Question about GI GU Pathology

[Unty]

I was wondering why do you need to do a GI or GU fellowship when any pathologist can sign out a GI biopsy or prostate biopsy? It's when there is a complicated case where a fellowship is handy.

I ask this because I recently learned of an attending who is a general pathologist (who I guess has a lot of experience signing out GI, but never did a fellowship) and is signing out cases for a GI pod lab. I hear pod labs just hire any pathologist (without a fellowship) and have them signout their tubular adenomas...while the same can't be said for dermpath.

On the other hand, general pathologists cannot signout dermpath (maybe your simple SK, BCC, nevi cases) unless they do a fellowship because of the complexity of the field and you really need to know clinical derm to do so while for GI anyone can sign out "active colitis" or "Crohn's" So, what's the value in doing a GI fellowship when anyone can signout a GI biopsy and likewise for prostate biopsies?

That's the value in dermpath fellowships....you can't just be a joe shmoe pathologist and signout derm by yourself...you really need to do a fellowship.

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[malchik]

Disagree, there are plenty of joe schmoe general pathologists who can sign out derm. Fellowship is sufficient but not necessary.

 

[zao275]

Malchik is on a role today! I agree again. I love dermpath and will be doing a fellowship next year, so if anything, I would be biased to agree with the OP on this...but I don't. Maybe many pathologists are not comfortable with dermpath (particularly dermatoses), but I think there are also many general pathologists who have taken the time to learn derm well and are quite good at it. One of my faculty during residency was exactly like this, although she was good at pretty much EVERYTHING. The other dermpaths in town all highly respected her even though she was not a boarded dermpath.

 

[yaah]

Yeah, the OP is confusing things. You don't "need" a fellowship to sign out dermpath. What you need is for someone to send you their cases. In some places, particularly rural places, veteran pathologists who are not DP boarded sign out the derm. In some cases, having years of experience is the equivalent of doing a DP fellowship. Same with GI/GU. Many well known GI/GU/Dermpaths did not do specific fellowships in their area.

The benefit of the fellowship is primarily 1) for increasing your expertise and credibility in the area, and 2) marketing.

 

[lipomas]

That's the value in dermpath fellowships....you can't just be a joe shmoe pathologist and signout derm by yourself...you really need to do a fellowship.

Where did you hear that? Lots of general paths do dermpath.

 

[KCShaw]

Ditto.

While it's true that in general terms having a fellowship in something means you're more likely to have previously seen and thus better understand nuances with both common & complicated cases in that subspecialty, having a fellowship isn't strictly "necessary." Non-hemepaths sign out marrows, non-dermpaths sign out skin, non-FP's perform autopsies & testify on forensic cases, etc.

Fellowships are a relatively recent craze in the pathology world. There are a lot of reasons for that, some of them better than others. The bottom line is that a pathologist needs a good educational foundation, some experience, some confidence, and to not exceed their limits. These days it seems like a lot of individuals don't find that confidence level as they near the end of residency and ultimately seek it in fellowship. At the same time, with so many "fellowship trained" pathologists out there, it affects how potential employers and potential clients view you.

 

[deleted314957]

when i started back in the 80's folks did not do gi fellowships but in my situation, i had a lot sent to me. over the years i have gotten pretty good and have a lot of long term gi docs who swear by me. i now do approx 40-50 cases ( average 2-3 parts per case ) of GI/day and it is no problem. i recently worked with a gastroenterologist who did a path residency then a gi fellowship and he certainly considered me to be his peer. He was a "new pathologist" and did not have the gestalt that almost 30 years gives you almost as an instinct

 

[trudyfae]

you do not need a derm fellowship to sign out derm cases. this is a fallacy perpetuated by dermatologists who are trying to take those cases from us. pathology is for pathologists, dermatology is for dermatologists.

 

[zao275]

you do not need a derm fellowship to sign out derm cases. this is a fallacy perpetuated by dermatologists who are trying to take those cases from us. pathology is for pathologists, dermatology is for dermatologists.

One of my favorite dermatopathologists is derm trained. He is a fantastic teacher and an incredible morphologist. No one who has worked with him would ever dare say that he is not a pathologist just because he is derm trained. Oh, his name is Ron Rapini (author of Practical Dermatopathology). Your other point may be right (I don't know), but I don't think it is fair to say that dermatologists have no right to sign out dermpath cases.