Should there be a match for pathology fellowships?

[DarksideAllstar]

The guy who has fellowships locked up 2 and 3 years out.

Supposedly.

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[trent05]

I personally don't have a problem with the current system. I think a match system would just cause added headache and anxiety. Do really want to worry about things like "did I interview at enough places", "am I ranked to match?", and "what if I have to scramble ". I think going through that once is enough. Besides, it is nice to know where you are going several years in advance . I think there is nothing wrong with giving strong consideration to the residents at the same institution. As DPL said, you should take into account which fellowships a particular residency program has, especially if you are considering one of the competitive ones or if you are undecided. For me, it was one of the most important factors for my rank list.

 

[yaah]

And not to dwell on the MD/PhD thing again p ) but I've known a few that had thier fellowships lined up after only one year in residency based I'm guessing on their talent, skill, CONNECTIONS, and publication record.

Is that really right though? Once you get to residency you will see that people start to distinguish themselves in certain areas, and it is rarely that obvious when they start training. In my program, almost every resident has gone through a period of changing their mind about where their true interests lie or where their talents lie. Personally, I have had a bunch of shifts, from my early interest in GI (which persisted but not to the extent that I want a fellowship in it) to an early interest in GU which has sustained and grown, to a surprising like of dermpath and hemepath, etc etc. But I have had to "pick one" (or two). It's frustrating at times to have to decide, but I also count enormously on my own experiences as to what I like and don't like, and I look at the complete ***** I was when I started here and under no circumstances do I want THAT goofball deciding my future.

Now, you may postulate that one's talent and skill is often clear after only one year of residency. Sure, I will grant you that that is often true. But it is rarely to the level that as I pathologist I would consider significant. Just because someone "decides" early on (like in the first week of residency) that they like dermpath and then they start doing projects doesn't make them a potentially better dermatopathologist. Nor does it mean they deserve it more (although in SOME cases it can). The ideal situation is when you know early on where your specific interests lie and you act on this. But you have to be VERY careful to not close the door on other potential successful areas, and I think it is incumbent on fellowship directors to realize this also (and many do).

Are we really to think that the peak of one's talent and skill during residency manifests itself during first year? I find that ludicrous. I have seen many residents here grow quite a bit and modify their interests, and when they finally do decide on their specific subspecialty, it is a lot clearer to them as to what they want and how to go about doing it. If they get shut out of it because they were "too late" is that really fair?


The points that trent makes are very good, but you also have to consider that applying for fellowships in the current system is FAR from stress free. As someone who is going through this now, I find it far more stressful and uncertain. As I said, it is going to work out for me, probably quite well (trying to decide on specialty A + specialty B or just doing Specialty B), but that doesn't make it right.

I agree there is nothing wrong with giving high consideration to local applicants, but one also must be cautious not to count on this. We have a lot of fellowships here, but also a lot of residents, and many get denied their fellowship of choice, sometimes appropriately, sometimes unfairly. But I do agree that doing your training at a place with lots of fellowships is important, if nothing less than you know that the place has enough volume to train you sufficiently in that area.

 

[deleted113029]

Arrrrrgh! Stop the madness! let's all go out drinking and smoke cubans...mmmm...love those cubans.

MD vs MD/PhD vs MD/MS (This is me...damn it, what about me?!!! )

Fellowships: internal vs. external, match vs. nonmatch (I just wanna start path residency. maybe i'll be one of those subpar MD only (closest category to MD/MS) people that 1Path mentioned. )

I'm ranting because my attendings are working me to the bone these days...fully aware that i'll be going into pathology!

 

[yaah]

Don't worry villin, we subpar people do pretty well

 

[Sean2tall]

Maybe I missed it, but what fellowship are you going for yaah?

 

[1Path]

Are we really to think that the peak of one's talent and skill during residency manifests itself during first year? I find that ludicrous. I have seen many residents here grow quite a bit and modify their interests, and when they finally do decide on their specific subspecialty, it is a lot clearer to them as to what they want and how to go about doing it. If they get shut out of it because they were "too late" is that really fair?

I really don't disagree with your position on the fellowship situation, it's simply that the system as it stands now looks a LOT like real world employment situations to me. And after thinking about this in a little more depth, I'd say that most of the residents I worked around and with, had their fellowship plans locked down by the end of their 3rd year of residency. In other words I'd say anyone seriously thingking about fellowships AFTER 3rd year may find themselves well behind thier peers.

In the end, I don't know how much of this is about "fairness" or people distinguishing themselves or peaking during their first year at least from what I've already observed, it's more like folks start jockying for fellowships positions early in the game.

 

[1Path]

Fellowships: internal vs. external, match vs. nonmatch (I just wanna start path residency. maybe i'll be one of those subpar MD only (closest category to MD/MS) people that 1Path mentioned. ):

Dude, I never said MD onlies were subpar so don't hate the playa, hate the MD/PhD's!

 

[b&ierstiefel]

Dude, I never said MD onlies were subpar so don't hate the playa, hate the MD/PhD's!

Don't hate us MD/PhDs...we are but a simple folk.

We have small hands and we smell like cabbage (OK, what movie am I referencing? And what group of people are being referenced?)

Good points trent and yaah...and yes, with the current system, things are not stress free. If a certain fellowship has only two spots, let's say, and we have 4 people interested in the fellowship for the same year, things can get dicey. Imagine the competition...imagine the potential for backstabbing...I imagine that situations like this are stressful. So let's not make it anymore stressful than it is and limit fellowships to in-house candidates (so as to not add additional stress associated with competing against outsiders who kissed a lot of ass in their residency programs and got great letters)...j/k

 

[yaah]

CARNIES

Only two things scare me.

In terms of what fellowship I am doing, I haven't said. So you didn't miss anything. I think I'll be cryptic. Let's just say it's NOT cytology.

And 1path you are right that residents should have their fellowship in hand by the end of third year. There are VERY few that would fill within one year of start date. But we're talking about a growing necessity to "express an interest" before you even know what the hell that interest is all about. That's what I disagree with. I don't really think it is like real world employment. There are some similarities, but not really because the situations are not analogous enough.

Someday I hope to run a fellowship program, that way I can see if I can see through the phonies and the gunners.

 

[b&ierstiefel]

For yaah, I have my money on dermpath.

$10

yaah...ditch that dermpathlover account, man....it's so not you.

 

[dermpathlover]

CARNIES

Only two things scare me.

In terms of what fellowship I am doing, I haven't said. So you didn't miss anything. I think I'll be cryptic. Let's just say it's NOT cytology.

Someday I hope to run a fellowship program, that way I can see if I can see through the phonies and the gunners.

Who the hell is phony (people won't apply for fellowships if it is not what they want to do)? And being a gunner always pays off in life. There is no substitute for hard work. Think of the saying, the early bird gets the worm. It is a fact of life!! It is true in everything, including fellowships.

And you don't need to know what you want to go into your first year of residency. You can decide in your third year that you want to dermpath of GI, you just might have to sit out a year and do another fellowship between residency and that fellowship. There is nothing wrong with doing an extra year of surg path or cytology or something before doing derm path. If that is the price you have to pay to get derm, it would be worth it. Plus you would be that much better trained, could pass boards that much easier and possibly command a higher salary coming out.

 

[djmd]

Dermatohematopathology

Come on man... Hemodermatopathology (which is way better than your version) is ridiculous... You aren't synergizing the two.

 

[mcfaddens]

This thread is still going. Just let it and DPL die. Please.. for the children

 

[b&ierstiefel]

Come on man... Hemodermatopathology (which is way better than your version) is ridiculous... You aren't synergizing the two.

He can be the world's next expert in CTCL.

 

[yaah]

He can be the world's next expert in CTCL.

Not profitable enough.

 

[dermpathlover]

He can be the world's next expert in CTCL.

Or I can be the world's expert in dermatopathic lympadenopathy or identifying metastatic sebaceous carcinoma in a lymph node

 

[djmd]

Still no money in that either.