Practicing Pathologists -What are your Impressions of New Hires in your Group?

[KeratinPearls]

Just curious. Those who are in practice what has been your impression of new hires in your group? Past and present.

Lazy? Inefficient? Diagnostic issues? Slow? Can’t handle a busy workload? Lack of confidence (need hand holding) and can’t work independently?

Are programs adequately training residents and fellows?

Both positives and negatives welcome.

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[Guest8]

Our recent hires fresh out of fellowship have had no real downsides. They work hard, they're well-trained, they don't seem overly slow, and they can handle our busy private practice workload. Granted they have come from local top-tier programs which likely helps. But I haven't heard anyone complain about them or their training. They all seemed to hit the ground running when they started.

 

[Zarniwoop]

Sadly, any sign of weakness will be jumped on, so it is better career-wise for new grads to "fake it till you make it." This applies to all specialties with not always the best patient outcomes.

More sadly, when career success follows, the person who is "faking it" confuses what they are doing with real knowledge and skill, and stays comfortably at that level for their whole career, or even drifts downward slightly.

 

[Napoleon1801]

There seems to be two different trajectories:

1. Someone who starts out slow at first, but throughout their first year builds with mentorship and eventually becomes a valuable team member. They bring new energy and ideas to the group, actively improving quality.

2. The person who is constantly on the struggle-bus and despite numerous chances, babying, and accommodations, who inevitably finds additional ways to fail. They continue to crash and burn hard They are diagnostically inept and eventually move on to another practice (somehow??). One of these came from a top ten residency with good recommendations from their program. I highly suspect a few people are getting passes through residency, despite severe knowledge gaps.

 

[WEBB PINKERTON]

We are fortunate that we only hire people we are very familiar with beforehand. No time to baby here. Veteran only practice.

 

[Dave CX]

There seems to be two different trajectories:

1. Someone who starts out slow at first, but throughout their first year builds with mentorship and eventually becomes a valuable team member. They bring new energy and ideas to the group, actively improving quality.

2. The person who is constantly on the struggle-bus and despite numerous chances, babying, and accommodations, who inevitably finds additional ways to fail. They continue to crash and burn hard They are diagnostically inept and eventually move on to another practice (somehow??). One of these came from a top ten residency with good recommendations from their program. I highly suspect a few people are getting passes through residency, despite severe knowledge gaps.

Yor second point has happened to me also.

 

[cmz]

My experiences:

1) Pathologist who was excellent at a subspecialty area (e.g. GI/Liver) but took 10 days to sign out a placenta or appendix (go figure). Unfortunately, the GI area was eventually impacted as a result of their inability to do general surg path. Loss of confidence became a reality and they ended up missing a whopping Hodgkin lymphoma colonizing colonic mucosa (seen on bx). They had the mental ability to work up these "odd" and "unknown" cells but gave up when all stains they ordered came back as negatory and just chalked them up to "reactive histiocytes" or "fibroblasts." They nearly had a heart attack when I showed the pathologist a CD30 sea of brown covering most of the bx up.

2) Pathologist who needed a lot of hand holding for the easy cases but could sign out the super complex cases without much issue. Their mental aptitude was superb. They often communicated with a high level of understanding. Cockiness ensued and they began to challenge group consensus with some difficult diagnoses. We agreed to disagree rather than agonize over something challenging, recognizing that a true consensus was never going to happen. We are OK with this fact since we deal with cases like this all the time, and when this happens we punt things over to our expert consultants to get another opinion (as I am sure most groups do). On one occasion this pathologist became very upset with our apparent disagreement on a case. We urged the pathologist to send the case out, and the consultant agreed with the main group's consensus. Pathologist, still not satisfied, sent the case to yet ANOTHER consultant with whom they knew would agree with their POV. Sure enough, a slightly different diagnosis was rendered, one that was in alignment with what that pathologist was looking for. We explained to our newbie pathologist that you can throw a dart at a dart board 1000X and you will eventually hit the bullseye. This same opinionated pathologist would then often send consults to us with questions like, "Is this necrosis? Do you think I can call this acute appendicitis? What do you think of this B9 thyroid FNA? Is this colloid?" It was mind boggling. They were "qualified" enough to challenge super complex cases but didn't have the ability to recognize what a first year medical student would easily recognize on a histology 101 exam.

3) Pathologist who never could handle a single case for the life of them. Their reports were overly complicated and convoluted (much like my post). They would often overly-emphasize the wrong thing in a report. Also, they were physically destructive (e.g. super-glue on all objective lenses in a brand new BX63 olympus with high-tech optics; microscope re-mounted on a stack of unstable books/journals because they needed to sit in an "ergonomic" position to read slides). The only thing that helped their cause was their attitude. I often thought to myself, "Did someone kill this person years ago and assume their identity somehow?" because they came to our group with the makings of a varsity athlete (unlike Tony Soprano), having coming from good residency and fellowship training programs.

4) Pathologist that basically could hit the ground running without much hand holding. A+ superstar so far.

I guess we're batting 0.250, which is somewhat serviceable for the major leagues. Maybe it's superb if you're a catcher, which is kind of what I think my group has become lately after the endless reaming we get from the majority of our hospitals that we service.

 

[mike-sheree]

Really, what can you expect? After a minimum (AP only) of 3 years, they have NEVER been required to or allowed to sign out ONE case with SOLE responsibility. I frankly don’t see how they can be expected to be at all productive. Webb has the same feeling our group had. Can you even envision a brand new surgeon who had never done so much as an appy on their own?

 

[KeratinPearls]

Really, what can you expect? After a minimum (AP only) of 3 years, they have NEVER been required to or allowed to sign out ONE case with SOLE responsibility. I frankly don’t see how they can be expected to be at all productive. Webb has the same feeling our group had. Can you even envision a brand new surgeon who had never done so much as an appy on their own?

Agree the real learning starts when you begin signing out.

 

[CDX-2]

Really, what can you expect? After a minimum (AP only) of 3 years, they have NEVER been required to or allowed to sign out ONE case with SOLE responsibility. I frankly don’t see how they can be expected to be at all productive. Webb has the same feeling our group had. Can you even envision a brand new surgeon who had never done so much as an appy on their own?

Are US pathology residents allowed to legally sign out a histology case with ONLY their name on it?

For Australia,

I heard that RCPA (Royal College of Pathologists of Australasia) apparently used to allow registrars "reporting privileges", in that those who fully passed the AP Part 1 exams ("normally" done in 3rd year) to have privileges to independently authorize reports for "simple" cases (eg appendices, gallbladders, TA LGDs) as determined by the consultants/attendings of the lab.

This is no longer the case, as RCPA has re-defined it so even if a registrar fully passes the AP Part 1 exams (or even the Part 2 exams, which are "normally" done in 4th and 5th year assuming you don't fail any exams at all), the report still has to have another AP fellow's name on it, and that the AP fellow is still ultimately responsible for the histology case (and not the AP registrar/resident). This is even if the AP registrar (resident) has their own private medical indemnity insurance.

- Apparently only when the AP registrar (resident) has received official fellowship (FRCPA) confirmation from the College AND have specialist registration established with the medical board / national health regulatory board (AHPRA), are they allowed to independently authorize cases.

- Most AP fellows aren't happy to have their name on a histology report without seeing the slides themselves, so then they end up checking the slides and the draft report that the AP registrar (resident) did.

- To me, this completely defeats the purpose of "reporting privileges" as by the time this happens (FRCPA + specialist registration by AHPRA) , there's at best only ~2 months left in their final year as an AP registrar/resident.

On top of passing the exams, there's also logbook requirements, such as needing to do draft reports on at least 3000 histology cases in order to attain fellowship. Some AP registrars (residents) also include draft notes on slide sets and online e-cases in that count though.

 

[TrojanRaggy]

Are US pathology residents allowed to legally sign out a histology case with ONLY their name on it?

For Australia,

I heard that RCPA (Royal College of Pathologists of Australasia) apparently used to allow registrars "reporting privileges", in that those who fully passed the AP Part 1 exams ("normally" done in 3rd year) to have privileges to independently authorize reports for "simple" cases (eg appendices, gallbladders, TA LGDs) as determined by the consultants/attendings of the lab.

This is no longer the case, as RCPA has re-defined it so even if a registrar fully passes the AP Part 1 exams (or even the Part 2 exams, which are "normally" done in 4th and 5th year assuming you don't fail any exams at all), the report still has to have another AP fellow's name on it, and that the AP fellow is still ultimately responsible for the histology case (and not the AP registrar/resident). This is even if the AP registrar (resident) has their own private medical indemnity insurance.

- Apparently only when the AP registrar (resident) has received official fellowship (FRCPA) confirmation from the College AND have specialist registration established with the medical board / national health regulatory board (AHPRA), are they allowed to independently authorize cases.

- Most AP fellows aren't happy to have their name on a histology report without seeing the slides themselves, so then they end up checking the slides and the draft report that the AP registrar (resident) did.

- To me, this completely defeats the purpose of "reporting privileges" as by the time this happens (FRCPA + specialist registration by AHPRA) , there's at best only ~2 months left in their final year as an AP registrar/resident.

On top of passing the exams, there's also logbook requirements, such as needing to do draft reports on at least 3000 histology cases in order to attain fellowship. Some AP registrars (residents) also include draft notes on slide sets and online e-cases in that count though.

US residents and in most cases even fellows don't get to do what you are doing! We attend a PA school for 4 years then do an unnecessarily hyperspecialized fellowship and are expected to start signing out everything just one day after the fellowship ends! Most jobs want one to cover one additional or even two additional subspecialties. 99% of fellows don't know this and expect that they will only be signing out cases from their subspecialty.

 

[mike-sheree]

US residents and in most cases even fellows don't get to do what you are doing! We attend a PA school for 4 years then do an unnecessarily hyperspecialized fellowship and are expected to start signing out everything just one day after the fellowship ends! Most jobs want one to cover one additional or even two additional subspecialties. 99% of fellows don't know this and expect that they will only be signing out cases from their subspecialty.

Well, for you fellows out there, fellowship is expected to provide knowledge IN ADDITION to COMPETENCY in general anatomic and clinical pathology. Now ya know.

 

[allopathdoc]

Our last few hires have been trainees who did most of the residency and training during COVID. Not sure if it was the remote signout and remote lectures, they are not as ready to sign out as the people before them.

 

[mike-sheree]

What did Covid do to y’all educationally-wise? Cut down on #of specimens due to less operative procedures?

 

[cmz]

What did Covid do to y’all educationally-wise? Cut down on #of specimens due to less operative procedures?

That and "remote learning"

 

[DoctorInQuotations]

What did Covid do to y’all educationally-wise? Cut down on #of specimens due to less operative procedures?

There were programs where residents did not sit down and sign out with the attending for ~2 years due to social distancing policies. They signed out by joining a video call with the attending, who broadcasted the cases through a scope camera. I can't imagine learning AP that way...

 

[mike-sheree]

There were programs where residents did not sit down and sign out with the attending for ~2 years due to social distancing policies. They signed out by joining a video call with the attending, who broadcasted the cases through a scope camera. I can't imagine learning AP that way...

What a dumpster fire 😱

 

[mike-sheree]

Sadly, any sign of weakness will be jumped on, so it is better career-wise for new grads to "fake it till you make it." This applies to all specialties with not always the best patient outcomes.

More sadly, when career success follows, the person who is "faking it" confuses what they are doing with real knowledge and skill, and stays comfortably at that level for their whole career, or even drifts downward slightly.

The whole point is that you didn’t have to do that before. Folks could generally hit the ground running. Whatever has changed needs to be addressed. Should AP/CP be 2 yr CP and 3 yrs AP? Something clearly needs to be done.

 

[MetroPath]

The whole point is that you didn’t have to do that before. Folks could generally hit the ground running. Whatever has changed needs to be addressed. Should AP/CP be 2 yr CP and 3 yrs AP? Something clearly needs to be done.

CP training at most places is a joke. You’re basically just studying on your own. Kinda sad all those tax dollars being spent on “training” residents for clinical path.

Lack of oversight by the ABP in my opinion.

 

[mike-sheree]

It is a horrible lack of oversight, Metro. It is time for residents to bitch loud and long about it to the residency review committee rather than snark about it as has been done for years. It can be different. My CP was 2 solid years of didactic academics, assigned study and bench work. I thanked god every day during my 25 years as a community hospital lab medical director that I was afforded that background.

 

[MetroPath]

It is a horrible lack of oversight, Metro. It is time for residents to bitch loud and long about it to the residency review committee rather than snark about it as has been done for years. It can be different. My CP was 2 solid years of didactic academics, assigned study and bench work. I thanked god every day during my 25 years as a community hospital lab medical director that I was afforded that background.

Good CP training can be had in large hospitals with a high volume of material that you can learn from. Add in good teachers with a lot of expertise who tell you and guide you to everything you need to know.

In smaller training programs, CP training can be atrocious with a very poor curriculum. Sad that it is like this. Some people study for the CP boards, pass then go into practice hoping to never see anything CP related again.

Then there are those who fail CP boards. They just drop their CP certification since everything tested was like a different language to them since they weren’t exposed to much in residency.

 

[mike-sheree]

Good CP training can be had in large hospitals with a high volume of material that you can learn from. Add in good teachers with a lot of expertise who tell you and guide you to everything you need to know.

In smaller training programs, CP training can be atrocious with a very poor curriculum. Sad that it is like this. Some people study for the CP boards, pass then go into practice hoping to never see anything CP related again.

Then there are those who fail CP boards. They just drop their CP certification since everything tested was like a different language to them since they weren’t exposed to much in residency.

Such programs need to be shut down, full stop.

 

[mike-sheree]

Good CP training can be had in large hospitals with a high volume of material that you can learn from. Add in good teachers with a lot of expertise who tell you and guide you to everything you need to know.

In smaller training programs, CP training can be atrocious with a very poor curriculum. Sad that it is like this. Some people study for the CP boards, pass then go into practice hoping to never see anything CP related again.

Then there are those who fail CP boards. They just drop their CP certification since everything tested was like a different language to them since they weren’t exposed to much in residency.

Dropping CP must just put a meat cleaver in their future career choices. When I was around, it was a big, big plus (and expected) for the group to take a slew of medical directorships. ( read-CP required).
Now granted, the junior folks (as I did) had to do most of the “road warrior” stuff but that is just dues paying. Most folks settled into a hospital medical directorship with perhaps a trivial side directorship that took minimal commitment after a while. But, you just don’t start out at the top of the heap. Dues paying doesn’t end with residency/fellowship. It begins with your first job.

 

[KeratinPearls]

Dropping CP must just put a meat cleaver in their future career choices. When I was around, it was a big, big plus (and expected) for the group to take a slew of medical directorships. ( read-CP required).
Now granted, the junior folks (as I did) had to do most of the “road warrior” stuff but that is just dues paying. Most folks settled into a hospital medical directorship with perhaps a trivial side directorship that took minimal commitment after a while. But, you just don’t start out at the top of the heap. Dues paying doesn’t end with residency/fellowship. It begins with your first job.

CP training is horrible at some places. Like no teaching. No hands on experience. I know some programs that got put on probation. I know of a program that had no blood bank lectures and no blood bank calls.

Residents graduate and aren’t able to field calls regarding basic CP questions in a hospital. It’s really unfortunate.

 

[mike-sheree]

CP training is horrible at some places. Like no teaching. No hands on experience. I know some programs that got put on probation. I know of a program that had no blood bank lectures and no blood bank calls.

Residents graduate and aren’t able to field calls regarding basic CP questions in a hospital. It’s really unfortunate.

These younger folks need to realize that damned near any shot at a “sweet” job is going to require CP, even if they only use that training to be a glorified signature and a name on a CLIA license. Want AP only? Great, you are useless at any health care institution other than an academic hospital AND you are perfect fodder for a slide mill, not that there’s anything wrong……

 

[coroner]

CP training is horrible at some places. Like no teaching. No hands on experience. I know some programs that got put on probation. I know of a program that had no blood bank lectures and no blood bank calls.

Residents graduate and aren’t able to field calls regarding basic CP questions in a hospital. It’s really unfortunate.

Sounds like my program...

 

[Iceman24]

We had a normal blood bank training, lectures and call.
But microbiology was a joke - independent reading and sitting with the tech witnessing their pipetting and Petri dish foreplay for hours. Once I asked clinical director what microbiology fellows do (we have micro fellowship filled by PhDs), are they staring at pipetting too (cause it is just ******ed waste of time for us and waste of money for tax payers)? They are doing inpatient rounds with infectious disease doctors, she responded. I was shocked, nuff said.