Molecular diagnostic fellowship

[Matte Kudesai]

To LADoc and others...

Is a molecular diagnostic fellowship valuable for private practice at all?

Does it relegate one to academic centers?

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[DrBloodmoney]

My understanding is that you have very little opportunity to bill for tests. Or that reimbursement is far below your cost to operate.

 

[b&ierstiefel]

For private practice...hmm...I don't see a significant utility although I may be missing something. I've considered molecular diagnostics to be a "low yield" fellowship.

 

[Matte Kudesai]

For private practice...hmm...I don't see a significant utility although I may be missing something. I've considered molecular diagnostics to be a "low yield" fellowship.

I hear ya....
Not sure how molecular studies such as FISH (prognosis in HEME) or MLH methylation status TCRB rearrangements etc. for prognosis or more detailed diagnosis fare in the private practice arena now or in the not too distant future.

 

[DarksideAllstar]

For private practice...hmm...I don't see a significant utility although I may be missing something. I've considered molecular diagnostics to be a "low yield" fellowship.

In the DP-lover world would that be a ZERO star fellowship? I need to know because I am only considering fellowships rated at ONE star and above. Get back to me on this...

 

[LADoc00]

To LADoc and others...

Is a molecular diagnostic fellowship valuable for private practice at all?

Does it relegate one to academic centers?

I dont even think you can GET an academic job in mol path unless you train at Stanford/Brigham/MSKCC/Hopkins etc and do serious basic science research. Do you have 30 papers?

The field is really heavily saturated now, the earliest fellows (and I knew the first fellow in mol path at BWH) had a much easier time landing gigs because no one had boards in it. Now they are increasing exponentially.

Mol path has no value in community private path. None. Zero. hell I was using more mol path services 3 years ago then I am now!

There was this guy like 8 years ago who came to a BWH/MGH grand rounds (I think) from Cornell and said mol path would revolutionize pathology...still waiting. Waiting for the revolution!!! Fidel will lead us into the glorious era of mol path for all.

You could go work for a reference lab, where they would likely pay you about 80K a year because the job can also be done by a PhD in molecular, which are more numerous than hippies at Burning Man.

 

[yaah]

Problem with molecular path is that everything seems to be getting more and more esoteric (i.e. the purview of the reference lab or large academic center). As you get more you may get more useful for individual patients but you also get less useful for the general population. You need one machine plus multiple techs, etc, to run a factor V leiden assay which is relatively "simple" molecularly (and that's just one test). An important test but no way anyone who would get a couple dozen a year could ever compete with a big center that gets a couple dozen a day (because of costs and the simple fact that the more of those tests you do the better you are).

I think (I may be wrong) molecular might be a nice fellowship for someone who wants to be in academics but doesn't necessarily want to do molecular as a career - just to do it, be familiar with it, use it in research, etc. But then again, you probably don't need to do a fellowship to get what you need.

It seems logical that as molecular tests become more prevalent and more useful and important for diagnosis that private labs will start doing them and need fellowship trained people to run them, but probably not to a huge extent.

 

[CameronFrye]

I think (I may be wrong) molecular might be a nice fellowship for someone who wants to be in academics but doesn't necessarily want to do molecular as a career - just to do it, be familiar with it, use it in research, etc. But then again, you probably don't need to do a fellowship to get what you need.

This is something I've thought about, but like you said, you can probably pick up what you need to know without the fellowship.

 

[Adrian Cocot]

This still confuses me. Heavy hitters at the CAP talk a huge game about molecular diagnostics. I still fail to see how anyone could use a mol path fellowship outside of the academic sector.

Unless you set up your own fish lab or do all your own Her2-neus or have a paternity testing gig on the side. But do you really need a fellowship to be able to do that?

 

[DrBloodmoney]

One of our staff is studying for molecular boards currently. This book is basically the only thing he is studying.

 

[Adrian Cocot]

Yo Adrian

That is precisely why I posted this question. I have been hearing lots of buzz about the future wave of "molecular pathology".

I have no idea how it would translate to reality. If you do set up your own lab will you need to be "fellowship certified"?

Most of the techniques are not rocket science....

On a somewhat related note, the CAP is also heavily lobbying the AMA to parse words and change around the definition of medicine to include diagnostics. I think that's so the PhD's won't be able to sign off on any molecular/cytogenetics testing. But I thought that PhD's couldn't bill Medicare anyhow, so what's the friggin' point?

Either those people know something I don't, or they all have some kind of vested interest in biotech companies.

 

[LADoc00]

On a somewhat related note, the CAP is also heavily lobbying the AMA to parse words and change around the definition of medicine to include diagnostics. I think that's so the PhD's won't be able to sign off on any molecular/cytogenetics testing. But I thought that PhD's couldn't bill Medicare anyhow, so what's the friggin' point?

Either those people know something I don't, or they all have some kind of vested interest in biotech companies.

Although a MD must sign off as being a medical director of a CLIA certified lab, technically he can be a retired old fart sitting in a wheelchair drooling for all they care.

The issue at hand is there is essentially no professional component to molecular pathology. Meaning, there is no real billing role for someone to attach a -26 MD billing modifier after. MolDx is all technical, meaning unless you are exec at Quest Diagnostics, you wont see a dime.