No other specialty sees residents commonly doing 2-3 fellowships

PathDoctor

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Example: Multiple People At Michigan With Two Fellowships:
She then completed her AP/CP residency and fellowship in breast and gynecologic pathology at Duke University in 2017. She also completed a second fellowship in Cancer Biomarker Pathology (with a focus in breast cancer biomarkers) at The University of Texas MD Anderson Cancer Center in 2018.

His training included a residency in Anatomic and Clinical Pathology (2008-2013), and fellowships in Hematopathology (2011-2012) and Molecular and Genetic Pathology (2013-2014).

She also completed her postgraduate training at the University of Michigan, including a residency in Anatomic and Clinical Pathology followed by fellowships in Surgical Pathology and Gastrointestinal and Hepatobiliary Pathology.

He joined the University of Pittsburgh Medical Center (UPMC), (Pittsburgh, PA) Anatomic Pathology and Clinical Pathology residency training program in 2005 and graduated in June 2009. He completed a Cytopathology Fellowship in 2010 at UPMC, followed by a Pediatric Pathology Fellowship at the Children’s Hospital of Pittsburgh in 2011.

After residency in anatomic and clinical pathology at Johns Hopkins, pursued a fellowship in hematopathology also at Johns Hopkins, followed by a dermatopathology fellowship at the University of Colorado School of Medicine, Denver, Colorado.

How about three?

completed his residency training in pathology at Cleveland Clinic, where he served as Anatomic Pathology Chief Resident. Dr. Patel completed fellowships in surgical pathology and soft tissue pathology, the latter under the direction of Dr. Sharon Weiss, at Emory University and dermatopathology at Cleveland Clinic.
Department of Pathology

He completed his residency in Anatomic and Clinical Pathology at the Mayo Clinic in Rochester, Minnesota in 2011 where he served as co-chief resident. He then completed fellowships in Surgical Pathology (2012, serving as chief fellow) and Cytopathology (2013), both at the Mayo Clinic. He then completed a fellowship in Gynecologic Pathology at the University of Michigan in 2014.

Fellowship
Dermatopathology, Indiana University School of Medicine, Indianapolis, IN, 2014
Bone and Soft Tissue Pathology, Emory University School of Medicine, Atlanta, GA, 2013
Oncologic Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, 2012

2004–2005 Fellow, Dermatopathology, Cockerell and Associates Dermatopathology Laboratories
1998–2000 Fellow, Pediatric Pathology, Children’s Hospital of Philadelphia
1996–1998 Fellow, Neuropathology, Duke University Medical Center

She completed fellowships in Gastrointestinal Pathology at Boston University, Hematopathology at Harvard University Beth Israel Deaconess Medical Center in Boston and Oncologic Surgical Pathology at MD Anderson Cancer Center in Houston, TX.

completed her residency in Anatomic and Clinical Pathology at the University of Chicago in 2001, followed by a fellowship in cytopathology at New York Presbyterian Hospital. Dr. Harigopal also completed fellowships in breast pathology and renal pathology at New York Presbyterian.

He completed his residency at the University of Hawaii School of Medicine and completed three fellowships: one in genitourinary and gastrointestinal pathology at the University of Pittsburgh Medical Center in PA, and two (oncologic surgical pathology and cytopathology) at the University of South Florida.
 

MetroPath

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Most residents I know have done two fellowships. I think they don’t feel comfortable or marketable by just doing one fellowship.

I think some can get a job after one year, especially with an on demand fellowship but I think some don’t feel adequate or comfortable signing out surg path or whatever and hence that second fellowship.
 
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Guest8

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I think they don’t feel . . . marketable by just doing one fellowship.
That's the whole issue right there. The job market is bad enough that people are doing extra fellowships to gain some sort of job market advantage. But in reality you don't need those fellowships at all to work (short of dermpath or hemepath), just to find a damn job in the first place.
 
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I’m going to ask around but I think most of my friends never received a CAP survey in regards to the job market. In one of those papers they targeted CAP junior members or fellows in practice. How the hell are you going to keep track of where fellows go for jobs when residency programs can’t dven keep track of it!!!!

I think most people after they leave residency don’t continue their CAP memberships or maybe some do? I surely didn’t.
 

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2-3 fellowships is also great for your personal/social/family life. Add that to struggling to find work. How many times can I move?
 
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How realistic is it to expect 200k as a starting salary in an academic place right out of a single fellowship (GI) in a mid-sized city (metro area of ~3 mil)?
 

Unty

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How realistic is it to expect 200k as a starting salary in an academic place right out of a single fellowship (GI) in a mid-sized city (metro area of ~3 mil)?

Realistic.
 
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Med Director New England

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How realistic is it to expect 200k as a starting salary in an academic place right out of a single fellowship (GI) in a mid-sized city (metro area of ~3 mil)?
first yr in academia if you start at assistant rank Salary range is 150- low 200s. That would not include 401k match and some other bene’s with real value.

Much lower at instructor rank. GI training should be enough to be able to negotiate appointment as assistant
 
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yaah

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Some of the people you linked have highly specialized careers, for which multiple fellowships is appropriate.

So the theory some of you have is that people are doing multiple fellowships because they can't find jobs, but you also say that academic jobs suck. So why is it that the examples you are picking of people with multiple fellowships are academics who have careers where they utilize both of their fellowships in specialized careers?

And you also picked a bunch of people who trained 15-20 years ago, when one fellowship was required because path training required 5 years of residency (and it basically had to be surg path or a subspecialty. If you wanted a board certified subspecialty, that wouldn't count). That requirement changed I think in about 2005 - before that point essentially everyone did a surgical pathology fellowship. Because the other option was to do a transitional year in medicine or surgery.

What theory is this even trying to support? Go look for a bunch of private practice pathologists in smaller groups, or reference lab positions (this less desirable jobs) who also have 2-3 fellowships. Or find data that says most RECENT grads are doing multiple fellowships. I think they are too, but I don't have actual data.

The main problem "multiple fellowships" brings up is that current training is inadequate for many. The amount of stuff you have to learn and number of rotations you have to do has increased exponentially, yet residency is still 4 years. Residency is the same length of time it was when there was no molecular path, no subspecialty signout, etc. Maybe residency should just be 5 years instead (ducks).
 
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bauber

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Some of us did 2 fellowships because we wanted to, as hard as that may be to believe. I really enjoyed the academic environment, especially as a fellow. I'm the only one in my group with 2 fellowships.
 

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Yes there are people that did two because they wanted to. I wonder if some did two because they thought they had to, when they could’ve gotten a job.
 

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Yes there are people that did two because they wanted to. I wonder if some did two because they thought they had to, when they could’ve gotten a job.

IMHO it's more of a mindset. If there is a perception that you have to do 2 fellowships to get a job, that alone may drive market forces to adopt that approach regardless of whether the underlying premise is true or not. How many of you have spoken with colleagues that attempted to get a job after 1 fellowship, failed, and took another fellowship? I bet very few. This is also confounded by the fact that you have to set up a fellowship in advance, sometimes by 2-3 years. So if you suspect that you may have to have 2 fellowships, you will line up 2 fellowships long before you try to enter the market, and when it is time, you may not really try to escape your commitments and look for a job (for many reasons).

More anecdotes from me- As stated before, I only did one fellowship and was never going to do more than one. When I sought to leave my home institution, I applied for 7 jobs (all cold "calls" with my Chair's support in academia). Of these, only one got back to me stating that they required 2 fellowships. So the "requirement" is real at least somewhere. However, my opinion is also that if that institution was actively hiring someone with my unique skill set, they would have overlooked this requirement.
 
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yaah

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There is definitely a perception out there among many (I find it's actually more common in academics) that you can't sign out something (except for really basic stuff) unless you've done a fellowship in it. I don't find that to be as big of a problem in private groups, but many residents and trainees also are uncomfortable signing things out like hemepath unless they did a hemepath fellowship. Some of that comes from training programs instilling that belief in them, unfortunately. The way most practices are now, with the exception of really small groups, is that there will be some degree of subspecialization, even if most people still do more than one thing, so you have an "expert" in each area.
 
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MetroPath

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I agree I know people who wouldn’t feel comfortable signing out heme or cyto if they didn’t do a fellowship. Now, is that an issue with programs not training us adequately to be generalists? I don’t know but with three or four months of heme or cyto in residency I can see why. You can always look at cases on your own, but I think you would need guidance (previewing and signing cases out) from attendings to feel more comfortable.
 
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Yeah, I get it. But there are ways to learn more about it and be competent. The best situation is when a group has existing hemepath experts who you can rely on for the tougher cases. I don't think I would want to be a primary hemepath for a private group, but I am comfortable being one in a group with 3 with hemepath fellowships. Cyto is a little different I think - fellowships help but so does just doing it for a couple of years.
 

rirriri

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IMHO it's more of a mindset. If there is a perception that you have to do 2 fellowships to get a job, that alone may drive market forces to adopt that approach regardless of whether the underlying premise is true or not. How many of you have spoken with colleagues that attempted to get a job after 1 fellowship, failed, and took another fellowship? I bet very few. This is also confounded by the fact that you have to set up a fellowship in advance, sometimes by 2-3 years. So if you suspect that you may have to have 2 fellowships, you will line up 2 fellowships long before you try to enter the market, and when it is time, you may not really try to escape your commitments and look for a job (for many reasons).

More anecdotes from me- As stated before, I only did one fellowship and was never going to do more than one. When I sought to leave my home institution, I applied for 7 jobs (all cold "calls" with my Chair's support in academia). Of these, only one got back to me stating that they required 2 fellowships. So the "requirement" is real at least somewhere. However, my opinion is also that if that institution was actively hiring someone with my unique skill set, they would have overlooked this requirement.

you're right it's a perception problem. Most residents are freaked out by people saying they have to do more than 1 fellowship. Fuelled by some kind of paranoia and expectation that such is the case. It is simply not true. More people should be doing 1 fellowship.

Like you i had said plainly i was only going to do 1 subspecialized ellowship and that's what i did. I then received a job offer without sending a single application out for my 1st job through word of mouth.

A few years ago i was having lunch with a Chairman of a large academic program in the midwest and he told me that he tries to never hire people with more than 1 fellowship. He's made a couple exceptions however most of the time he felt that candidates with only 1 fellowship were far more focused and confident in their abilities than those who have done 2 or 3. I would tend to agree.
 
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you're right it's a perception problem. Most residents are freaked out by people saying they have to do more than 1 fellowship. Fuelled by some kind of paranoia and expectation that such is the case. It is simply not true. More people should be doing 1 fellowship.

Like you i had said plainly i was only going to do 1 subspecialized ellowship and that's what i did. I then received a job offer without sending a single application out for my 1st job through word of mouth.

A few years ago i was having lunch with a Chairman of a large academic program in the midwest and he told me that he tries to never hire people with more than 1 fellowship. He's made a couple exceptions however most of the time he felt that candidates with only 1 fellowship were far more focused and confident in their abilities than those who have done 2 or 3. I would tend to agree.
Then why aren't residents actively dissuaded from doing more than one ?????????
 

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Even with 2 fellowships the training is 6 years. That's the same as radiology and most IM subspecialties.
 
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Med Director New England

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Then why aren't residents actively dissuaded from doing more than one ?????????
So if one is just beginning their first fellowship, sept / oct rolls around and the job prospects don’t look good - what do you do?

line up A 2nd fellowship.
The reason for 2nd and third fellowships is difficulty finding jobs. No one wants to be stuck making a pgy 6 salary if they had a real job.
 
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Nilf

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3 fellowships? OMG, this is like another residency. How do you get funding to do 3 fellowships? Does ACGME pay for this? If that is the case, then just cut your losses and try to get a spot in family medicine or IM. This is madness.
 

MetroPath

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So if one is just beginning their first fellowship, sept / oct rolls around and the job prospects don’t look good - what do you do?

line up A 2nd fellowship.
The reason for 2nd and third fellowships is difficulty finding jobs. No one wants to be stuck making a pgy 6 salary if they had a real job.
you're right it's a perception problem. Most residents are freaked out by people saying they have to do more than 1 fellowship. Fuelled by some kind of paranoia and expectation that such is the case. It is simply not true. More people should be doing 1 fellowship.

Like you i had said plainly i was only going to do 1 subspecialized ellowship and that's what i did. I then received a job offer without sending a single application out for my 1st job through word of mouth.

A few years ago i was having lunch with a Chairman of a large academic program in the midwest and he told me that he tries to never hire people with more than 1 fellowship. He's made a couple exceptions however most of the time he felt that candidates with only 1 fellowship were far more focused and confident in their abilities than those who have done 2 or 3. I would tend to agree.
you're right it's a perception problem. Most residents are freaked out by people saying they have to do more than 1 fellowship. Fuelled by some kind of paranoia and expectation that such is the case. It is simply not true. More people should be doing 1 fellowship. Sometimes they can’t find a job and do three fellowships.

Like you i had said plainly i was only going to do 1 subspecialized ellowship and that's what i did. I then received a job offer without sending a single application out for my 1st job through word of mouth.

A few years ago i was having lunch with a Chairman of a large academic program in the midwest and he told me that he tries to never hire people with more than 1 fellowship. He's made a couple exceptions however most of the time he felt that candidates with only 1 fellowship were far more focused and confident in their abilities than those who have done 2 or 3. I would tend to agree.

There are some IMGs who have J1 visa issues. They do two or more because they need to work in an underserved area or they have to go back to their country to do two years before coming back. These jobs in underserved areas are limited and go to primary care fields first before pathology.

If you thought it was hard to find a job as a US citizen imagine how hard IMGs have it which make up a lot of pathology trainees.
 
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MetroPath

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So if one is just beginning their first fellowship, sept / oct rolls around and the job prospects don’t look good - what do you do?

line up A 2nd fellowship.
The reason for 2nd and third fellowships is difficulty finding jobs. No one wants to be stuck making a pgy 6 salary if they had a real job.

Some people do two fellowships just because they think they may not be able to find a job (some have visa issues) and use the fellowship to be safe.

Some people do two because they want to do it. I know few who have done three.

Some do two because they don’t feel comfortable signing out on their own after residency and feel a surgpath fellowship will help.

Some do two because it’s what residents perceive as the “default” to land a job or “since everyone’s doing two I better do two as well.”

Some programs have low volume in one area, so residents from said program go on to do a fellowship in an area that they are interested but feel deficient in.
 
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3 fellowships? OMG, this is like another residency. How do you get funding to do 3 fellowships? Does ACGME pay for this? If that is the case, then just cut your losses and try to get a spot in family medicine or IM. This is madness.

LOL what?
Welcome to reality of modern pathology, sir!
I personally know a good handful of people who did 3 fellowships and have heard about the folks who did 4 fellowships or 4 years of fellowships (like neuro+peds+forensic).
Just don't ask me WHY they do it because I simply don't know the answer.

Also, there is an official statistics coming from ASCP which confirms that more then half residents do more then one fellowship.

Thinking about popular myth that primary care pays much less then pathology I can recall experience of my friends who are outpatient PC, hospitalists, urgent care clinic docs, outpatient psych - NOBODY is making less then 250K per year fresh out of training while with some experience or willingness to go slightly "rural" one easily bumps up to 300K and more.
 
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Iceman24

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There are some IMGs who have J1 visa issues. They do two or more because they need to work in an underserved area or they have to go back to their country to do two years before coming back. These jobs in underserved areas are limited and go to primary care fields first before pathology.

If you thought it was hard to find a job as a US citizen imagine how hard IMGs have it which make up a lot of pathology trainees.

Everything you said is correct except doing multiple fellowships doesn't increase one's chances to find a job after J1 visa.
 

MetroPath

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Everything you said is correct except doing multiple fellowships doesn't increase one's chances to find a job after J1 visa.

Yes what I meant is that it doesn’t increase ones chances but it prolongs their stay in the US if they can’t find a job and want to work in the US. In other words they keep doing fellowships until they find a job.

I know one IMG who did three fellowships and eventually landed a job back where he did residency.
 
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Alteran

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Some people do two fellowships just because they think they may not be able to find a job (some have visa issues) and use the fellowship to be safe.

Some people do two because they want to do it. I know few who have done three.

Some do two because they don’t feel comfortable signing out on their own after residency and feel a surgpath fellowship will help.

Some do two because it’s what residents perceive as the “default” to land a job or “since everyone’s doing two I better do two as well.”

Some programs have low volume in one area, so residents from said program go on to do a fellowship in an area that they are interested but feel deficient in.

I think a lot of it has to do with the overall sub-par training a lot of residents get from, at best, mediocre programs.
 
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MetroPath

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I think a lot of it has to do with the overall sub-par training a lot of residents get from, at best, mediocre programs.

Yes that’s a whole other topic for discussion. I think some residency programs can do a better job at making sure residents are competent at least in surgical path prior to graduation. Some don’t and residents easily can fall through the cracks and have to pick it up later by doing multiple fellowships.

I’ve seen places with low heme volume, weak didactics, few unknowns sessions all throughout all fours years of residency.
 
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solitarius

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You should be glad those fellowships even exist. The other option is to be unemployed for multiple years after post-graduate training, which is far worse from a general job-seeking perspective. Fellowships give people the opportunity to keep their skills sharp, form more (useless?) networks, and most importantly, earn any kind of money.
 

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So if one is just beginning their first fellowship, sept / oct rolls around and the job prospects don’t look good - what do you do?

line up A 2nd fellowship.
The reason for 2nd and third fellowships is difficulty finding jobs. No one wants to be stuck making a pgy 6 salary if they had a real job.

This is for sure.
 

rirriri

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There are some IMGs who have J1 visa issues. They do two or more because they need to work in an underserved area or they have to go back to their country to do two years before coming back. These jobs in underserved areas are limited and go to primary care fields first before pathology.

If you thought it was hard to find a job as a US citizen imagine how hard IMGs have it which make up a lot of pathology trainees.
You are absolutely correct! There are some logistics reasons why this is done—-but people should know about these things and not everyone should be following suit.

IMO it’s not a competitive advantage to have 2 or 3 fellowships vs. 1. I would gladly hire the 1 fellowship candidate over someone with extra ones they did for other reasons. This is NOT meant to be discriminatory towards visa holders—-I am strictly referring to the merits of how many fellowships and what that number means.
 
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rirriri

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Then why aren't residents actively dissuaded from doing more than one ?????????
I look around and I see everyone being encouraged and even forced to do more than 1 fellowship. It’s absurd. It’s a cultural issue within the field.

I always encouraged Residents to do 1 strong fellowship they want to do. Sure rarely there are people who genuinely want to do molecular OR informatics or something additive—-fine. But peeps who do Gyn, Renal, and Surgpath? That’s like walking into a store and buying a cake, a pair of socks, and a guitar.
 
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MetroPath

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I look around and I see everyone being encouraged and even forced to do more than 1 fellowship. It’s absurd. It’s a cultural issue within the field.

I always encouraged Residents to do 1 strong fellowship they want to do. Sure rarely there are people who genuinely want to do molecular OR informatics or something additive—-fine. But peeps who do Gyn, Renal, and Surgpath? That’s like walking into a store and buying a cake, a pair of socks, and a guitar.

I agree that if you do an in demand fellowship for private practice, you should be able to get a job somewhere. I’m seeing a lot of demand for heme and cyto in private practice currently.

Again in this instance some may do heme+surgpath if they don’t feel confident with their general surgpath skills. Some group may be willing to hire you based on that hemepath fellowship and you can learn surgpath on the job.

I’ve talked with one group who has an urgent need for a hemepath and in this case you may be able to get that job just doing one heme fellowship and learning surgpath on the job. They are also looking for cytopath trained people as well. So if you did heme and cyto fellowships, then you would be ultra-marketable for this group. Thus, doing two fellowships may not be a bad idea. The group then gets one person who can fill two voids.

Yes you don’t need to do two fellowships if your first fellowship is in demand and your surgpath skills aren’t stinky. I’d recommend everyone to do one of these two fellowships (heme or cyto) and test the job market before doing a second.

Hemepath and cytopath are in demand as I see now in my perusal of job ads. Some remote places may just want you to sign out surgpath and doing a surgical path fellowship may even suffice.

Getting the job may also depend on if you are willing to move and if not, let’s hope the practices around you are looking for your skillset.
 
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Only one of the people in my practice has done 2 fellowships. Other than that one person, everyone younger than 50 has done one (including those of us who have completed fellowship within the last 5 years). A minority of the people older than 50 did no fellowships (most of these being in the 60 and older camp).


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Seems like a balance between those that have done one vs. two fellowships. Few with three.

I know of 11 people who have done one, two of which were in forensics, two guys did cyto only, one girl did GI only, one girl did neuropath and three people did heme only, one did dermpath only, one did blood bank only.

The fellowship combos I know of are:

Surgpath+cyto+GI (1)
Pediatrics+ Cyto (2)
Pediatrics+SP+ cyto (2)
Surgpath+cyto (several)
Heme+GU+ Surgpath (1)
Heme+surgpath (1)
Heme+molecular (1)
Surgpath+neuropath (1)
Heme+cyto (2)
SP+GI (1)
SP+dermpath (1)
Cyto+GU (1)

I may have missed some.
 
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I joined a large “premier” group in a large populous state in an urban area in the 80’s.
We had 2 derms, one heme, one neuro(only one year), one new hire cyto and one forensic(me). None of the other non boarded fellowships existed. You could take any board (except possibly neuro) based on claimed experience and become boarded. We all pretty much did everything. After a few years, one of the derms got too busy and had to do derm only. Back then, cyto and heme was something everyone did to a greater or lesser extent.
When people left residency they were generally full of confidence that they could function in a hospital environment and were encouraged to consult as their abilities or conscience dictated. Things worked fine.

In Residency it was a different story, especially in clinical path which seems to be a joke nowadays. We were specifically prepared for hospital lab management. There was a boarded clinical chemist, medical microbiologist and heme path and blood banker and we spent approximately 6 months with each one on a daily basis. When we got out we were very conversant with the enterobacteriaciae (for example). Nowadays folks get sent home with Todd and Sanford and told to read.

How times have changed.
 
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Yes things are more specialized nowadays. I know a bunch of people who wouldn’t feel comfortable doing everything like you guys did years ago.
 

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You should be glad those fellowships even exist. The other option is to be unemployed for multiple years after post-graduate training, which is far worse from a general job-seeking perspective. Fellowships give people the opportunity to keep their skills sharp, form more (useless?) networks, and most importantly, earn any kind of money.
This is true
Better to accumulate more fellowships than to be unemployed. I believe the abundance of fellowships is masking the imbalance of trainees who want to enter the workforce vs. the need for them.

imagine this hypothetical - acgme suddenly no longer allows path trainees to do multiple fellowships. You would have unemployed, boarded pathologist literally forced to apply for PA positions to earn a living.
 
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gbwillner

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This is true
Better to accumulate more fellowships than to be unemployed. I believe the abundance of fellowships is masking the imbalance of trainees who want to enter the workforce vs. the need for them.

imagine this hypothetical - acgme suddenly no longer allows path trainees to do multiple fellowships. You would have unemployed, boarded pathologist literally forced to apply for PA positions to earn a living.

That might work for any given individual, but I am not sure that logic holds up at a population level. It does not really create a new job as it only removes them from the pool for one year. ACGME only pays for 5 years of training for pathologists.
 

Med Director New England

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Fellowships are a bit more elastic than resident spots. Programs with a lot of spots (Ex MSKCC surg path) that may have had Trouble filling every spot and occasionally under enrolled now have no problems. Some fellowships near me That are internally funded often take on an extra fellow based on demand. There are also many fellowships that non-paths MDs and PhDs can enter. If the ratio shifts toward more path residents entering these spots this allows the number of paths in training to grow. Clinical chem fellows for example used to be more PhDs than pathology trained I bet this ratio has flipped in recent yrs.

Someone has this data - too bad it hasn’t been shared. It would shed a lot of light on this debate.

Thinking about the math if 10 yrs ago the avg fellowship/ path resident was 1.5 and now is 2.5 (ball parking this, have no idea of the actual #) . The math only works out if the fellowships are somehow expanding their own capacity (for path trainees at least). Can’t last forever though.
 
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27G

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Some trainees are just terrified to actually work and put their name on a case they sign out. I have heard from numerous friends that it’s a disaster hiring recent grads with multiple fellowships.... unless it’s an academic program that is marginal or one that hires you after they train you so they can pay you some bs clinical instructor salary and abuse you. Many many multiflowship trainees wash out of PP groups because they cannot sign out and generate income for the group.
 
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Alteran

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Some trainees are just terrified to actually work and put their name on a case they sign out. I have heard from numerous friends that it’s a disaster hiring recent grads with multiple fellowships.... unless it’s an academic program that is marginal or one that hires you after they train you so they can pay you some bs clinical instructor salary and abuse you. Many many multiflowship trainees wash out of PP groups because they cannot sign out and generate income for the group.

We've experienced this very thing in our practice, multiple times. However, the phenomenon of multiple fellowships I think can be attributed to a combination (and not of equal proportions) to 1) foreign medical grads looking to extend visa stays, 2) sub-par residency training such that graduating residents actually need additional training/experience at a real program, and 3) tight job market.
 
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Unty

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We've experienced this very thing in our practice, multiple times. However, the phenomenon of multiple fellowships I think can be attributed to a combination (and not of equal proportions) to 1) foreign medical grads looking to extend visa stays, 2) sub-par residency training such that graduating residents actually need additional training/experience at a real program, and 3) tight job market.

Totally agree with what you mentioned.
 

mikesheree

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Fellowships are a bit more elastic than resident spots. Programs with a lot of spots (Ex MSKCC surg path) that may have had Trouble filling every spot and occasionally under enrolled now have no problems. Some fellowships near me That are internally funded often take on an extra fellow based on demand. There are also many fellowships that non-paths MDs and PhDs can enter. If the ratio shifts toward more path residents entering these spots this allows the number of paths in training to grow. Clinical chem fellows for example used to be more PhDs than pathology trained I bet this ratio has flipped in recent yrs.

Someone has this data - too bad it hasn’t been shared. It would shed a lot of light on this debate.

Thinking about the math if 10 yrs ago the avg fellowship/ path resident was 1.5 and now is 2.5 (ball parking this, have no idea of the actual #) . The math only works out if the fellowships are somehow expanding their own capacity (for path trainees at least). Can’t last forever though.

How about entirely separate residencies. Clinical path-3 years. Anatomic path-4 years
If one cannot be released upon the unsuspecting public after that, there is no help for them.
That should eliminate the “surg path “ fellowship and most of the “organ system“ ones like gi, gu, etc. Probably peds, neuro, forensics and dp stay. dp is the only one with any numbers.
 

HeyDalaron

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How about entirely separate residencies. Clinical path-3 years. Anatomic path-4 years
If one cannot be released upon the unsuspecting public after that, there is no help for them.
That should eliminate the “surg path “ fellowship and most of the “organ system“ ones like gi, gu, etc. Probably peds, neuro, forensics and dp stay. dp is the only one with any numbers.

Much like you are suggesting, in Canada most path trainees do AP only (1 year rotating clinical internship and 4 years of AP), as CP has become the wheelhouse of PhD chemists, microbiologists and the like. Only a few remote community hospital labs prefer AP/CP trained people (what we call general pathology, which is 1 year rotating internship and 2 years each of AP and CP).

We are starting to have fellowship creep up here too because there are too many pathologists who want to live in the bigger centers like Toronto and Vancouver. One thing we don't really have is the 'surgical pathology fellowship', as we already do 4 years of AP, so adding on a fifth seems wasteful of time and would serve nobody in the job hunt.
 

Spikebd

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Much like you are suggesting, in Canada most path trainees do AP only (1 year rotating clinical internship and 4 years of AP), as CP has become the wheelhouse of PhD chemists, microbiologists and the like. Only a few remote community hospital labs prefer AP/CP trained people (what we call general pathology, which is 1 year rotating internship and 2 years each of AP and CP).

We are starting to have fellowship creep up here too because there are too many pathologists who want to live in the bigger centers like Toronto and Vancouver. One thing we don't really have is the 'surgical pathology fellowship', as we already do 4 years of AP, so adding on a fifth seems wasteful of time and would serve nobody in the job hunt.
Is it realistic for American pathologists to get employed up in Canada? Just asking to see if anybody has experience with it.
 

MetroPath

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Is it realistic for American pathologists to get employed up in Canada? Just asking to see if anybody has experience with it.

Yes I have a friend who finished training and went to Canada for work.
 
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deleted978973

You guys really helped me steer away from path with these threads. The number of fellowships a new doc should have to do to get a job is 0-1.
 
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