Stanford Hemepath

[pongo]

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Hey LADoc (or anyone else on the West Coast) - any thoughts on the Stanford Hempath fellowship? Some of our faculty didn't know they had a separate hemepath fellowship - I guess it has traditionally been part of their surgpath fellowship. It's amazing how many fellowships are already filled for 2008-2009. I guess people are locking down their in-house candidates during the first two years.

 

[LADoc00]

Hey LADoc (or anyone else on the West Coast) - any thoughts on the Stanford Hempath fellowship? Some of our faculty didn't know they had a separate hemepath fellowship - I guess it has traditionally been part of their surgpath fellowship. It's amazing how many fellowships are already filled for 2008-2009. I guess people are locking down their in-house candidates during the first two years.

Stanford definitely has a separate and reknowned Hemepath fellowship. The reason why so many connect the surg path and hemepath programs is because Stanford is legendary for lymph node pathology, dating to its founding in the 1970s (prior to that Stanford's only path training program was in fact run by the local VA system) with Dorfman of Rosai-Dorfman disease fame, an expat from the juggernaut WashU program where Lauren Ackerman (not related to Bernie) invented the 'hot seat' method/Méthode à l'Ancienne of training fellows after WWII.

Although fantastic in lymph node path, it was never a big bone marrow center like Foucar/Vardiman/MDA level. Stanford then recruited the guy who ran hemepath for the City of Hope in LA (which trained an insane number of famous hemepath people) and simultaneously built a new cancer center.

Given all that, I would say Stanford has the top hemepath fellowship in the country just because they have every base covered in terms of specimen load. In terms of competiveness, I would guess that is the toughest fellowship to land there, probably far beyond even dermpath. Many are MDPhD-types I would guess, probably on the short road to working in Irv Weissman caliber labs.

Outside of Stanford, I would look at Utah, MDA, MGH and even the NCI/NIH.

PS- An interesting little factoid for those not familiar, Stanford's medical school had in fact been in downtown San Francisco in the remote past and was owned by the University of the Pacific (which still has the associated dental and pharmacy schools). Suprisingly, many people said a medical school and hospital in the South Bay would never survive financially because it was all farm land....then came 2 engineers working out of a detached garage named Bill and Dave...

PS2-for super bonus brownie points who knows the original name of the UCSF medical school?

 

[futureresident]

LaDoc,

Do you know anything about Stanford's Molecular Pathology Fellowship?

Thanks.

 

[LADoc00]

LaDoc,

Do you know anything about Stanford's Molecular Pathology Fellowship?

Thanks.

What would you do with it????

Realize Stanford Mol Path Fellowship does NOT equal working with people like Andrew Fire....

I have met a few molpath fellows and not many have been that satisified with niche they are getting, be they at Brigham or Stanford. I figure in the future molpath will be a purely PhD administrated field, similar to biochemical genetics.

 

[futureresident]

I don't know about that. Most directors of molecular diagnostic laboratories are MDs and not PhDs....Furthermore, though they might be able to validate and implement different molecular assays, I don't think a PhD would have a clue about DEVELOPING molecular assays that have predictive, prognostic, and/or diagnostic utility.

A molecular pathology fellowship is a great fellowship to combine with any other pathology subspecialty, most importantly with hemepath. Though it would almost invariably limit you to an academic setting, I've been told by pathology chairmen and PDs that it is a very desirable fellowship to have.

 

[Gut Shot]

PS2-for super bonus brownie points who knows the original name of the UCSF medical school?

I believe that would be Toland Medical College.

 

[LADoc00]

I don't know about that. Most directors of molecular diagnostic laboratories are MDs and not PhDs....Furthermore, though they might be able to validate and implement different molecular assays, I don't think a PhD would have a clue about DEVELOPING molecular assays that have predictive, prognostic, and/or diagnostic utility.

A molecular pathology fellowship is a great fellowship to combine with any other pathology subspecialty, most importantly with hemepath. Though it would almost invariably limit you to an academic setting, I've been told by pathology chairmen and PDs that it is a very desirable fellowship to have.

good luck with that. Asking a PD or chairman of department career advice is like asking a real estate agent if its a good time to buy a house...Im telling you molecular will be consolidated in the future into very few hands, huge places like Quest, ARUP and USLABS will be the primary clearinghouses and those places only need a small number of MD or PhDs or whatever the hell is cheaper to run them. There is NO, I repeat...NO professional component billing I am aware of, maybe other than difficult gel confirmations (and I dont even have a clue what that CPT code is..) in all of molecular. that likely means nothing to you now and probably means nothing to a salaried academic PD...but trust me on this...no professional billing, no job. Its that simple.

In terms of developing future assays...give me a break. Most assays for such things as quant PCR for BCR-ABL or even newer stuff like FLT3 assays are developed by biomed corporations based on basic science research, which and note this: Does not require any input whatsoever from a mol path MD. In fact most molecular stuff now is marketed directly to Oncologists, bypassing pathology altogether. Genomic health is a great example.

In conclusion, Yes Molecular diagnostics IS important and will continue to be so, But... Molecular path fellowships are indeed worthless in their current form.

The only way I would even remotely see mol path being worth something is if you did it as part of a biotechnologies partnership program with a large corporation and took a hefty load of business school/management classes along with it.

 

[futureresident]

I never said that molecular pathology makes money; in fact, it doesn't as you rightly pointed out and therefore, wouldn't be a sought after fellowship in private practice currently. Molecular tests are expensive, cumbersome, and currently not standardized. The reimbursement sucks too.

My point, however, was that a molecular fellowship will certainly make someone more marketable for an academic career in pathology, especially if they do not have a PhD or a molecular biology background. There is so much molecular related research spanning every subspecialty of pathology. I don't see why combining molecular pathology with another subspecialty will not make you a more desirable candidate to academic programs.

With reference to development of assays, I know this: Path Uroyvsion, a multitarget FISH assay for detecting bladder cancer was developed by a biotech company (VYSIS) and I know for a FACT that a pathologist was instrumental in its development. I also know for a FACT that a pathologist played a huge role for the implementation of HER2Neu FISH testing to predict response to Herceptin; without his input, Genentech was going to recommend Her2Neu amplification testing on IHC---which would have been a HUGE mistake. Also, a recent molecular assay (one developed at NIH) based on gene expression profiling has been shown to be superior to current diagnostic modalities to classify a lymphoma as DLBCL versus Burkitt Lymphoma (NEJM). This was NOT developed at a biotech lab, and they are looking to roll out a smaller, molecular based assay for clinical use. The original NEJM paper which discussed development of Oncotype DX by Genomic Health had lots of MDs on the paper, one of which is a pathologist. Another assay to detect lung cancer (LAVysion, multi-targeted FISH), which more accurately predicts lung cancer than cytology (recent CHEST article), was developed by pathologists.

 

[LADoc00]

I never said that molecular pathology makes money; in fact, it doesn't as you rightly pointed out and therefore, wouldn't be a sought after fellowship in private practice currently. Molecular tests are expensive, cumbersome, and currently not standardized. The reimbursement sucks too.

My point, however, was that a molecular fellowship will certainly make someone more marketable for an academic career in pathology, especially if they do not have a PhD or a molecular biology background. There is so much molecular related research spanning every subspecialty of pathology. I don't see why combining molecular pathology with another subspecialty will not make you a more desirable candidate to academic programs.

With reference to development of assays, I know this: Path Uroyvsion, a multitarget FISH assay for detecting bladder cancer was developed by a biotech company (VYSIS) and I know for a FACT that a pathologist was instrumental in its development. I also know for a FACT that a pathologist played a huge role for the implementation of HER2Neu FISH testing to predict response to Herceptin; without his input, Genentech was going to recommend Her2Neu amplification testing on IHC---which would have been a HUGE mistake. Also, a recent molecular assay (one developed at NIH) based on gene expression profiling has been shown to be superior to current diagnostic modalities to classify a lymphoma as DLBCL versus Burkitt Lymphoma (NEJM). This was NOT developed at a biotech lab, and they are looking to roll out a smaller, molecular based assay for clinical use. The original NEJM paper which discussed development of Oncotype DX by Genomic Health had lots of MDs on the paper, one of which is a pathologist. Another assay to detect lung cancer (LAVysion, multi-targeted FISH), which more accurately predicts lung cancer than cytology (recent CHEST article), was developed by pathologists.

We have a serious communication disconnect here....Im not saying Molecular diagnostics is worthless, Im saying the fellowship in its current form is. You will likely not develop a single assay during your 12 month stint there. The point of the fellowship is not 'assay development', that is translation type research that predominantly occurs in biotech. Why not spend 12 months in biotech if that is your goal??

Watch: We use LOTS and lots of formalin in pathology too, but people dont do a formalin fellowship, right? We use lots of antibodies in immunohistochemistry all the time, but how many people do an IHC fellowship??

Do a rotation in mol path, I have, in fact Ive done one at 4 different hospitals. You know what? There is only so many times I can read a quant PCR protocol and watch a tech pipet nucleotides before I scratch my eyes out.

Doing a mol path fellowship will not give you any street credentials for academics unless you publish, and publish MIGHTILY during that year.

Do not do mol path. That is my opinion, take it as one's man perspective. Ask people who have done it, see how much of it they use year 1 after, year 5 afterward...

LADOC's WATCH OUT LIST of fellowships
mol path
forensics
chemistry
medical micro
pulmonary
gyn
soft tissue/bone
pediatrics
IHC
neuro
transplant
renal
oncologic
cytogenetics

dont do these unless you have a very very clear idea of what you want out of em...

LADOC's nobrainer fellowships
Derm
Cyto
Heme
GI
GU
General Surg path

those will be good almost anywhere you land, its a nobrainer you arent going to be totally wasting a year of opportunity cost (which after 30 years is anywhere between 1-4 million dollars) on.

 

[dermpathlover]

^I think Mole path could potentially be a good move if you were strong in heme or GI or Derm and surg path in general and if you had a winning personality. I don't mean you are going to go out and set up a molecular lab and try to compete with the reference labs. But older pathologists are going to become more and more intimidated by molecular, and you can sell yourself on the guy that is going to explain it to them and make sure their group is on the cutting edge in the community while building their D-path empire.

And once you are the big revenue generator in the group you tell them you want more $$$ than the other partners or that you will split with the clients and your precious Molecular path knowledge.

Oh also to the original poster, I have heard from an inside source that Stanford is increasing their fellowship spots to 3, so that they will for sure have room for one outside person (as in-house people usually have pick of the litter over out-house people). I am going to go interview if I get one.

 

[DarksideAllstar]

^I think Mole path could potentially be a good move if you were strong in heme or GI or Derm and surg path in general and if you had a winning personality. I don't mean you are going to go out and set up a molecular lab and try to compete with the reference labs. But older pathologists are going to become more and more intimidated by molecular, and you can sell yourself on the guy that is going to explain it to them and make sure their group is on the cutting edge in the community while building their D-path empire.

And once you are the big revenue generator in the group you tell them you want more $$$ than the other partners or that you will split with the clients and your precious Molecular path knowledge.

Oh also to the original poster, I have heard from an inside source that Stanford is increasing their fellowship spots to 3, so that they will for sure have room for one outside person (as in-house people usually have pick of the litter over out-house people). I am going to go interview if I get one.

 

[Cougarblue]

I'm loving the vomit animation. Very nice. In an attempt at a 180 degree turn, LADoc00, you mentioned Utah and MD Anderson as top hemepath fellowships, what do you think of the fellowship at Mayo? I know that you are less than enthused about their residency, but I am curious about how their fellowship is perceived. It is a long way off, but after three rotations in path, hemepath has definitely been my favorite. I love the coasts, but I can't afford them, and you can't beat the cost of the midwest. Thanks.

 

[pongo]

Good to hear that Stanford has spots available. This whole fellowship process needs standardization, esp. with the switch from 5 to 4 years. I thought I was getting my application off in a timely manner, only to find that two programs I liked (UNC, MUSC) both were already filled. I know my program isn't even going to review apps until January. I guess some PDs have gotten shafted in the process by waiting too long. Anyone know if New Mexico has their slots promised out?

 

[LADoc00]

I'm loving the vomit animation. Very nice. In an attempt at a 180 degree turn, LADoc00, you mentioned Utah and MD Anderson as top hemepath fellowships, what do you think of the fellowship at Mayo? I know that you are less than enthused about their residency, but I am curious about how their fellowship is perceived. It is a long way off, but after three rotations in path, hemepath has definitely been my favorite. I love the coasts, but I can't afford them, and you can't beat the cost of the midwest. Thanks.

I dont know the hemepath faculty there. If you want big names in the midwest people like:
Vardiman at Chicago
Wiesenburger at Nebraska
come to mind.

Im unclear why you feel you cant afford the coasts tho, this is for a span of 12 months, you can always apply to rural Iowa 3-4 months into your training and rent while you spend a year in NYC or Palo Alto or LA etc.

 

[Cougarblue]

In all honesty, it is because I am sick and tired of being dirt poor. By the time fellowship comes around I will likely have three or four children, be in my late thirties, and be the sole income provider for my family. If I live in the midwest, I will be able to take my wife out once in a while, put my kids in sports, own a house, etc.

That being said I am applying to Stanford for residency. They have stellar benefits in comparison to Brigham, MGH, and UCSF, but we would still be pinching every penny. We applied for low income housing in Palo Alto without having any clue how the match will turn out, because many of the programs have three year wait lists, and that is for a two bedroom apartment which still costs $1600 month. We could definitely make it work. I go nuts when my single classmates complain about how little financial aid they get when I am supporting a family of four on the exact same amount. Fortunately, my wife is a saint and has a degree in finance, so we get by, and still have alot of fun. Crazily enough, the cut off for a family of four for low income benefits in Palo Alto is $90,000/year. That is just wild!

Thanks for the info!

 

[futureresident]

I'm loving the vomit animation. Very nice. In an attempt at a 180 degree turn, LADoc00, you mentioned Utah and MD Anderson as top hemepath fellowships, what do you think of the fellowship at Mayo? I know that you are less than enthused about their residency, but I am curious about how their fellowship is perceived. It is a long way off, but after three rotations in path, hemepath has definitely been my favorite. I love the coasts, but I can't afford them, and you can't beat the cost of the midwest. Thanks.

The hemepath fellowship at Mayo is excellent. Paul Kurtin and William Macon are pretty well known in their field. Also, I've heard that it is a very congenial atmsosphere in hemepath which also is important when figuring out where you want to go. You and your family would be able to live VERY comfortably on a fellow's (even resident's) salary in Rochester, MN. You could get a huge two bedroom apartment for 8-900 per month. The only problem with Rochester is that it is in the middle of friggin nowhere, but it's a great place for a family.

 

[SLUsagar]

In all honesty, it is because I am sick and tired of being dirt poor. By the time fellowship comes around I will likely have three or four children, be in my late thirties, and be the sole income provider for my family. If I live in the midwest, I will be able to take my wife out once in a while, put my kids in sports, own a house, etc.

That being said I am applying to Stanford for residency. They have stellar benefits in comparison to Brigham, MGH, and UCSF, but we would still be pinching every penny. We applied for low income housing in Palo Alto without having any clue how the match will turn out, because many of the programs have three year wait lists, and that is for a two bedroom apartment which still costs $1600 month. We could definitely make it work. I go nuts when my single classmates complain about how little financial aid they get when I am supporting a family of four on the exact same amount. Fortunately, my wife is a saint and has a degree in finance, so we get by, and still have alot of fun. Crazily enough, the cut off for a family of four for low income benefits in Palo Alto is $90,000/year. That is just wild!

Thanks for the info!

yes stanford has stellar benefits (i can vouch for it), but please do note that our friends up north at UCSF also offer a fairly decent housing compentation package, that's just a bit under what we offer. And both are good programs, tops in the west coast in my opinion if not the country. Obviously i've got my bias towards stanford, but i think it's fair to at least give my $0.02 about our competition. 😀