Saturday Grossing; Is it useful or Scut?

[Benni]

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Simple question. It seems that only small or private institutions require Saturday grossing; usually with the statement that 3 day signout is not acceptable. What I take this to mean is 3 day signout is unliked by surgeons/clinicians and makes less money due to less turnover. It may also enhance resident learning or perhaps it just ends up being scut.

What's your opinion?

 

[sohsie]

Simple question. It seems that only small or private institutions require Saturday grossing; usually with the statement that 3 day signout is not acceptable. What I take this to mean is 3 day signout is unliked by surgeons/clinicians and makes less money due to less turnover. It may also enhance resident learning or perhaps it just ends up being scut.

What's your opinion?

Plenty of big places do Saturday grossing and some do mandatory Saturday signout as well. I went to a very large program that did weekend grossing (ie just get it in by Sunday night). I managed to do all my work on Sat night and/or Sunday (I am Sabbath observant).

The length of signout (48 hour vs 72 hour) will not affect revenue in it of itself, since it does not alter volume Signing out cases in 48 hours vs 72 does not increase the capacity to do cases.

 

[2121115]

I am at a large program (> 60K surgicals) and we have mandatory weekend grossing.

 

[Ruination]

Saturday grossing to me is scut.

 

[yaah]

It is not scut. It's doing your job. Pathology residency is not going to be a 9-5 job five days a week. I would wager that most of the larger and better programs require someone to gross on weekends. This is not really about billing and such, it's about patient care and quality. At some programs saturday grossing is part of call, at others it's built into whatever rotation you are on. When I trained we had to come in at some point before sunday evening to finish anything up that came in late on friday or needed to fix on friday. This is not onerous.

If every resident has to come in every saturday and gross in small bits, then that would be scut. Some measure of grossing on weekends to ensure quality care is NOT SCUT. If I was a program director I would seriously question the motivations of someone who considered all weekend grossing as "scut."

 

[gungho]

i'm in private practice and either my partner or i gross every sunday-part of the job.

 

[icpshootyz]

Saturday grossing is done by the residents on call, both at the large program where I did my post-sophomore fellowship and at my large program where I'm doing residency. It's hardly scut - it's good patient care. It assures that cases are signed out in a more timely fashion and it prevents a large glut of cases from sitting in the fridges and deteriorating over the weekend. Especially long weekends. In fact, I'll be in tomorrow as the resident on call to take care of the grossing, and that's fine with me. Personally I have little trust in pathologists that look down on grossing as being "scut" or below them. Do your work and quitcher bitchin.

 

[Parts Unknown]

Simple question. It seems that only small or private institutions require Saturday grossing; usually with the statement that 3 day signout is not acceptable. What I take this to mean is 3 day signout is unliked by surgeons/clinicians and makes less money due to less turnover. It may also enhance resident learning or perhaps it just ends up being scut.

What's your opinion?

Just imagine your mom's ovary sitting in a bucket from Friday afternoon until Monday morning.

 

[Art]

Simple question. It seems that only small or private institutions require Saturday grossing; usually with the statement that 3 day signout is not acceptable. What I take this to mean is 3 day signout is unliked by surgeons/clinicians and makes less money due to less turnover. It may also enhance resident learning or perhaps it just ends up being scut.

What's your opinion?

I can imagine that people with this attitude will also have trouble finding a job, if they believe that working an occasional Saturday to improve patient care is scut.

 

[BrainPathology]

Even Saturday grossing is a small compromise in patient care. The cases grossed in on Saturday and Sunday were signed out on Monday which would be a 48 hour TOT for Saturday cases. We rotated weekend cutting which amounted to 3 to 10 hours of grossing each day depending on the case load and the resident. Also, an attending was there on Saturday to sign out much of the cases from Friday, not sure how they were chosen; and to assist the resident with any questions.

If weekend grossing is scut for residents then off season workouts are scut for professional athletes. Guess which people in both professions are better at their jobs?

 

[pathcrazed]

Even Saturday grossing is a small compromise in patient care. The cases grossed in on Saturday and Sunday were signed out on Monday which would be a 48 hour TOT for Saturday cases. We rotated weekend cutting which amounted to 3 to 10 hours of grossing each day depending on the case load and the resident. Also, an attending was there on Saturday to sign out much of the cases from Friday, not sure how they were chosen; and to assist the resident with any questions.

If weekend grossing is scut for residents then off season workouts are scut for professional athletes. Guess which people in both professions are better at their jobs?

completely agree. Saturday grossing is NOT scut. it's part of our training.

 

[Milky Way]

Geez, people. Rip his head off, why don't you... the OP is just a med student, and I seriously doubt whether he/she realizes that most programs and private practices do gross on weekends and how much grossing would be considered scut. I happen to enjoy grossing and think it's important for a good pathologist to understand how to do it well, but there is such a thing as too much of a good thing; i.e. when it's at the expense of ever getting to look at slides, so it's not a stupid/lazy question. Having said that, grossing on the weekends in of itself is not scut, but simply good patient care as other posters have said, so that specimens don't sit around for two, possibly three days. Many clinicians don't even realize we're around on the weekends, so I don't think it's an individual's crappy work ethic that leads to this misconception. I'm sure that the OP has a different view on it now realizing that this is common rather than isolated practice.

 

[green mantis]

Grossing & signing out policies vary at each institution. Here's what occurred at my residency, which included 3 hospitals.

University medical center - On call resident grossed on Sat. This was to clean up cases from Fri & take care of any Sat cases. Last pick-up was at noon. No sign out on Sat unless it was a rush case.

VA - No grossing on weekends.

Large private hospital - On call resident grossed on Sat. This was to clean up cases from Fri & take care of any Sat cases. Hospital had fair number of outside contracts, so there were many biopsies that came in on Sat. On call attending triaged cases to sign out, usually biopsies.

A fair number of the groups I interviewed at had Sat sign out. Sat grossing occurred, so late Fri cases didn't get delayed for an additional day. While we may not like it, it's part of the job.

Also, keep in mind that pathology is a customer service related specialty. If grossing / signing out on Sat keeps your clinicians happy, it's unavoidable. It's not only important for patient care, but it's also important for your bottom line.

Lastly, I wouldn't consider grossing as scut work. Just because one doesn't like doing it or considers it tedious doesn't make it scut. In my opinion, there's actually very little scut work in pathology. One of the things that comes to mind is photographing slides for residents in other specialties who want to present at some conference, whether in house or out house. We get minimal credit for this & not much educational value.


----- Antony

 

[pathstudent]

Just imagine your mom's ovary sitting in a bucket from Friday afternoon until Monday morning.

Yeah no doubt.

And imagine if the operation is done late on Thursday and sits on Friday and fixes over the weekend and doesn't have slides coming out until Tuesday to not be signed out until Wednesday at the earliest.

 

[smellycat]

I have to agree. Saturday grossing is not scut. Small, medium, and large institutions gross on saturday. One thing you have to remember is that pathology is also a business. We need to keep our surgeons business by keeping turnaround times low. Thinking that we shouldn't cater to them would be naive.
If you don't find grossing on Saturday educational, one more thing you have to realize is that as a resident you are getting paid. If you were back in medical school and paying for your education, then it would be scut. But now someone is paying you (not that much though ;p).

 

[salt]

Also, keep in mind that pathology is a customer service related specialty. If grossing / signing out on Sat keeps your clinicians happy, it's unavoidable. it's also important for your bottom line.

This is what it comes down to. Keeping your customers satisfied. And avoiding a huge backlog to keep your workload managable. All the melodramatic hyperbole (visualize my mother's ovary - come on!) and highfalutin verbiage about quality and patient care is self-aggrandizing grandstanding. How does it REALLY effect actual "quality" or diminish patient care to delay a diagnosis a day or so? Sure, there are those infrequent cases where a diagnosis really needs to be made in short order, and that's what frozen sections are for, although a fair proportion of those are requested just because they can be and not because they are really needed. But what does it matter, really, from a "quality" or "patient care" point of view, if someones ovarian cyst, colectomy for tumor, enlarged thyroid, prostatectomy, ect, ect, sits in formalin an extra 24-48 hours?

You can make the point that getting our work done ASAP does what it can to get the info to the patient ASAP and therefore may be of value in helping an anxious person get their diagnosis quicker. That's patient care I suppose and I'll buy that all the way.

Mind you, I don't cotton at all to people whining about being expected do their job. And weekend grossing, if that's the way your shop rolls, is your job. Whatever glorious fable you want to tell yourself about why you need to toe the line, Suck it up and get it done.

 

[2121115]

And weekend grossing, if that's the way your shop rolls, is your job. Whatever glorious fable you want to tell yourself about why you need to toe the line, Suck it up and get it done.

This should be posted in every resident work room.

 

[icpshootyz]

But what does it matter, really, from a "quality" or "patient care" point of view, if someones ovarian cyst, colectomy for tumor, enlarged thyroid, prostatectomy, ect, ect, sits in formalin an extra 24-48 hours?

If it's in formalin, sure. But most of our late cases on a Friday or cases that come in Sat would not get into formalin if no one came in over the weekend. They would sit in a fridge slowly autolyzing or drying out. That was my point. I've tried to look at a temporal artery biopsy that was left in a fridge with no saline/formalin for 24 hrs by the surgeon and the histology was useless. That was my point about quality of patient care. Sure I recognize that the business aspect and turn-around-time is tantamount, but there are plenty of instances where the actual quality of the diagnosis would be worse if no one grossed on weekends. And as I'm typing this, I'm the one responsible for today's batch of cases 😉 Off to gross!

 

[KeratinPearls]

If it's in formalin, sure. But most of our late cases on a Friday or cases that come in Sat would not get into formalin if no one came in over the weekend. They would sit in a fridge slowly autolyzing or drying out. That was my point. I've tried to look at a temporal artery biopsy that was left in a fridge with no saline/formalin for 24 hrs by the surgeon and the histology was useless. That was my point about quality of patient care. Sure I recognize that the business aspect and turn-around-time is tantamount, but there are plenty of instances where the actual quality of the diagnosis would be worse if no one grossed on weekends. And as I'm typing this, I'm the one responsible for today's batch of cases 😉 Off to gross!

😱😱😱😱😱

 

[pathstudent]

OK I agree with some of what you are saying. Sitting on a benign thyroid is no big deal, but I have seen some cases get seriously F'ed up and/or delayed by pathology residents who didn't want to hustle.

I remember one in particular where a 30 year-old woman had a dermoid in her ovary but after sectioning it ended up being infiltrated by a Burkitt-like lymphoma. That took a few days for the gyn attending to figure out and she asked the resident to show it to the head lymphoma attendings. Well she was busy and overwhelmed and didn't get it shown for 2-3 days to him. The lymphoma attending blew up at her and said 'if this was your sister's case, would you have waited 3 days to show me'. The patient didn't find out for about ten days after her surgery that she had a serious disease and not just a benign teratoma. She needs to get staged and start treatment.

And yes even if it doesn't matter if the the report is put out today or tomorrow, you should still think of the patient behind the specimen.

Trust me Salt, when you or your wife has a lumpectomy or ovarian tumor or brain biopsy, you will want the diagnosis ASAP and won't think "oh it doesn't matter if we don't know until Friday". So it does matter.

This is what it comes down to. Keeping your customers satisfied. And avoiding a huge backlog to keep your workload managable. All the melodramatic hyperbole (visualize my mother's ovary - come on!) and highfalutin verbiage about quality and patient care is self-aggrandizing grandstanding. How does it REALLY effect actual "quality" or diminish patient care to delay a diagnosis a day or so? Sure, there are those infrequent cases where a diagnosis really needs to be made in short order, and that's what frozen sections are for, although a fair proportion of those are requested just because they can be and not because they are really needed. But what does it matter, really, from a "quality" or "patient care" point of view, if someones ovarian cyst, colectomy for tumor, enlarged thyroid, prostatectomy, ect, ect, sits in formalin an extra 24-48 hours?

You can make the point that getting our work done ASAP does what it can to get the info to the patient ASAP and therefore may be of value in helping an anxious person get their diagnosis quicker. That's patient care I suppose and I'll buy that all the way.

Mind you, I don't cotton at all to people whining about being expected do their job. And weekend grossing, if that's the way your shop rolls, is your job. Whatever glorious fable you want to tell yourself about why you need to toe the line, Suck it up and get it done.

 

[vada]

OK, WOW! We see over 100,000 surgical specimens a year at my program and the residents absolutely DO NOT gross on weekends!

 

[exPCM]

A situation where getting a diagnosis on a Monday versus getting the diagnosis on a Tuesday has real clinical significance is uncommon. I think grossing on weekends shows what doormats pathologists have become. I have met a number of dermatologists who have dermpath labs and I have not met a single one who routinely reads cases on weekends. Exceptions can always be made for the rare case where a frozen or touch prep was not performed and a rapid diagnosis is essential.
However routine grossing on weekends IMO is the epitome of scut which is a response to pathologists in a saturated job market who feel the need to do everything they can to kiss their clinicians' a**e$. I bet there are some pathologists who could justify picking up a clinician's dry cleaning as being part of good "customer service".
It's very simple: the ORs typically operate (with exceptions for emergent cases, etc.) on a 5 day work week and there is no legitimate reason that pathology grossing cannot be typically performed on a corresponding 5 day work week schedule (barring emergencies/special circumstances).

 

[pathstudent]

A situation where getting a diagnosis on a Monday versus getting the diagnosis on a Tuesday has real clinical significance is uncommon. I think grossing on weekends shows what doormats pathologists have become. I have met a number of dermatologists who have dermpath labs and I have not met a single one who routinely reads cases on weekends. Exceptions can always be made for the rare case where a frozen or touch prep was not performed and a rapid diagnosis is essential.
However routine grossing on weekends IMO is the epitome of scut which is a response to pathologists in a saturated job market who feel the need to do everything they can to kiss their clinicians' a**e$. I bet there are some pathologists who could justify picking up a clinician's dry cleaning as being part of good "customer service".
It's very simple: the ORs typically operate (with exceptions for emergent cases, etc.) on a 5 day work week and there is no legitimate reason that pathology grossing cannot be typically performed on a corresponding 5 day work week schedule (barring emergencies/special circumstances).

This attitude explains why you can't get a good job, and if I was a skull and bones private practice partner, I wouldn't ever hire you.

 

[JPmamd09]

I'm gathering from this thread that every program is different when it comes to this issue. Also that pathology, like every other specialty in medicine, involves doing some stuff we aren't necessarily thrilled about. While I absolutely concede that residency is about education, it is a job - that's why residents get paid, right? I don't know, that's kind of the way I see it.

 

[exPCM]

This attitude explains why you can't get a good job, and if I was a skull and bones private practice partner, I wouldn't ever hire you.

I have a job. And the partners in my group will continue to hire doormats for 130K per year (non-partnership track) who are willing to gross on weekends, pick up the tab at lunch, and spout off a lot of nonsense about how they love pathology. Anyone with sense will tell you that after a couple of years the idealism usually fades as reality sets in.

 

[path19]

I agree with ex-PCM's point on this one. It is not often you see a surgeon doing a tumor resection on the weekend and that is directly equivalent to pathologists grossing in order to get a quicker result to the patient. So, why should a pathologist gross a case that came in late on a Friday but the surgeon shouldn't resect a tumor on a Saturday or Sunday rather than waiting until Monday? And that doesn't even address the time (weeks?) patients have to wait to get onto the OR schedule.

If you want to talk about biopsies, we can sometimes make a difference in immediate patient care and no physician can complain about reading stat biopsies or cytologies for infection, rejection, etc on the weekend when this is the case. But routine biopsies? Ridiculous. We are the end of the chain which likely started weeks or even months earlier when the patient first saw their primary care doc who advised them to get a colonoscopy, see a urologist, etc. This pressure for TOT is a direct result of pathologists competing against each other for business.

As an aside, the clinician who performs a procedure and leaves a specimen without making sure it has been properly fixed (regardless of whether they put it in formalin or inform the on-call pathologist, etc) is responsible for the poor/uninterpretable result. (Assuming the pathology department has appropriately educated the clinicians on this issue).

 

[pathstudent]

I agree with ex-PCM's point on this one. It is not often you see a surgeon doing a tumor resection on the weekend and that is directly equivalent to pathologists grossing in order to get a quicker result to the patient. So, why should a pathologist gross a case that came in late on a Friday but the surgeon shouldn't resect a tumor on a Saturday or Sunday rather than waiting until Monday? And that doesn't even address the time (weeks?) patients have to wait to get onto the OR schedule.

If you want to talk about biopsies, we can sometimes make a difference in immediate patient care and no physician can complain about reading stat biopsies or cytologies for infection, rejection, etc on the weekend when this is the case. But routine biopsies? Ridiculous. We are the end of the chain which likely started weeks or even months earlier when the patient first saw their primary care doc who advised them to get a colonoscopy, see a urologist, etc. This pressure for TOT is a direct result of pathologists competing against each other for business.

As an aside, the clinician who performs a procedure and leaves a specimen without making sure it has been properly fixed (regardless of whether they put it in formalin or inform the on-call pathologist, etc) is responsible for the poor/uninterpretable result. (Assuming the pathology department has appropriately educated the clinicians on this issue).

Again, if your wife had a lumpectomy and was waiting to know if she would need chemo or not, would you want some J-off who complains about the job market non-stop, wore scrubs to CP rotations, listened to headphones while at work and rarely went to conferences to not deal with it because it doesn't matter if the diagnosis is made today or delayed a few days or would you want it done ASAP with the highest combination of speed without sacrificing quality.

People like you don't deserve good jobs. You will reap what you sow with ex=PCM and Raider!

I wish pathology wouldn't draw such losers. No wonder our job market is so messed up. There are a bunch of D minuses in our profession.

 

[APCPBBNP]

Again, if your wife had a lumpectomy and was waiting to know if she would need chemo or not, would you want some J-off who complains about the job market non-stop, wore scrubs to CP rotations, listened to headphones while at work and rarely went to conferences to not deal with it because it doesn't matter if the diagnosis is made today or delayed a few days or would you want it done ASAP with the highest combination of speed without sacrificing quality.

People like you don't deserve good jobs. You will reap what you sow with ex=PCM and Raider!

I wish pathology wouldn't draw such losers. No wonder our job market is so messed up. There are a bunch of D minuses in our profession.

O, Pathstudent, you are so pathetic!!!!😴

 

[salt]

OK I agree with some of what you are saying. Sitting on a benign thyroid is no big deal, but I have seen some cases get seriously F'ed up and/or delayed by pathology residents who didn't want to hustle.

I remember one in particular where a 30 year-old woman had a dermoid in her ovary but after sectioning it ended up being infiltrated by a Burkitt-like lymphoma. That took a few days for the gyn attending to figure out and she asked the resident to show it to the head lymphoma attendings. Well she was busy and overwhelmed and didn't get it shown for 2-3 days to him. The lymphoma attending blew up at her and said 'if this was your sister's case, would you have waited 3 days to show me'. The patient didn't find out for about ten days after her surgery that she had a serious disease and not just a benign teratoma. She needs to get staged and start treatment.

And yes even if it doesn't matter if the the report is put out today or tomorrow, you should still think of the patient behind the specimen.

Trust me Salt, when you or your wife has a lumpectomy or ovarian tumor or brain biopsy, you will want the diagnosis ASAP and won't think "oh it doesn't matter if we don't know until Friday". So it does matter.

Word of advice: when you send your brain on vacation let your fingers go with it. better that than let them waste ATP tapping rudderlessly on a keyboard and posting it here.

I'll save you some back looking and quote myself: "You can make the point that getting our work done ASAP does what it can to get the info to the patient ASAP and therefore may be of value in helping an anxious person get their diagnosis quicker. That's patient care I suppose and I'll buy that all the way."

That may be crap or whatever anyone wants to call it, but it in no way runs contrary to what you put up to oppose it. Anybody home? Huh? Think, McFly.

And your melodramtic sob story - while a very nice example of a transparent attempt to to elevate yourself to siant status by not so implicitly contrasting your sez you impecable work ethic with that of the straw dog sloth villian in your trite anecdote – is totally irreleavent to the issue being discused. Was there a Saturday in there? I missed it.

The thing about doormat is funny. I don’t post much on this forum but I've been watching it a loong time. in the old days, folks usta whine on and on about how pathologists don’t' get no respect. that yawn has been supplanted and then some by the current incessant lamentation about dwindling job prospects and how pod labs are ushering in the apocalypse. in short, about the disappearing dinero in this field. A flailing attempt to counter that tide is bending over taking it deep (including upping your TOT by weekend grossing) in the hopes of keeping the procurers of your raw material satisfied. Meanwhile, these neopathologists self rightously sanctify the doormatting of us by re-farting out the accredtiing council and certifying board style buzz words like 'quality" in the defence of things like weekend grossing.

Further convinces me that the highest tier in Maslow's Hierarchy of Need (remember that question that appeared on every f-n RISE?) should really have been self-rationalization.

 

[Parts Unknown]

And the partners in my group will continue to hire doormats for 130K per year (non-partnership track) who are willing to gross on weekends, pick up the tab at lunch, and spout off a lot of nonsense about how they love pathology.

How ironic.

 

[yaah]

A situation where getting a diagnosis on a Monday versus getting the diagnosis on a Tuesday has real clinical significance is uncommon. I think grossing on weekends shows what doormats pathologists have become. I have met a number of dermatologists who have dermpath labs and I have not met a single one who routinely reads cases on weekends. Exceptions can always be made for the rare case where a frozen or touch prep was not performed and a rapid diagnosis is essential.

Why are you equating reading out cases with grossing? Very few pathologists read out cases on weekends either. Since I started as an attending I have read out a couple of flow cases on saturday (when I was on call) and one surgical case which was a medical lung. We're talking about grossing, which is part of patient care. Other physicians don't take weekends off either - why should pathologists be any different if we are on call? And cases are performed all the time on weekends - they would be performed even more frequently if OR staffing issues could be resolved. The barrier to weekend surgery is generally not physician demand - it is hospital staffing.

Pathology residents have been grossing on weekends for decades, this is nothing new. It is part of being a professional. At my program we were responsible for our daily cases. On friday most of us decided we would prefer to leave at 5pm instead of spending another couple of hours grossing things, and come in on the weekend to finish up instead. Grossing does not have to be done on the weekend if you stay late enough on friday and treat it like any other day. But people want to have it both ways. It doesn't work like that!

You guys are acting like this is something so incredibly onerous. Pathology call is so light compared to other specialties. I can understand the rebellion against bowing at the altar of turnaround time but at the same time, patient care is patient care. Your job as a pathologist is to provide accurate diagnoses in as timely a fashion as is prudent. Patients do not exist to serve your needs.

This attitude is really puzzling. I get the objection to being forced to gross for hours on weekends, but I really don't get the objection to actually putting in a little work to do your damn job a little better. That attitude is hurting the field, not helping it - it doesn't matter one bit what the job market has to do with it.

 

[exPCM]

Why are you equating reading out cases with grossing? Very few pathologists read out cases on weekends either. Since I started as an attending I have read out a couple of flow cases on saturday (when I was on call) and one surgical case which was a medical lung. We're talking about grossing, which is part of patient care. Other physicians don't take weekends off either - why should pathologists be any different if we are on call?
Totally wrong here.
The vast majority of allergists, dermatologists, endocrinologists, and rheumatologists take weekends off.
Also many FPs, Peds, and IM docs now take weekends off as they are using hospitalists to cover inpatients.
Other than handling phone calls most plastic surgeons, ophthalmologists, psychiatrists, PM&R, nephrologists, and occ med docs do not work weekends.
The docs that work frequently on weekends like radiologists, some surgeons, and EM docs all make a lot more money that most pathologists.
The vast legions of government workers earning six figure incomes by and large do not work weekends ( http://www.boston.com/bostonglobe/e.../01/27/income_angst_not_for_public_employees/ )

And cases are performed all the time on weekends - they would be performed even more frequently if OR staffing issues could be resolved. The barrier to weekend surgery is generally not physician demand - it is hospital staffing.

So now you want everyone else to work weekends too.

Pathology residents have been grossing on weekends for decades, this is nothing new. It is part of being a professional. At my program we were responsible for our daily cases. On friday most of us decided we would prefer to leave at 5pm instead of spending another couple of hours grossing things, and come in on the weekend to finish up instead. Grossing does not have to be done on the weekend if you stay late enough on friday and treat it like any other day. But people want to have it both ways. It doesn't work like that!
So I guess anyone who doesn't work on weekends is not a professional. I don't think being a doctor should automatically preclude having a life outside medicine.
You guys are acting like this is something so incredibly onerous. Pathology call is so light compared to other specialties. I can understand the rebellion against bowing at the altar of turnaround time but at the same time, patient care is patient care. Your job as a pathologist is to provide accurate diagnoses in as timely a fashion as is prudent. Patients do not exist to serve your needs.

This attitude is really puzzling. I get the objection to being forced to gross for hours on weekends, but I really don't get the objection to actually putting in a little work to do your damn job a little better. That attitude is hurting the field, not helping it - it doesn't matter one bit what the job market has to do with it.

The real attitude that hurting the field is the attitude that I will be a doormat and then rationalize how my being a doormat is a noble thing. As pathology becomes populated with a mass of wimps and doormats, the status of the field will drop further.

Here's a simple grossing schedule:
Monday: gross Monday cases and the late night Friday-Sunday cases (small number usually since the ORs typically run on full staffing only Monday-Friday daytime.
Tuesday: gross Tuesday cases and late Monday night cases.
Wednesday: gross Wednesday cases and late Tuesday night cases.
Thursday: gross Thursday cases and late Wednesday night cases.
Friday: gross Friday cases and late Thursday night cases.

This schedule is just fine. As an earlier poster pointed, many patients wait weeks or more to get their surgery performed and one day extra for a pathology report is typically not critical from a clinical standpoint.

I am a very hard worker but I think that in pathology you can really get things done predominantly on Monday-Friday leaving the weekends as time for family activities, religious activities, exercise, outside interests, etc. just like our many bureaucrats do. How many people at the ACGME (our residency accrediting body) work weekends? I have never seen a hospital administrator at the hospital on a weekend. How many med school deans/employees frequently work weekends? Do you think you will ever find Dr. Betsy Bennett or the rest of the ABP workers in the office on a typical weekend? Are you saying Dr. Bennett is not a professional? Gimme a break.

-

 

[yaah]

Again, you are using fallacious arguments to support your opinions. Dr Bennett is not in the business of patient care. Medical school deans and ACGME officials are not in the business of direct patient care. So whether they work weekends or not is completely irrelevant and is akin to saying that bankers don't work weekends (even though they do!). And you are also making arguments that aren't true - pathologists at my hospital do make more than the EM docs and more than many of the surgeons. But again, this is not really relevant to the argument. What is relevant is patient care and getting work done. I cannot believe you are seriously suggesting that nephrologists, psychiatrists, rheumatologists, plastic surgeons, and ophthalmologists do not work weekends! This is so patently untrue it doesn't deserve further comment. Of course many of them can choose a career or practice model where they don't, but they generally have to make sacrifices if they do.

Grossing for a couple of hours on an occasional weekend does not detract from the rest of your life. Let's get some perspective here. No one is suggesting you be a doormat. I am not a doormat either. But you can be a professional and not be a doormat. There are reasonable compromises between being a doormat and refusing to accomodate the interests of anyone other than yourself.

 

[Art]

A situation where getting a diagnosis on a Monday versus getting the diagnosis on a Tuesday has real clinical significance is uncommon. I think grossing on weekends shows what doormats pathologists have become. I have met a number of dermatologists who have dermpath labs and I have not met a single one who routinely reads cases on weekends. Exceptions can always be made for the rare case where a frozen or touch prep was not performed and a rapid diagnosis is essential.
However routine grossing on weekends IMO is the epitome of scut which is a response to pathologists in a saturated job market who feel the need to do everything they can to kiss their clinicians' a**e$. I bet there are some pathologists who could justify picking up a clinician's dry cleaning as being part of good "customer service".
It's very simple: the ORs typically operate (with exceptions for emergent cases, etc.) on a 5 day work week and there is no legitimate reason that pathology grossing cannot be typically performed on a corresponding 5 day work week schedule (barring emergencies/special circumstances).

A close freind had a biopsy that was grossed on a Saturday, which allowed the diagnosis to be made a full day earlier. It did not change the diagnosis or the treatment plan. But knowing the diagnosis a full day earlier made a huge difference in the clinical state of mind for this person. In my opinion, as medical professionals, we have an obligation to work an occasional Saturday.

 

[icpshootyz]

Exactly. No one's making the argument that pathology will somehow become a 24/7 department, that's not the point. The point is that having someone come in for a few hours on a Saturday to take care of the late Friday cases is hardly a big deal. In a residency it would be the on-call resident. In a practice it would only be one of the pathologists. Therefore it is something that will not happen very frequently for any one resident/pathologist. The most call I've ever had in a single year was 10 weeks, so that mean 10 Saturdays the entire year I had to come in. Whoopity doo. Plus, there's often a glut of larges that come out late on Fridays. Yesterday (Saturday) I had 4 lumpectomies, two colons (one w/ an ovary), a TAH/BSO, and then several biopsies and junk smalls. None of these specimens came in early enough to be late-run and placed in formalin, and therefore would have sat until Monday morning autolyzing. I suppose the argument could be made to have a resident/pathologist stay very late Fri to insure all cases were placed in formalin so they could fix until Monday. But, for breast cases I think the new ER/PR/Her2neu marker studies state that they can't sit in formalin too long without affecting the marker status, so that might not work anyways.
I came in at my normal weekday time and was done grossing by noon. Sure, I didn't go out partying on Friday night, but that's what being on call means. I don't feel like I was bent over and raped by my department for having to come in and take care of that. There are fights to pick as our field progresses, but Sat grossing doesn't seem like a worthwhile battle.

 

[exPCM]

Exactly. No one's making the argument that pathology will somehow become a 24/7 department, that's not the point. The point is that having someone come in for a few hours on a Saturday to take care of the late Friday cases is hardly a big deal. In a residency it would be the on-call resident. In a practice it would only be one of the pathologists. Therefore it is something that will not happen very frequently for any one resident/pathologist. The most call I've ever had in a single year was 10 weeks, so that mean 10 Saturdays the entire year I had to come in. Whoopity doo. Plus, there's often a glut of larges that come out late on Fridays. Yesterday (Saturday) I had 4 lumpectomies, two colons (one w/ an ovary), a TAH/BSO, and then several biopsies and junk smalls. None of these specimens came in early enough to be late-run and placed in formalin, and therefore would have sat until Monday morning autolyzing. I suppose the argument could be made to have a resident/pathologist stay very late Fri to insure all cases were placed in formalin so they could fix until Monday. But, for breast cases I think the new ER/PR/Her2neu marker studies state that they can't sit in formalin too long without affecting the marker status, so that might not work anyways.

WTH: Most sensible hospitals require that the OR personnel place the specimens in formalin so that they don't autolyze on a shelf so this argument is weak. And yes if you leave the breast tissue in formalin for 20 days there will be some marker degradation but there is a big difference between 3 days and 20 days: http://www.ncbi.nlm.nih.gov/pubmed/12051639
http://www.medscape.com/viewarticle/712991
If you don't mind working 20% of your Saturdays each year then good for you - very heroic.
I have never met a dying patient who said that they regretted not working more hours or working more weekends. I have met numerous terminal patients who wished they had spent more time with their families.

I came in at my normal weekday time and was done grossing by noon. Sure, I didn't go out partying on Friday night, but that's what being on call means. I don't feel like I was bent over and raped by my department for having to come in and take care of that. There are fights to pick as our field progresses, but Sat grossing doesn't seem like a worthwhile battle.

-

A close freind had a biopsy that was grossed on a Saturday, which allowed the diagnosis to be made a full day earlier. It did not change the diagnosis or the treatment plan. But knowing the diagnosis a full day earlier made a huge difference in the clinical state of mind for this person. In my opinion, as medical professionals, we have an obligation to work an occasional Saturday.

Of course if your friend had the biopsy on Thursday he/she could have got a diagnosis on Friday instead of Monday - but let me guess - it was impossible to do the biopsy on Thursday.

 

[Benni]

Geez, people. Rip his head off, why don't you... the OP is just a med student, and I seriously doubt whether he/she realizes that most programs and private practices do gross on weekends and how much grossing would be considered scut. I happen to enjoy grossing and think it's important for a good pathologist to understand how to do it well, but there is such a thing as too much of a good thing; i.e. when it's at the expense of ever getting to look at slides, so it's not a stupid/lazy question. Having said that, grossing on the weekends in of itself is not scut, but simply good patient care as other posters have said, so that specimens don't sit around for two, possibly three days. Many clinicians don't even realize we're around on the weekends, so I don't think it's an individual's crappy work ethic that leads to this misconception. I'm sure that the OP has a different view on it now realizing that this is common rather than isolated practice.

1. Thank you for coming to my defense
BUT 2. I'm happy this post generated so much debate, as the points made (while some highly laden with emotion), were generally quite useful in educating on the matter.
3. You are right, I don't have a good feel for how this works. I thought that once pathologists obtain work as an attending or in private practice, they generally did not gross as much because they had residents, PAs or some of both doing most of that work. (I did not think this would be a sacrifice to pt care or client satisfaction as PAs appear to be very good at what they do).
4.My concern also was not so much that I am not willing to work on a Saturday, but whether grossing is the best way to spend my Saturday time (as I was under the incorrect assumption that if I am not grossing, a PA would be). My thought being, is it better to spend required time as a resident grossing on a Saturday or would it be better to train at a place that does not require Saturday grossing so one could spend that time studying/reviewing cases/etc or if you're on call, signing out frozens/emergent cases. I perhaps had been incorrectly led to believe that you know how to gross 6 months into residency. Thereafter, I was also led to believe coming in on a Saturday to gross biopsies or perhaps even big cases would not necessarily enhance your learning. However, I was also led to believe those residents who take time on Saturdays/evenings/etc. to study are the same residents who excel. So regardless of how I spend my time when I get a real job, my main concern in residency is spending as much of my time doing what adds the most learning so I can excel in what I do, which I think would be the best for my patients and my clients in the future. Nonetheless, many of you made the point that you feel grossing on Saturdays is good for learning as well as pt care and client satisfaction.

 

[exPCM]

1. Thank you for coming to my defense
BUT 2. I'm happy this post generated so much debate, as the points made (while some highly laden with emotion), were generally quite useful in educating on the matter.
3. You are right, I don't have a good feel for how this works. I thought that once pathologists obtain work as an attending or in private practice, they generally did not gross as much because they had residents, PAs or some of both doing most of that work. (I did not think this would be a sacrifice to pt care or client satisfaction as PAs appear to be very good at what they do).
4.My concern also was not so much that I am not willing to work on a Saturday, but whether grossing is the best way to spend my Saturday time (as I was under the incorrect assumption that if I am not grossing, a PA would be). My thought being, is it better to spend required time as a resident grossing on a Saturday or would it be better to train at a place that does not require Saturday grossing so one could spend that time studying/reviewing cases/etc or if you're on call, signing out frozens/emergent cases. I perhaps had been incorrectly led to believe that you know how to gross 6 months into residency. Thereafter, I was also led to believe coming in on a Saturday to gross biopsies or perhaps even big cases would not necessarily enhance your learning. However, I was also led to believe those residents who take time on Saturdays/evenings/etc. to study are the same residents who excel. So regardless of how I spend my time when I get a real job, my main concern in residency is spending as much of my time doing what adds the most learning so I can excel in what I do, which I think would be the best for my patients and my clients in the future. Nonetheless, many of you made the point that you feel grossing on Saturdays is good for learning as well as pt care and client satisfaction.

I learned how to gross in residency but since becoming an attending I have not grossed a single specimen (have PAs that handle the grossing). Grossing on Saturdays (particularly small biopsies) is only weakly educational at best. To be a pathologist today you need to be able to read lots of glass every day. If you can't accurately and swiftly read glass then even if you are lucky enough to land a job, it won't matter how much Saturday grossing you did - you won't make it in pathology. In many groups you also need to be able to handle frozen sections and evaluate FNAs in real time for adequacy/diagnosis.

 

[yaah]

3. You are right, I don't have a good feel for how this works. I thought that once pathologists obtain work as an attending or in private practice, they generally did not gross as much because they had residents, PAs or some of both doing most of that work. (I did not think this would be a sacrifice to pt care or client satisfaction as PAs appear to be very good at what they do).

It depends on the private practice. If you work in a true private practice (partnership stuff) then your group would almost certainly have to pay the PA, which then becomes a financial calculation. Many groups don't want to pay a trained PA so they gross cases themselves (smaller cases like biopsies can be done by non PAs). You have to understand grossing as an attending because occasionally you will get really complicated cases that you need to help out with, or if you only pay one PA then someone will have to gross when the PA goes on vacation. Our group has 1.5 PAs for about 60,000 specimens, plus other techs who are trained to gross most small biopsies. So we almost never have to gross. If you are in academics as an attending you probably won't ever have to gross unless you want to take a hands-on approach to teaching residents (which can be very helpful).

It is easy to learn the basics of grossing but takes work to become truly good at it - a lot of people dismiss the importance of the gross exam or treat it like something anyone can do. But a good gross exam makes a huge difference in cost savings for your lab (fewer cassettes, quicker grossing of each case) plus patient care (more accurate staging, etc). IMHO, too many residents blow off grossing as "scut" or something else instead of spending the time to truly learn it and become proficient at it. You can pass the boards and be a competent pathologist without being a good grosser but it will make you better if you are a good one. Unless all you read out is biopsies, that is.

 

[2121115]

To be a pathologist today you need to be able to read lots of glass every day. If you can't accurately and swiftly read glass then even if you are lucky enough to land a job, it won't matter how much Saturday grossing you did - you won't make it in pathology. In many groups you also need to be able to handle frozen sections and evaluate FNAs in real time for adequacy/diagnosis.

This just underscores how much time in residency we spend doing things that are irrelevant to what 90% of us will be doing in the future. Pathologists always say that new graduates aren't good enough, aren't well trained etc, but what do they expect? If you don't sign out 60 cases a day as a resident then how do you just show up one day as an attending and start doing it? It is like a general surgery resident operating 2 or 3 months per year as a resident. Absurd.

 

[icpshootyz]

At my hospital only small biopsies are placed into formalin directly by the OR staff. No larges ever come to the path department already in formalin. I've actually never seen that done, either here or where I did my post-sophomore fellowship. Besides that, many of our surgeons have a tendency to forget to put the biopsies in formalin, too. But then again, sometimes you don't want your tissue coming down in formalin because you may want to take samples for tissue banking or molecular studies, who knows.
Look, I'm not saying I'd be opposed to skipping the Sat grossing, I'm just saying there's other battles I would pick before getting all worked up about that one. And as a senior resident I have two weeks of call the entire year, so it's really not an issue. Sure a PA could do it, but then the hospital would have to pay a PA overtime to come in on a Sat and we know that's not going to happen. I recognize that the department uses residents to save money, no kidding. Same thing happens in every field. We're cheap labor, always have been and always will be.
I do feel that grossing smalls/skins/biopsies should be a first-year only responsibility. As a senior, grossing larges still has educational value, and I would argue that as an attending I would like to physically see my large cases. I hate trying to decipher someone else's gross report and section code. To be honest if I do general surg path I might try to find a job where I do some grossing, I like it. To each his own, I suppose.

 

[lipomas]

Holy crap. I thought the job market discussion were annoying. Since when does having to do a little work on a weekend from time to time mean you are someone else's bitch? Damn, there is a major league sense of entitlement on here. You people all do understand that there are degrees of things, right? It's not like you either work 12 hours every saturday doing meaningless work or you do only absolute emergencies. I would say both of those extremes are unacceptable and neither are realistic. I think some of you are trying to pick fights meaninglessly - what's the deal? There are a lot of pathologists out there who totally suck at gross exams and correlating gross findings with microscopic findings. Perhaps not coincidentally these are the same people who often complain about how much time they have to gross and how "useless" it is.

This just underscores how much time in residency we spend doing things that are irrelevant to what 90% of us will be doing in the future. Pathologists always say that new graduates aren't good enough, aren't well trained etc, but what do they expect? If you don't sign out 60 cases a day as a resident then how do you just show up one day as an attending and start doing it?

If you look at those studies, people say new graduates are not good enough in almost everything except signing out cases. There are always some comments about signing out cases (like new hires show too many cases around, things like that) but in general "surgical pathology skills" almost always comes out near the top of those surveys in terms of how prepared graduates are. Perhaps it's because residency programs pay too little attention to the other stuff and pay too much attention to signing out cases. To be honest, I learned a ton of stuff that I am finding out now applies to private practice while I was on call in residency - the "meaningless" stuff. Some practicing pathologists do almost nothing except read out slides, but many of us do lots of other stuff too, even if reading out slides is still the majority of our day.

 

[djmd]

This issue needs to be separated from "patient care"...

Improper fixation, lack of fixation, specimens in refrigerators without formalin or saline are patient care issues... if grossing on Saturday is the only way you can address that then so be it...

But saying that not grossing on Saturday is inadequate patient care is ridiculous.
And listing off cases where cases took multiple extra days is not the same. I guess we should gross on Christmas, new year, and every other holiday too no?

Appropriate patient care means giving every case your full attention and appropriate handling. So in fact getting the afternoon breast bx in to the processor is not good patient care (need appropriate formalin fixation for good IHC/FISH). Signing out a case when you are tired and ready to go home is a bad idea..

I had one attending literally tell me he never signs out a case when he is "Tired, hungry, or has to go to the bathroom." If a case sits for one extra day because you think you are not in the right state of mind (fatigue, etc), it is not bad patient care. You want the right dx not the fastest. Speed of dx is not the best way to talk about patient care.

(that being said cases that are holding for longer than the standard need physician contact so they know why/what to tell the patient).

 

[BrainPathology]

This issue needs to be separated from "patient care"...

Improper fixation, lack of fixation, specimens in refrigerators without formalin or saline are patient care issues... if grossing on Saturday is the only way you can address that then so be it...

But saying that not grossing on Saturday is inadequate patient care is ridiculous.
And listing off cases where cases took multiple extra days is not the same. I guess we should gross on Christmas, new year, and every other holiday too no?

Actually my program does/did gross on all holidays. JUST like OR's are open on holidays. You rotate the call on holidays just like you do on weekends. An attending was always reachable on the holiday as well. Again, just like the OR's were - open, not on a full schedule but for whatever needed to be done.

If some of you people hope/want to be "respected" like surgeons and other speciaties then get a grip, get out of your soft comfy bed on days that people not in medicine don't work and f*ckig work as if you deserve respect. . .

For the OP.. the most relevant reason for YOU to want to gross on weekends is that the board exam is peppered with gross pictures. You won't get good at corresponding gross pictures with pathology unless you gross as much as you can. Additionally, at least in my residency, some of the most complicated/rare cases that required lots of OR time were scheduled on the weekends when there was lots of available OR time. These kinds of cases, that I grossed usually on Sunday mornings or afternoons, are what often came up on the board exams (at least for me).

.. AND the one thing that exPCM says that actually corresponds with reality is that you may not gross much after residency. It will actually help you sign cases out faster if you can correspond gross reports to your slides and all the grossing you do in residency may be the only chance you have to learn how to do that. (and it may save your butt if you can correspond what you DON'T see from the gross report on the slides) My original post which was jumped on as mean wasn't directed at you, but at the residents/attendings who are equating having to work more than 40 hour weeks with somehow morphing into a submissive sexual object for the rest of medicine.