medicine and pathology

[todds]

As I have to apply to residency soon, I've been really enjoying patients but at the same time loved second year and learning about pathology.

I'm leaning more towards medicine due desire to work with patients but I can't help but think that I would really enjoy that diagnostic side of pathology.

So my question is that is it possible to be trained through fellowship to do path in a subspecialty? For example, if I were to do a GI fellowship, could you be trained to do the pathology for the biopsies a GI doc would obtain?

I know (in Canada), there is a lady in vancouver who got trained in hemepath after doing internal/hematology residency and now she does a bit of both. Just wondering if that is something that you can do in the US in other specialties, particularly something like GI or Oncology.

EDIT: I know this is a path forum so I'm not sure how people on here would take it if a medicine guy think he can just train in pathology subspecialty through fellowship, so not trying to offend anyone, just wondering what options I have in my future.

Thanks!

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[Ombret]

EDIT: I know this is a path forum so I'm not sure how people on here would take it if a medicine guy think he can just train in pathology subspecialty through fellowship, so not trying to offend anyone, just wondering what options I have in my future.

Heh. Many pathologists did enjoy patient contact in their days of doing that, so the fact that you do enjoy it does not automatically DQ you from pathology. In fact you will probably be a better pathologist for it. There are also pathologists for whom direct patient care was not a great fit but I would say that it's a minority that did not feel some regret in giving it up. Talk to some attendings you respect and see how big a factor this was for them.

There are currently no specific ways of doing a medicine subspecialty, then training in pathology for that subspecialty. Probably derm is the closest to this (you can do derm followed by derm path; I know derm is not exactly part of medicine; anyway see the jobs thread to get idea of the sparks that this generates). Some of the medicine subspecialists are pretty good at looking at biopsies of their own organ system (in particular the average renal doc is a better renal pathologist than the average surgical pathologist; pulmonary docs are often not bad at medical lung; hem/onc could develop some aptitude for heme path I suppose). These are fields in which anatomic pathology plays a large role. However, the skill of examining the biopsies is basically a hobby for those people; they do not sign out the cases or even have direct access to them in most practices.

There is a cardiologist at the Children's Hospital of Philadelphia who is the world's expert on cardiac malformations and does all their gross cardiac pathology, but there is approximately one of him in the world.

I don't know what to say about the Canadian lady you describe. Overall, that is not common. I would say do a little more thinking about which field you prefer, but do not do one and hope to turn it into the other.

 

[KCShaw]

There are alternative ways into some CP subspecialties like blood bank/transfusion medicine, microbiology, etc., and on the AP side dermatopathology, hematopathology, and neuropathology, with additional training. The alternative methods don't appear to be common, except for derm, and I suspect many fellowship or residency programs might shy away from someone with zero to limited/nonstandard pathology experience. One should look at the booklet of information on www.abpath.org for current information on qualification requirements to take the relevant subspecialty board exams. I don't know of a way other than AP residency into the other boarded AP subspecialties (forensic path, pediatric path, etc.), nor a way to get into reimbursement for signing out the non-boarded subspecialties (GI, breast, cardiac, etc.) without getting some sort of pass from the board of pathology..which I wouldn't exactly count on. I also can't think of anyone who practices both the pathology subspecialty and the non-path specialty they used to get into it, except for derm.

Rumor has it there were discussions about this sort of thing, like letting renal physicians handle renal biopsies (after some sort of specific training), and various pushes by the biopsy-prone specialties to sign out their own biopsies (personally) which in some cases has been replaced by in-house labs with an in-house pathologist. Of course in the semi-remote past, as someone recently pointed out, most physicians were all-in-one's -- treated medical conditions like an internist, operated like a surgeon, and diagnosed like a pathologist. But specialization and subspecialization has been in vogue for some time now.