tell me more about why this is such an issue?

Freezing tissue introduces artifacts that "ruin" the histology and thus makes diagnosis more difficult. Mayo does defer difficult cases and may have to go back to the specimen for more sampling - but the surgeons seem to like the short turn around time of the frozen section diagnosis. It is not a perfect system. However, good diagnostic skills in frozen section specimens and correctly/artfully communicating your impression to the surgical staff is an integral function/stressful aspect of the anatomic pathologist's job - so it is good to get a significant amount of exposure to frozen section diagnosis.

Wow, you have a big decision coming up in a couple of years. Having a MD-PhD will make you a very "hot" commodity - most of the high powered academic programs will want you because of your potential to move the field of pathology and medicine forward - physician scientists are a dying breed because of greed. Three basic options are open to you: private practice pathology, academic pathology, and/or experimental pathologist. Being an MD-PhD, you can pursue any of these three very easily - each has a disadvantage depending on what your goals are. If you decide upon the last two options you won't be making bank like LADoc, but you will probably be contributing to the advancement of medicine/pathology. If you decide private practice - you'll probably have a decent life style. I would choose the residency that you feel most comfortable in and is in a location that you are happy being in - definitely take advantage of a second visit and get to know the residents during interviews. Most of the academic centers have enough material for you to learn bread and butter anatomic pathology (breast, prostate, thyroid, colon etc). However, if you plan to live and work on either the west coast or east coast - I would choose to go to a well known residency on either coast - pathology is a small field and jobs are often spread word of mouth, chairman to chairman and having connections is good. Hope this helps.

 

[Selectin-Man]

Very helpful. Thanks a lot!

 

[djmd]

You guys seem to rag on the Mayo path department based on very limited information - kind of like the Bush adminstration going to war with Iraq on very little and suspect data.

OHHHHH BURN!!!

 

[Patholog]

I've always wondered about the Mayo pathology residency program, but I've rarely seen any mention of it on these boards. My older brother did his internal medicine residency at Mayo Rochester, and he seemed to think that their pathology residency might be strong. But that's an opinion based on limited info.

Does anyone have any information or opinions about the Mayo (Rochester) program??

I know that residency in path at Mayo is organized quite differently than most other programs, mainly for a reason listed above (frozen section only). That being said, their fellowships are extremely strong, especially surg path (I am somewhat biased, as I will be doing my surg path fellowship there). One thing that might be mentioned is that they make H&E cuts at the time of frozen section (they cut a thick section en face of chilled tissue, not frozen, of what will be their frozen section slide, sink it in formalin and process it regularly). Then the fellow who looked at the frozen will look at the regularly-processed material the next day as a form of Q&A and make any necessary adjustments to the final report. Now, I have not started there yet, but that is my understanding from what I was told during my interview. Needless to say, the big things that need to be addressed at the time of surgery (margins, is this cancer or not, etc) are likely addressed accurately at the time of frozen and the other stuff (receptor status, precise immunoprofile) are dealt with off the H&E.

They do have excellent facilities with exceptional staff (same-day immunos for one) and excellent staff. Yeah, some of the older famous people are not there any more, but people they trained are. You can't live forever. One thing I had heard before I went there for interview is that Mayo is great for fellowships. I was told flat-out by one of the fellows there that some people elect to do their residency there so that they will have a foot in the door for the surg path fellowship.

Take that for what it is worth, compile all of the replies you receive and make the best decision about residency you can for you.

 

[Andrea17]

All I know is the most competitive surg path fellowship. It's very difficult to get that fellowship... even for the inside people.

 

[LADoc00]

All I know is the most competitive surg path fellowship. It's very difficult to get that fellowship... even for the inside people.

Most competitive? I see...

Im sure Mayo is good. Im sure you will see a reasonable number of interesting cases, maybe even Unni-class bone tumors. To each his own. If I had a infinite amount of time and lived forever, I might even spend a year in Rochester just to see what it's all about, but lets not throw around superlative phrases like "most competitive" because they are just plain incorrect. If getting a surg path fellowship is at all difficult for the inside people at Mayo, it is most likely their lack of English fluency.

There, Ive said my peace about this matter.

 

[DarksideAllstar]

If getting a surg path fellowship is at all difficult for the inside people at Mayo, it is most likely their lack of English fluency.

There, Ive said my peace about this matter.

I never understood why they put the hospital in Rochester. Why the hell couldn't they have set it up in Minneapolis?

 

[jayman]

I never understood why they put the hospital in Rochester. Why the hell couldn't they have set it up in Minneapolis?

From what I recall, the Mayo brothers' dad (also a doc) practiced in the town of Rochester and when some sort of a natural disaster occurred, everyone realized a hospital was necessary. He helped to set up St. Mary's Hospital (now part of Mayo). Rochester was a big train hub back in the day connecting the East and the West, so it made sense that that's where the hospital should be. The kids (Chuck and Will, I believe) helped to take over/expand what dad had done.

Feel free to correct me if I'm wrong on any of these points.

 

[Patholog]

One thing that I was told as to why the Clinic is in Rochester is for the sheer fact that it was isolated. Travel obviously was much more difficult at the time of the Clinic's founding (escpecially in MN winters). People would work more if they were isolated, instead of frolicking at the riverside. The isolation is not so much of an issue now thanks to modern transportation, but that it what I was told.

When I interviewed, I met one person there who could not claim English as their native language (Italian staff member). Even the Candadians were not French Canadians.

I think Mayo was certainly one of the more competitive fellowships for "outsiders" when five years of residency were still required, as a lot of people did their fifth years in Surg Path, and the natural choice (and path of least resistance) was to do fellowship at your own program, if they were good enough. Now that the fifth year is out, I think more people are electing to do true fellowships in other things, opening up more slots for outsiders.

That being said, Mayo has 9 fellowship slots/year for Surg Path. They filled 3 before outside interviews even began, and I think they interviewed around 25 people for the remaining six slots. You may decide for yourself if that is competitive.

 

[LADoc00]

One thing that I was told as to why the Clinic is in Rochester is for the sheer fact that it was isolated. Travel obviously was much more difficult at the time of the Clinic's founding (escpecially in MN winters). People would work more if they were isolated, instead of frolicking at the riverside. The isolation is not so much of an issue now thanks to modern transportation, but that it what I was told.

When I interviewed, I met one person there who could not claim English as their native language (Italian staff member). Even the Candadians were not French Canadians.

I think Mayo was certainly one of the more competitive fellowships for "outsiders" when five years of residency were still required, as a lot of people did their fifth years in Surg Path, and the natural choice (and path of least resistance) was to do fellowship at your own program, if they were good enough. Now that the fifth year is out, I think more people are electing to do true fellowships in other things, opening up more slots for outsiders.

That being said, Mayo has 9 fellowship slots/year for Surg Path. They filled 3 before outside interviews even began, and I think they interviewed around 25 people for the remaining six slots. You may decide for yourself if that is competitive.

I would call that on the low side of competitiveness. Many dermpath programs get over 200+ applications/slot, competitive hemepath programs will get 50-100/slot. Rarely is there much a need to interview more than 3-4 people/slot at a super competitive fellowship, because you know if offered these people will take it. 9 fellowship slots in general surg path is WAY too many. Given that is approximately the number of UCSF(4-5), Stanford (4-5) and UC Davis (1) combined, accounting for an employment area of 18 million people or 4 times the size of the whole state of Minnesota. Even 9 spread between Mayo at Rochester, Arizona and Florida is too many. Ive long said that these huge general AP fellowships at places like MSKCC or MDA are dinosaurs of a bygone era. My opinion is that if you absolutely NEED a surgpath fellowship to do general community pathology, then you were poorly trained as a resident. A fellowship should be developing/refining a specific skill set, not simply repeating residency with a greater caseload/longer hours.

Also from:
http://www.mayo.edu/msgme/anatomicpath-r-residents.html
Mayo only has 3 4th year residents. They couldnt even begin to fill just the general surgpath slots let alone dermpath, hemepath, molecular, GI, transfusion, cytogenetics, clinical biochem, micro, chemistry, pulmonary, neuropath!! 12 fellowships:
http://www.mayo.edu/msgme/labmed-programs.html
that is INSANE. And someone actually mentioned its tough for the inside people to get a fellowship..what crackpipe are you hitting off? They could unload an entire class from Shanghai Medical University and have room to spare.

I know Mayo is a solid place but FFS lets not exaggerate.

/rant over

 

[Patholog]

I would call that on the low side of competitiveness. Many dermpath programs get over 200+ applications/slot, competitive hemepath programs will get 50-100/slot. Rarely is there much a need to interview more than 3-4 people/slot at a super competitive fellowship, because you know if offered these people will take it. 9 fellowship slots in general surg path is WAY too many. Given that is approximately the number of UCSF(4-5), Stanford (4-5) and UC Davis (1) combined, accounting for an employment area of 18 million people or 4 times the size of the whole state of Minnesota. Even 9 spread between Mayo at Rochester, Arizona and Florida is too many. Ive long said that these huge general AP fellowships at places like MSKCC or MDA are dinosaurs of a bygone era. My opinion is that if you absolutely NEED a surgpath fellowship to do general community pathology, then you were poorly trained as a resident. A fellowship should be developing/refining a specific skill set, not simply repeating residency with a greater caseload/longer hours.

Also from:
http://www.mayo.edu/msgme/anatomicpath-r-residents.html
Mayo only has 3 4th year residents. They couldnt even begin to fill just the general surgpath slots let alone dermpath, hemepath, molecular, GI, transfusion, cytogenetics, clinical biochem, micro, chemistry, pulmonary, neuropath!! 12 fellowships:
http://www.mayo.edu/msgme/labmed-programs.html
that is INSANE. And someone actually mentioned its tough for the inside people to get a fellowship..what crackpipe are you hitting off? They could unload an entire class from Shanghai Medical University and have room to spare.

I know Mayo is a solid place but FFS lets not exaggerate.

/rant over

Thank you for your reply.

As I said, you may decide for yourself if that is competitive, and obviously you decided.

Of note, they interviewed 25...I don't know how many applications they dismissed out of hand, but granted, I am sure it is not 200+ by any stretch. However, one must consider that dermatology residents also apply for dermpath.

Also of note (and according to their websites this PM):

Stanford takes 8 residents a year and 6 Surg Path fellows for 39,000 surg path cases (11,000 of which are consults)

UCSF takes 7 Surg Path fellows/year with 32,000 specimens (unclear as to how many are consults) I don't know how many residents they take...

UCD takes 3 residents a year (I couldn't find any more info online as their website was down)

Mayo has >100,000 in house surgicals and 50,000 consults per annum (150,000 cases total at the Rochester campus alone)...they take 5 residents and 9 surg path fellows a year.

Now, I think we are all in agreement that no one can see every case there is, but, if you crunch the numbers...

There is one surg path fellow for every 6,500 specimens at Stanford...

There is one surg path fellow for every 4,571 specimens at UCSF...

There is one surg path fellow for every 16,666 specimens at Mayo Rochester.

But I forgot...those programs you mentioned are all in California, and therefore inherently superior regardless. Just kidding (sort of)

As I said, you can't see all the cases every day, but the more you have, the more you see, and in a referral center such as Mayo, one must expect to see some rather bizarre and complicated cases that will allow you to be comfortable with that much more in practice (and also to better understand your limitations).

In addition, I would not look at the pursuit of a surg path fellowship as a sign of weakness or a poor residency program in every case. I look at it as a function of the huge amount of information one must master in order to serve patients well, whether it be in private practice or in academics (as I am hoping to do). Given the fact that the vast majority of what I plan to do in the future is Surg Path, I feel for me this is a good option.

Thank you for your time...

 

[b&ierstiefel]

Interesting comparison with the number crunching. I would caution though that there are probably a lot of cases where the resident manages the case and not the fellow. Also, the case volume in many places can actually be an underestimate because of the number of consult cases are not completely accounted for in those numbers.

Oh BTW, UCSF takes quite a few residents each year I think. The year I applied, they took a total of 12 or 13, granted a few of them were CP only. I don't feel like doing this now but you can check out the UCSF roster by going to their pathology residency homepage.

In any case, along the lines of what LADoc00 said, I think that surg path fellowships at these powerhouse programs like MSKCC, MD Anderson, Mayo, etc. can serve to level the playing field. To think that every residency program in this country offers adequate surgical pathology training is foolish. So let's say Joe Schmoe goes to a crappy program and doesn't get great surg path training...yeah a one-year surg path fellowship at a place like Sloan or Mayo would be a great thing. But yeah, if you go to a place where your surg path training is respectable, then just stay there and do a surg path fellowship if you think you need it. On that note, I have a feeling that 2 years of AP training is not sufficient enough to go out and practice general surgical pathology.

 

[Patholog]

Interesting comparison with the number crunching. I would caution though that there are probably a lot of cases where the resident manages the case and not the fellow. Also, the case volume in many places can actually be an underestimate because of the number of consult cases are not completely accounted for in those numbers.

Oh BTW, UCSF takes quite a few residents each year I think. The year I applied, they took a total of 12 or 13, granted a few of them were CP only. I don't feel like doing this now but you can check out the UCSF roster by going to their pathology residency homepage.

In any case, along the lines of what LADoc00 said, I think that surg path fellowships at these powerhouse programs like MSKCC, MD Anderson, Mayo, etc. can serve to level the playing field. To think that every residency program in this country offers adequate surgical pathology training is foolish. So let's say Joe Schmoe goes to a crappy program and doesn't get great surg path training...yeah a one-year surg path fellowship at a place like Sloan or Mayo would be a great thing. But yeah, if you go to a place where your surg path training is respectable, then just stay there and do a surg path fellowship if you think you need it. On that note, I have a feeling that 2 years of AP training is not sufficient enough to go out and practice general surgical pathology.

I think at Mayo the cases are more fellow-driven, hence the greater number of fellows than residents. This is in stark contrast to where I am training now, where the residents outnumber the fellows and all non-consult cases are resident (or PSF/extern) driven.

One of the reasons I personally chose Mayo was to simply get a different perspective. The surg path fellowship (and residency) at my program is highly respected around the country, yet I chose to go elsewhere so as to learn from a different group of people and see an arguably greater variety of cases. My program is also a referral center, but not 50,000 cases/year from around the world referral center. I have always had the mindset that one should go to med school at one place, residency at another and fellowship at yet another to get different perspectives. That is just me, and my family is flexible enough to do that, so why not?

See ya...

 

[b&ierstiefel]

I think at Mayo the cases are more fellow-driven, hence the greater number of fellows than residents.

Well, I think this is the reasoning behind previous posts by others that Mayo isn't the best place to go for residency. Well, more cake for the fellows, I guess.

I have always had the mindset that one should go to med school at one place, residency at another and fellowship at yet another to get different perspectives. That is just me, and my family is flexible enough to do that, so why not?

Can't agree with you more. I too have moved around for various stages of my life never having stayed at the same place. That was the primary reason for me to move out after med school and go to a different city (although, I miss A2 a lot and I'll be back very very soon). Of course, let's say that residency is only like 2 years, I don't mind staying a 3rd year for a fellowship at the same place Don't like to move THAT often.

 

[LADoc00]

On that note, I have a feeling that 2 years of AP training is not sufficient enough to go out and practice general surgical pathology.

I will sign out over 8,000 general surgicals this year and have never done a surg path fellowship. Fellowship yes, but not surg path. I agree if all you did was 2 years of AP, but 2 years in a a 4 year program with constant AP exposure+fellowship in a related AP field is MORE than enough. Still, surg path fellowships will never hurt.

Once again tho, Mayo is a great place, I may disagree with their practice style and training philosophy, but Im sure coming from there can *potentially* land you a cherry spot in a the high paying upper Midwest region.

In conclusion tho, there are still WAY the hell too many pathology slots. Somebody needs to do something soon.

 

[LADoc00]

Also of note (and according to their websites this PM):

Stanford takes 8 residents a year and 6 Surg Path fellows for 39,000 surg path cases (11,000 of which are consults)

UCSF takes 7 Surg Path fellows/year with 32,000 specimens (unclear as to how many are consults) I don't know how many residents they take...

Im not doubting the volume Mayo has is high. Maybe its the highest of any academic med center in the US, that wouldnt suprise me.

You are right UCSF is somehow riding with 7 general surg path fellows. That is WAY THE HELL too many for their caseload. Which as a potential employer, makes me apprehensive. To give SF some due, the 32K number is likely just Parnassus, and isnt including the General.(or at least I hope) On a per fellow basis, they are hitting around 4600, while Im doing >8+managing a lab+cytology+autopsy+business crap. You should be rolling AT LEAST 8K/year as a general surgpath fellow IMO.

Now Stanford I hope is still at 5 fellows, which is a respectable 10K/year/fellow at a 50K volume (which is just inside surgicals+surg path consults but also includes derm, which UCSF's numbers certainly do not).

In conclusion, I was merely proposing that Mayo *might* be overtraining but in the end it appears likely UCSF is bigger culprit especially considering the city of SF and Oakland both declined 5% with the last census and the continued expansion of Kaiser. So my bad. G'luck.

 

[dermpathlover]

UCSF parnassus is only a 500 bed hosptial. Could they really be doing 32K surgeries a year there?

HEY UCSF BOUND, What's your accession number at right now for Parnassus?

 

[Patholog]

To give SF some due, the 32K number is likely just Parnassus, and isnt including the General.(or at least I hope)QUOTE]

I found this on UCSF's website today...

"The Division of Surgical Pathology provides a wide range of clinical and consultative services at Moffitt and Mt Zion Hospitals, San Francisco General Hospital, and the Veterans Administration Medical Center in San Francisco."

It doesn't say anything about Parnassus, and I don't know enough about the program to say.

Later...

 

[b&ierstiefel]

To give SF some due, the 32K number is likely just Parnassus, and isnt including the General.(or at least I hope)QUOTE]

I found this on UCSF's website today...

"The Division of Surgical Pathology provides a wide range of clinical and consultative services at Moffitt and Mt Zion Hospitals, San Francisco General Hospital, and the Veterans Administration Medical Center in San Francisco."

It doesn't say anything about Parnassus, and I don't know enough about the program to say.

Later...

I think Moffitt is the main UCSF hospital on Parnassus. Gosh, I should remember this considering it wasn't that long ago when I was interviewing at programs.

Say no to EtOH.

 

[yaah]

(although, I miss A2 a lot and I'll be back very very soon).

Uh oh. You're coming back?

 

[DarksideAllstar]

Ok... I had only spent one year in the department, so if there are any residents who disagree with my assessment of the program, feel free to chime in.


Hospitals and Case Volume
Moffitt is the hospital located at Parnassus, and is the "main hospital". It also has the Childrens hospital contained within it. Pediatric surgery, neuro, ortho, and ENT/ head and neck stuff typically take place there. Mt Zion is the cancer center, which feeds most of the surg path volume through the department. So, I cant for the life of me remember how many specimens had been accessioned at the end of last December, so I fumbled through some of my recuts to check out the date, and as of May 2nd there were 4000 surg path cases accessioned from Mt Zion alone, and probably about 1000 less from Moffitt Hospital (located at the Parnassus Campus), which is not as busy as Zion. You can probably come to an estimate of around 30K/year, not including confirmation and outside consults. The San Francisco General Hospital, again by the numbering on my recuts probably sees around 10-12K cases per year but is not staffed by any surg path fellows. The VA is much much slower than the General (probably sees around 5K, if that).

Residents/Fellows
This year I was told that they are adding a 14th resident (incoming July 2007) to help with 80 hr work week limits, as Moffitt surgicals is notorious for residents exceeding the work hour limits. There are 7 surg path fellows. The fellow rotation is as follows: Gross room supervisor, Hot seat, Surg pathx 2 months, Inside (confirmation) consults, outside consults, and elective. Hot seat fellow sees every surgical case that comes out of histo. I think each fellow made it through the cycle, and hit a couple of rotations twice. Surg path fellows were kept extremely busy in my opinion, staying as late as residents on some rotations.

Anyway, thats about it. I gotta go get my drink on. Peace.

 

[b&ierstiefel]

Uh oh. You're coming back?

That's right! You better be scared! The streets of A2 will be filled with the blood of the non-believers!

But rest assured, I'm just visiting for this weekend that's all. No need to drop a brick in yer pantaloons.

 

[b&ierstiefel]

This year I was told that they are adding a 14th resident (incoming July 2007) to help with 80 hr work week limits, as Moffitt surgicals is notorious for residents exceeding the work hour limits.

Sorry, but I am shocked and appalled. How many residents are on surg path on a given week?

 

[tsj]

Aren't residents on a 3 day schedule at Moffitt (gross, preview and sign-out?) How could you ever break 80 hours a week? It sounds like people just need to go home.

 

[LADoc00]

Aren't residents on a 3 day schedule at Moffitt (gross, preview and sign-out?) How could you ever break 80 hours a week? It sounds like people just need to go home.

Hold the phone, even if there were no fellows helping:
32000 cases/yr /14 residents = ~2300 case per resident per year?!
Assuming 260 workdays possible - holidays (8 days) - 20 days of vacation - 5 days for education leave
=227 days
2300/227= 10 cases a DAY?! That is literally like 90 minutes of work IF you included grossing and dictation corrections. There is no way you could work more than 80 hours/week on such a load...IMPOSSIBLE.

SHENANIGANS. I CALL SHENANIGANS!

 

[DarksideAllstar]

Yes, residents are on a three day schedule, day 1: gross, day 2: frozen sections or biopsy s/o, day 3: bigs s/o. There are probably several reasons why residents were staying late (inefficiency probably being one of the biggest for the first year AP res). However, day 2 seemed to be causing the most problems, with biopsy signout lasting until 5 (or later with some really slow attendings), and then doing subsequent dictations, ordering special stains, showing cases, etc. Then you have something like 10-15 flats to preview. Some of us would try and write as much of the case up as possible (measure margins, look stuff up, etc), so inherently it would take longer, but would typically speed up sign out the next day. The same goes for the person on frozen sections on day 2. If you got nailed with 25 frozens, there is no way you are doing any previewing before 5pm. Grossing days are also long, typically you aren't leaving until 6:30-7 (when the processor goes off). Anyway, as someone mentioned people do need to just go home at a certain point, however, most of us liked being semi-prepared for sign out, not to mention, avoid the rath of the attending (What?!?! What do you mean you were tired ? You didn't look at these?).

To answer Andy's question, I think there were 6 (4 or 5 residents and 1 or 2 fellows) on my surg path rotations at any one time. It seemed like there was plenty of work to go around, so regarding the # of cases/resident, well I can't really speak to that, we just aren't as good as LADoc.

Anyway, I know that there are UCSF residents on this board, so I defer to them to help enlighten this forum as to why the service is so busy. If you are still skeptical, I suggest a visiting rotation.

 

[LADoc00]

well I can't really speak to that, we just aren't as good as LADoc.

Anyway, I know that there are UCSF residents on this board, so I defer to them to help enlighten this forum as to why the service is so busy. If you are still skeptical, I suggest a visiting rotation.

Dont make me come over and open a huge can of whoop ass.

To improve efficiency: use pretyped templates for malignancy whenever possible. Actually the CAP has these for all AJCC stageable cases. Begin creating a database for canned comments by organ system. Like GI->"Chronic Active Colitis. See comment."
Comment: Fragments of colonic type mucosa with evidence of acute cryptitis and crypt abscesses. The lamina propria is expanded with a lymphoplasmacytic population with focal aggregate formation, some of which contain germinal centers. There is some minimal glandular architectural disarray as well as gland dropout consistent with a chronic process. Granulomas are not seen. These findings favor inflammatory bowel disease. Recommend clinical and endoscopic correlation. There is no evidence of dysplasia or carcinoma.
Bam. You can have that one as a freebie.

 

[LADoc00]

I have at this very minute (9:41 am PST) 4 flats of biopsies. Im going to time how long (uninterrupted it takes to sign them out).

 

[b&ierstiefel]

Ya know UCSFbound, I realized one very important variable that can make a resident's life hell...and that has to do with the extent of PA support. With 13-14 residents per year and only 6 of them doing surg path at any given moment and with 34K specimens per year, this can amount to a lot of work if there is less PA support. With more PAs, the grossing load is significantly lightened making for a much less stressful existence. I can tell ya, that at my program, we had ample PA support and we got 2 more PAs and life is quite different now (for the better).

To improve efficiency: use pretyped templates for malignancy whenever possible. Actually the CAP has these for all AJCC stageable cases. Begin creating a database for canned comments by organ system. Like GI->"Chronic Active Colitis. See comment."
Comment: Fragments of colonic type mucosa with evidence of acute cryptitis and crypt abscesses. The lamina propria is expanded with a lymphoplasmacytic population with focal aggregate formation, some of which contain germinal centers. There is some minimal glandular architectural disarray as well as gland dropout consistent with a chronic process. Granulomas are not seen. These findings favor inflammatory bowel disease. Recommend clinical and endoscopic correlation. There is no evidence of dysplasia or carcinoma.
Bam. You can have that one as a freebie.

I like mnemonics and templates. Those rule. Especially for the malignancies...where all you do is circle stuff. Sure, there are those who say that templates are bad for learning how to write your own reports. But hell, after you've circled stuff on your 50th colon cancer case, 40th lung cancer case, 30th esophageal cancer case, blah blah blah, you already get a good sense of what to look for when you're looking at a given slide.

 

[b&ierstiefel]

I have at this very minute (9:41 am PST) 4 flats of biopsies. Im going to time how long (uninterrupted it takes to sign them out).

Will somebody give this man a cookie?

And we still need an LADoc00 action figure. 4 flats of biopsies can be an accessory that can be purchased separately.

Batteries not included.

 

[LADoc00]

Will somebody give this man a cookie?

And we still need an LADoc00 action figure. 4 flats of biopsies can be an accessory that can be purchased separately.

Batteries not included.

Start time 9:41am PST
End time: 10:44 am PST
Reviewed and dictated all cases for today as well as ordering special stains and read 12 pages of Odze's GI path book. Awaiting secretaries....

PS-25 frozens/d? A frozen should take you 6-7 minutes to examine, gross AND embed and roughly 30 seconds to read. Add 4-5 minutes for H+E staining baths, maybe another 3 minutes if you also do a touch prep/squash prep. Still, there is almost no way the Parnassus campus, Zion or the General is getting anywhere near 25 frozens, but I might agree they could theoretically get a 10-part ENT-type situation, which IMO should be even quicker than the timeframe I described above. Ink em with a 6-dye set and you could put 6 frozens on 1 single chuck.

 

[DarksideAllstar]

Yes, we do have "quick text" where you type in like three letters and a whole sentence comes up, etc. The problem, at least for me arises when an attending asks you to piece together a more elaborate comment (and then asks the same thing on like 6 more cases). For us newbies, this could be challenging to accomplish in a short amount of time.

The PA situation is in dire straits. There are PAs there to help out, but it definitely isn't to the level of Stanford's gross room (so I have heard from an ex-resident), for instance. This is one area that they are trying to improve (PAs grossing more of the bigger/complex specimens, doing more frozens, etc). I think this is what makes surgicals so damn time consuming (ie wasting your time grossing in gallbags, hernia sacs, multinodular goiters, etc).

The frozens can be problematic as well. We have an ENT surgeon who usually asks for 8-10 frozens on a case, but doesn't always send them all at once, so it can be a real pain in the ass. Again, our neurosurgeons nearly always ask for frozens on every case, and since there is so much neuro going on up there, it can be a real challenge when you are running frozens on head/neck cases simultaneously. Sure, if I got 25 frozens all in one shot from 8-10 am that would be ideal, but hell, I am gonna sit down at my desk after finishing one and then get called back down stairs in like 10-15 minutes for another, which makes it kinda hard to get much previewing done.

PS- LADoc, I'll be waiting for that can of whoop ass. Good job with those 4 flats .

 

[b&ierstiefel]

The PA situation is in dire straits. There are PAs there to help out, but it definitely isn't to the level of Stanford's gross room (so I have heard from an ex-resident), for instance. This is one area that they are trying to improve (PAs grossing more of the bigger/complex specimens, doing more frozens, etc). I think this is what makes surgicals so damn time consuming (ie wasting your time grossing in gallbags, hernia sacs, multinodular goiters, etc).

Yeah, we had to do that too when we started out first year...no more. I feel your pain.

The frozens can be problematic as well. We have an ENT surgeon who usually asks for 8-10 frozens on a case, but doesn't always send them all at once, so it can be a real pain in the ass. Again, our neurosurgeons nearly always ask for frozens on every case, and since there is so much neuro going on up there, it can be a real challenge when you are running frozens on head/neck cases simultaneously. Sure, if I got 25 frozens all in one shot from 8-10 am that would be ideal, but hell, I am gonna sit down at my desk after finishing one and then get called back down stairs in like 10-15 minutes for another, which makes it kinda hard to get much previewing done.

Ditto...same thing happens here too. What can I say...that's life. Probably happens at a lot of places.

 

[Logos']

...

 

[LADoc00]

LADoc, your math is inaccurate. There are 7 SP spots at Moffitt/Zion SP every month (filled by residents, PSF, fellows). That works out to a very rough average of 100 cases /week/ resident … and this will of course include many large, complex specimens.

Still, 20 cases/resident/day is not that bad. I was reacting to the news that SF had residents that were >80hr/week. Which I find outrageous. That has to be a personal issue as in the real world, 20 cases/staff pathologist/day even if you added in adminstrative duties, CP including marrows and flow as well as having to gross all of them would be <30hrs/week. Maybe they are working 30hrs/week in a basic science lab or something, I dont know, but there is no way they could stretch out 100 cases to >80 hours. No way.

 

[DarksideAllstar]

Still, 20 cases/resident/day is not that bad. I was reacting to the news that SF had residents that were >80hr/week. Which I find outrageous. That has to be a personal issue as in the real world, 20 cases/staff pathologist/day even if you added in adminstrative duties, CP including marrows and flow as well as having to gross all of them would be <30hrs/week. Maybe they are working 30hrs/week in a basic science lab or something, I dont know, but there is no way they could stretch out 100 cases to >80 hours. No way.

Logos' kindly addressed in his post my misstatement pertaining to the new work hour requirements (ie 80 hr work week, etc) and the precise issue UCSF was having with them. In short, residents aren't typically working >80 hrs/wk.

The issue with work hours was the ACGME enforced 10 hours off rule, which would require that you go home by 10 pm in order to come back to work at 8 am. This was potentially a problem on day 2, as you mentioned, so a 7th person was added and residents do not work past 10 pm (experienced residents are often done much earlier).

Oh yeah, I went by Treasures on Saturday but I didn't see your hot German-Asian stripper. What gives?