Pathology assistant salary versus academic instructor/assistant professor

[SLUsagar]

In a sense, the most dangerous pathologists (IMHO) are the arrogant ones. Lots of people agree with me. Big surprise, arrogant people tend to disagree with that statement and they see their confidence as a plus. But they are missing the fact that arrogance and confidence do not go hand in hand.

I was hired fresh out of fellowship at a place that has never hired someone without prior experience (perhaps I just got lucky with this great job). I had no formal slide test, although I was asked to come to several of the consensus-type conferences and asked to offer my thoughts. While my overall reputation from outside folks that the group knew was important, one key factor I was told and over and over again is that they want people who know what they know, and know what they don't know (i.e. corroborating your comments on arrogance).

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[mcfaddens]

one key factor I was told and over and over again is that they want people who know what they know, and know what they don't know (i.e. corroborating your comments on arrogance).

Excellent statement! This is so key and often overlooked when people are in training. I would never hire someone based upon where they trained or how many fellowships the did (actually a red flag in my book), you have to know your limits and at the same time be confident in the areas that you know well. Day to day practice is a constant collaboration of thoughts and ideas placed in to the actual function of practicing medicine. Someone told me once "you can't polish a turd"

 

[DOtoCanada]

All the pas at my university pull 100k. Bit I gurss ones in fly over country probably can't command that. I was just shocked that pas can earn more than faculty. But I also just read that anesthesia nurses can easily command 200k a year so a 100k for grossing sounds reasonible.

Ha! Your comment reminded me of a shirt a local design shop makes here in "fly over" country.

 

[yaah]

I was hired fresh out of fellowship at a place that has never hired someone without prior experience (perhaps I just got lucky with this great job). I had no formal slide test, although I was asked to come to several of the consensus-type conferences and asked to offer my thoughts. While my overall reputation from outside folks that the group knew was important, one key factor I was told and over and over again is that they want people who know what they know, and know what they don't know (i.e. corroborating your comments on arrogance).

That was my experience also - no slide test. When I was hired my group hired two of us at once, both of us right out of fellowship. Your latter point was also made to me - what I also heard was that they wanted someone who would be a good person to work with (i.e., a good colleague). All groups who do this understand that new hires are going to have somewhat of a learning curve and have to learn how to be independent. But there is a difference between that and a weak knowledge base.

I agree arrogance is very dangerous in pathology. Underconfidence is detrimental too, but underconfidence is detrimental to pathology groups and clinicians in different ways.

The phrase "Arrogant with insufficient cause" has been used to describe these people.

That's a good phrase - similar to one of my new favorites, "Eminence-based pathology."

 

[pathstudent]

That's a good phrase - similar to one of my new favorites, "Eminence-based pathology."

well it is true phrase. While most of medicine is evidence based pathology is eminence based. If you are community or a jr faculty and call a soft tissue tumor A but Fletcher calls it B, you are wrong even if you are right. They might just all be opinions but some opinions matter more than others.

 

[lipomas]

well it is true phrase. While most of medicine is evidence based pathology is eminence based. If you are community or a jr faculty and call a soft tissue tumor A but Fletcher calls it B, you are wrong even if you are right. They might just all be opinions but some opinions matter more than others.

There is a difference between calling some weird soft tissue tumor what it is versus creating literature and practice based on your own impression though. Prostate pathology is a good example of the latter. There are all kinds of articles which talk about modifications or applications of the Gleason grading system which often treat it like it is a uniformly applicable tool. But separately there will be articles which gather "consensus" from internationall known experts and the articles find that there is no consensus even on many gold standard cases. I was at a platform session once where an eminent pathologist was presenting his paper on secondary reviews of biopsies originally performed elsewhere, and how there was a tendency to undergrade certain cases. His evidence was that these were "cases that should be interpreted" the way HE interpreted them. Someone asked a question, "How are you sure that the outside pathologist isn't the one that was correct?" And the answer given was not really backed up with solid evidence, more opinion. I thought it was a great question. There have been other studies with Barrett's dysplasia, etc, that show similar results. Literature says all Barrett's dysplasia that are considered high grade should be reviewed by a GI pathologist. But literature shows that GI pathologists have poor agreement amongst each other as to what constitutes high grade dysplasia.

Sending an uncommon tumor to an expert is not the same thing in my book. It is kind of "eminence based" but it's different. There is also no harm in experts using appropriate data and drawing conclusions based on their unique experience. Fletcher's soft tissue experience is based on years of seeing all the oddball tumors and thus being able to distinguish them. Where it becomes a problem is in areas where defined criteria are not clear (like "dysplasia" or what constitutes a follicular variant of papillary thyroid carcinoma). I'm sure there are some that disagree with this distinction though. To me, this is a major reason why many private pathologists have a bit of a low impression of many academic pathologists. We all have experienced having a patient or clinician request a second opinion on a borderline case and having the academician clearly decide it is one or the other based on very little except their personal opinion. When that opinion is backed up by real evidence that is not a problem of course, even if we feel like bad pathologists for not getting it right. But when it's not, then it gets irritating. An example would be a small focus of prostate cancer that we show around the department and agree is best called 3+3=6, but the outside person decides it should be 3+4 and can't really explain why other than "I think there is subtle gland fusion." This bothers the crap out of community pathologists.

 

[pathstudent]

There is a difference between calling some weird soft tissue tumor what it is versus creating literature and practice based on your own impression though. Prostate pathology is a good example of the latter. There are all kinds of articles which talk about modifications or applications of the Gleason grading system which often treat it like it is a uniformly applicable tool. But separately there will be articles which gather "consensus" from internationall known experts and the articles find that there is no consensus even on many gold standard cases. I was at a platform session once where an eminent pathologist was presenting his paper on secondary reviews of biopsies originally performed elsewhere, and how there was a tendency to undergrade certain cases. His evidence was that these were "cases that should be interpreted" the way HE interpreted them. Someone asked a question, "How are you sure that the outside pathologist isn't the one that was correct?" And the answer given was not really backed up with solid evidence, more opinion. I thought it was a great question. There have been other studies with Barrett's dysplasia, etc, that show similar results. Literature says all Barrett's dysplasia that are considered high grade should be reviewed by a GI pathologist. But literature shows that GI pathologists have poor agreement amongst each other as to what constitutes high grade dysplasia.

Sending an uncommon tumor to an expert is not the same thing in my book. It is kind of "eminence based" but it's different. There is also no harm in experts using appropriate data and drawing conclusions based on their unique experience. Fletcher's soft tissue experience is based on years of seeing all the oddball tumors and thus being able to distinguish them. Where it becomes a problem is in areas where defined criteria are not clear (like "dysplasia" or what constitutes a follicular variant of papillary thyroid carcinoma). I'm sure there are some that disagree with this distinction though. To me, this is a major reason why many private pathologists have a bit of a low impression of many academic pathologists. We all have experienced having a patient or clinician request a second opinion on a borderline case and having the academician clearly decide it is one or the other based on very little except their personal opinion. When that opinion is backed up by real evidence that is not a problem of course, even if we feel like bad pathologists for not getting it right. But when it's not, then it gets irritating. An example would be a small focus of prostate cancer that we show around the department and agree is best called 3+3=6, but the outside person decides it should be 3+4 and can't really explain why other than "I think there is subtle gland fusion." This bothers the crap out of community pathologists.

You are missing the point. Even if Fletcher is wrong and you are right, you are still wrong.

If a esophagus biopsy truly has no genetic abnormalities and you call it reactive atypia but Odze calls it dysplastic. You are wrong even though you are right. Pathology is eminence based

 

[Pathwrath]

Have you seriously never met one of these people? There are board certified pathology graduates who are positively frightening to work with - either personality-wise or skills-wise. This is not apologist, this is not denialist, this is not anything except reality. To deny that these individuals exist is helping no one. It might make you feel better and make your argument sound stronger that the job market sucks, but to be honest it makes your opinion pretty much invalid because you are failing to acknowledge an important point...

...And so on.

Apologist: a person who makes a defense in speech or writing of a belief, idea, etc.

Now how is your very discursive argument explaining why these frightening pathologists can't land jobs not an apology?

 

[SLUsagar]

Someone told me once "you can't polish a turd"

there's an awesome mythbusters episode about this...(conclusion: indeed, you cannot polish a turd). You have to check this out!

 

[SLUsagar]

there's an awesome mythbusters episode about this...(conclusion: indeed, you cannot polish a turd). You have to check this out!

BAM.
http://dsc.discovery.com/videos/mythbusters-polishing-a-turd.html

 

[lipomas]

...And so on.

Apologist: a person who makes a defense in speech or writing of a belief, idea, etc.

Now how is your very discursive argument explaining why these frightening pathologists can't land jobs not an apology?

I fail to understand this obsession of yours, and others. Are you attempting to tell me that I don't think the pathology job market needs to be significantly improved? Because I do. But are you also attempting to tell me that every pathologist you have ever met is someone who is qualified to either work in your group or sign out your biopsy? Because that simply isn't true unless you are some sort of sadist. Even in a perfect job market there are going to be unemployed pathologists. Why is this? Because no matter how much training they have, some people just are not cut out to do the job.

I have no idea how many times I have to say it - it is quite clear that many people who have difficulty with the job market have personal or professional failings that are not helping their own circumstances. At the same time, it is also clear that otherwise qualified individuals are experience difficulty which is not their own fault.

Now if you can explain to me why the statement above implies that I am some sort of crazy fanatic who denies the existence of a poor job market, I am all ears.

 

[Pathwrath]

Now if you can explain to me why the statement above implies that I am some sort of crazy fanatic who denies the existence of a poor job market, I am all ears.

No, you are the sort of crazy fanatic who obsessively monitors every single negative comment made about the pathology job market, jumping down the throats of anyone who engages in the very same hyperbole you use and bitching about the solutions offered while offering none of your own.

Cue long, long LONG retort in 3,2,1...

 

[lipomas]

No, you are the sort of crazy fanatic who obsessively monitors every single negative comment made about the pathology job market, jumping down the throats of anyone who engages in the very same hyperbole you use and bitching about the solutions offered while offering none of your own.

Cue long, long LONG retort in 3,2,1...

Um, ok, I think I get it. So you don't want to bother reading my posts because they are too long, and you don't actually want to read what I am saying because it's easier to just presume what I am saying and misinterpret me. But you still want to argue with me and demonize me? I'll keep this point brief: I do not think the path job market is good. Some trainees come out unprepared to practice.

What solutions are you talking about that have been offered? Reduce the size of residency programs? That's a great solution. It's about 1 million times more difficult than what you make it though - mostly politically. I would consider present my ideas for solutions if I had any confidence at all you would pay attention to them.