Rank List Help

[panglosspath]

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Any advice would be great to help me rank these programs:

UPMC
University of Chicago
UNC
University of Washington, Seattle
Yale
Cleveland Clinic
Mayo

 

[deleted314957]

In that list, Seattle or North Carolina are the only places I personally
would consider living, and Seattle rains a lot.

 

[pathstudent]

Any advice would be great to help me rank these programs:

UPMC
University of Chicago
UNC
University of Washington, Seattle
Yale
Cleveland Clinic
Mayo

Maybe Seattle or Yale but I wouldn’t go to any of those programs as my first choice. Elite people are centered around ny, la, sf, dc and maybe Boston. People in those metro areas are separating from the rest of the country.

 

[Violetta80]

Yale should be the last one

rest depends on the family, fellowship interest

 

[Pathophile]

Yale should be the last one

rest depends on the family, fellowship interest

Why put Yale last?

 

[panglosspath]

How about UChicago and UWashington? Any comments on those?

 

[gbwillner]

Any advice would be great to help me rank these programs:

UPMC
University of Chicago
UNC
University of Washington, Seattle
Yale
Cleveland Clinic
Mayo

Are you interested in any particular subspecialty? Or region to live after? Or research? All these are relevant to giving you a good answer. You have some very respectable programs in that list.

 

[panglosspath]

Interested in hemepath and molecular path.
No particular region of interest but want to live in a big city, if possible.
I have done a lot of basic research before- so it would be good to continue that.

 

[pathslides]

Interested in hemepath and molecular path.
No particular region of interest but want to live in a big city, if possible.
I have done a lot of basic research before- so it would be good to continue that.

Just do hemepath. You don’t need to do both. Molecular will become like cytogenetics and taken over by PhDs or will be a system which is mainly ran by many PHDs who report to a single pathologist to get the case signed out. I don’t think the marketability of molecular is as good as hemepath especially in the future. Doing both or doing a molecular fellowship is only useful if you know you want to do academics, or work in industry. Molecular is not necessary for community practice.

 

[gbwillner]

I would start by looking for programs that have an MGP fellowship. What kind of career do you want?

 

[panglosspath]

I'm interested in an academic career.

 

[deleted314957]

Just do hemepath. You don’t need to do both. Molecular will become like cytogenetics and taken over by PhDs or will be a system which is mainly ran by many PHDs who report to a single pathologist to get the case signed out. I don’t think the marketability of molecular is as good as hemepath especially in the future. Doing both or doing a molecular fellowship is only useful if you know you want to do academics, or work in industry. Molecular is not necessary for community practice.

This is an excellent point. I was seeing this PhD shift 5+ years ago and there are
payor issues that make it less attractive for pathologists. Just do hemepath.

 

[gbwillner]

This is an excellent point. I was seeing this PhD shift 5+ years ago and there are
payor issues that make it less attractive for pathologists. Just do hemepath.

This could be a self-fulfilling prophesy. But I would argue there is need for physicians who understand diagnoses and the clinical implications of findings to be the intermediaries for genomic testing in cancer.

I would argue MORE physicians should be part of this field. This is the future of our field- if we don't pick up the new technology that will drive it, we will be obsolete.

 

[Dro133]

This could be a self-fulfilling prophesy. But I would argue there is need for physicians who understand diagnoses and the clinical implications of findings to be the intermediaries for genomic testing in cancer.

I would argue MORE physicians should be part of this field. This is the future of our field- if we don't pick up the new technology that will drive it, we will be obsolete.

I really appreciate your well-thought out and even-keeled posts and perspectives on here. My question (as a MS3 interested in molecular pathology) is if the PhD's can interpret the genomic testing and the oncologists can interpret how the results should drive the treatment strategy, what role does the molecular pathologist play? I'm really asking out of ignorance more than anything, so I apologize if I'm oversimplifying/overlooking something obvious. Would love to hear your perspective!

 

[gbwillner]

I really appreciate your well-thought out and even-keeled posts and perspectives on here. My question (as a MS3 interested in molecular pathology) is if the PhD's can interpret the genomic testing and the oncologists can interpret how the results should drive the treatment strategy, what role does the molecular pathologist play? I'm really asking out of ignorance more than anything, so I apologize if I'm oversimplifying/overlooking something obvious. Would love to hear your perspective!

Great questions!!!!

From my experience (as a Molecular Pathologist/Anatomic Pathologist/Geneticist):

1. the crux of the issue is what "interpretation" means. A PhD can interpret a variant as a true positive finding. They cannot interpret what the clinical implications of the finding are. A physician should do that. More specifically, a pathologist who understands: 1- the underlying biology and genetics of the tumor; 2- the laboratory methods and their liabilities; 3- the clinical significance of the findings in terms of diagnoses, prognosis, and predictive (therapeutic) implacations

2. Oncologists CANNOT generally interpret how the results drive treatment strategy. I say generally. At MGH/WashU/Hopkins whatever, they may all be experts or even PhDs in genetics themselves. In general, most oncologists know next to nothing about genetics. They may know very superficially very common things (like EGFR mutations and the use of erlotinib), but even common findings can easily lead them astray (like EGFR L858R mutation + EGFR T790M mutation, in addition to many other variants and mutations present). They want someone to explain all this to them. A molecular pathologist should be able to do this: 1- understand the diagnosis of lung adenocarcinoma; 2- understand the genomics/genetics of lung adenocarcinoma; 3- understand the ramifications of the molecular findings- in the example above it would be to advise the oncologist to d/c erlotinib/gefitinib and consider osimertinib therapy; in consideration with other clinical factors.

This is IMHO the most exciting field in all of medicine, and we are at the precipice of a paradigm shift in our approach to the patient with precision medicine. Molecular Pathology has the opportunity to be at the center of this change.

 

[Dro133]

Great questions!!!!

From my experience (as a Molecular Pathologist/Anatomic Pathologist/Geneticist):

1. the crux of the issue is what "interpretation" means. A PhD can interpret a variant as a true positive finding. They cannot interpret what the clinical implications of the finding are. A physician should do that. More specifically, a pathologist who understands: 1- the underlying biology and genetics of the tumor; 2- the laboratory methods and their liabilities; 3- the clinical significance of the findings in terms of diagnoses, prognosis, and predictive (therapeutic) implacations

2. Oncologists CANNOT generally interpret how the results drive treatment strategy. I say generally. At MGH/WashU/Hopkins whatever, they may all be experts or even PhDs in genetics themselves. In general, most oncologists know next to nothing about genetics. They may know very superficially very common things (like EGFR mutations and the use of erlotinib), but even common findings can easily lead them astray (like EGFR L858R mutation + EGFR T790M mutation, in addition to many other variants and mutations present). They want someone to explain all this to them. A molecular pathologist should be able to do this: 1- understand the diagnosis of lung adenocarcinoma; 2- understand the genomics/genetics of lung adenocarcinoma; 3- understand the ramifications of the molecular findings- in the example above it would be to advise the oncologist to d/c erlotinib/gefitinib and consider osimertinib therapy; in consideration with other clinical factors.

This is IMHO the most exciting field in all of medicine, and we are at the precipice of a paradigm shift in our approach to the patient with precision medicine. Molecular Pathology has the opportunity to be at the center of this change.

Fascinating, thanks for the reply!! I guess I took for granted that oncologists might not be completely up to date on all the latest genomic markers that drive care. And I certainly never thought that a pathologist would be expected to/have the knowledge base to suggest certain treatments to clinicians, that's amazing! Definitely looking forward to learning more about this field. Thanks again for taking the time to reply!

Will let the discussion hopefully circle back to OP's question, sorry for getting off topic OP!

 

[deleted314957]

This could be a self-fulfilling prophesy. But I would argue there is need for physicians who understand diagnoses and the clinical implications of findings to be the intermediaries for genomic testing in cancer.

I would argue MORE physicians should be part of this field. This is the future of our field- if we don't pick up the new technology that will drive it, we will be obsolete.

I think you are correct on all counts.

 

[bauber]

UNC, UPMC, and UW all have strong molecular programs. UNC was one of my top choices for residency 6 or so years ago, don't know about the other places.