SUNY Stony Brook - Program Review

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I am a current path resident at Stony Brook. Here's my take-

Basic information:
Stony Brook University Medical Center has 12 AP/CP residency spots (generally 3 per year) and is establishing fellowship positions in Hematopathology and Surgical Pathology. Annually, there are about 20k surgical pathology specimens, about 4k-5k cytology specimens and 80-90 autopsies. All of the required rotations are at Stony Brook except for the forensics rotation at the Medical Examiner’s office (approximately 15-20 minutes west of the hospital).

There are 8 attendings on the general surgical pathology rotation, and 4 of those 10 also sign out cytology cases. There are 9 other attendings that handle cases within various AP subspecialties (i.e. neuro, medical kidney, placenta, oral, derm etc.). There are 8 attendings that cover CP mainly and several other faculty members that mainly do research.

Schedule:
Year 1: In the past it was 10-12 months of general surgical pathology, but based on resident feedback, as of this year it has been reduced to 7-8 months in the first year.
Year 2-4: Residents generally do about 4 to 5 months of cytology, 2 months at the medical examiner’s office, 18 months of CP and the other 11 months is pretty varied. Most residents do various surgical pathology subspecialty rotations, research months, etc.

To give you an idea, most of our residents work 40-60 hours a week, with the variation due to different rotations and work ethic. Vacation time is generous…all state holidays plus 16 annual days/year. We also get 16 sick days a year. There are rules like if the 4th of July is on a Saturday you get a floating holiday day to use. As per the ACGME guidelines, residents are not supposed to take more than 4 weeks of vacation in a year.
Call is taken at home and over the course of 4 years is essentially q12 (there are 12 residents) although sometimes it might be q4 and other weeks will be without call. Both AP and CP call are mild, maybe 50% of the time you will have to stay late to cover frozen sections and CP calls typically require 1-3 phone calls to handle. Residents rarely have to come in on Saturday or Sunday.

The Surgical Pathology rotation operates on a 4 day cycle (3 first years + 1 PA).
Day 1 (busy) – Gross/Frozens. The PA helps with frozens and grosses biopsies and many small specimens
Day 2 (busy) – Preview biopsies, sign out biopsies
Preview small cases, sign out small cases
Preview large cases
Gross if you had any leftovers
Day 3 (medium) – Sign out large cases
Day 4 (light) – Finish signing out large cases that required immunos, extra sections, etc. Work on presentations, research, reading.

Location:
Stony Brook is in Suffolk County, east of NYC. It is about 70 minutes from Manhattan by car, or 80 minutes by LIRR from the Ronkonkoma train station. There are many nice beaches on the south shore that are less than an hour drive away.

Long Island- Upside: convenient, pleasant climate, great beaches and parks, excellent schools, diverse population. Downside: expensive, traffic.

Advantages:
Working conditions: Every resident has their own desk, computer, and microscope. There are spacious resident rooms that were renovated in 2009. The gross room and autopsy areas are above average compared with the 10+ programs I visited for interviews.

Faculty: The attendings for the most part will spend a lot of time at the scope teaching you. They will all without hesitation go to the gross room to help you orient an unusual specimen or teach you how to gross it. They will push you to succeed as a pathologist and help you get started on research projects. We got a new chair over a year ago that has instituted many changes with the goal of improving the department and the residency program.

Good salary/benefits: ~$53k to start with a ~$3-4k raise each year. Additional $800 annual book fund + Henry’s + a grossing text (i.e. Lester). If your abstract gets accepted, your travel expenses are covered to conferences. Parking costs ~$200/year, you get $25/month for food at the hospital.

Specimen variety: Residents get extensive experience with bread and butter type of cases and above average exposure to uncommon cases. For example, there are 1-3 Whipples scheduled weekly, and in a typical grossing day, you will most likely come across at least one or two things you have never seen before.

Research: Our department chair is an MD/PhD and provides ample support for resident research projects- basic science, translational, or clinical. I would say that about 25% of the residents do some type of bench research, but all are required to develop research projects.

Careers: I would say that ~15-20% of graduates from the last 5 years have gone straight into private practice and the rest have done fellowships in various areas (FP, SP, GI, Cyto, Heme, Micro, BB, other SP subspecialty areas, Mol). The attendings are willing to go the extra mile to help you find a job/fellowship (calls to friends, etc).

FP: The ME rotation is pretty well-received among residents here, even if (like me) they were not that psyched about FP going into it. There is about one resident every 2-3 years that pursues a Forensic Pathology fellowship.

Disadvantages:
In the past, my two major complaints were the need for AP fellowships and more dermpath specimens. They have addressed these two issues in the last 12 months-currently they are designing fellowships and they just hired a board certified dermatopathologist and have been getting more specimens. As the fellowships are a new addition, I do not have an idea exactly how they will be organized.

The next thing that I would like to see improve is an increase in the Cytology workload. This has been an ongoing goal of the administration, but has not yet been realized.

Autopsies - The number of hospital autopsies is relatively low (80-90 per year). This may increase after the recent hire of a new person in charge of decedents affairs. Regardless, residents have always finished with over 50 autopsies by the end without sharing, with an average I would guess somewhere between 55 and 60.

I would say it is not easy for our residents to get a DP fellowship.

Summary:
At Stony Brook’s pathology residency program, you will get out what you put in. There is a small amount of scut. The attendings are solid and care. The first year can be a drain if you don’t like surgical pathology. Overall I like my job and am happy here.

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[Johnny Sunshine]

I am a pathology resident at Stony Brook. The original poster (OP) graduated last summer. Here is my opinion, as well as an update to the factors the OP described:

I generally agree with the OP's assessment. In the interim, the surgical pathology and hematopathology fellowship spots (one each) have begun and appear to be going smoothly. Two new surgical pathology attendings have been hired - one specializing in renal path and the other in bone - though these gains have been balanced by two other AP attendings retiring. The faculty remains excellent, the facilities I agree are above average (and currently undergoing improvements and renovations), and the residents are a congenial and fun, friendly, supportive group.

I would say there has been a slight increase in the case load, starting about half a year after the OP left. New head & neck, bone, gyn and pediatric surgeons have been hired by the hospital. It is too early to know for certain how this affects our overall case load, but the numbers so far suggest a rate of around 22,000/year. There has been a small jump in frozen sections as well, perhaps about 10-20% (just personal estimate). Autopsies have increased as well, to around 110+ per year, and due to resident feedback we no longer have autopsy responsibilities while on surgical pathology rotations. As expected, the dermatopathology cases have greatly increased, to the point that one needs to be on a CP or other "light" rotation while covering the derm service to avoid being overwhelmed, but once again the program leadership has been very responsive to the residents' needs and quickly adjusted scheduling appropriately for this change.

This is a solid program. At the moment, I would only mention that we could use more support staff. Supposedly due to those high-profile NY state budget cuts, 4 members of the staff have been let go during my tenure, leaving us with nearly a skeleton crew. The remaining staff often work daily overtime to make up for these cuts. With the loss of a PA, it was common for additional residents to be called into the grossing room for several hours to help get the work done - even if they are on a completely unrelated rotation. Thankfully, this is an area of continual focus and I'm hopeful.

UPDATE 12/6/2012: A new PA has been hired and appears thus far to be an experienced resource. The improvements in the grossing room have been immediately noticed, and it is now rare for a non-surgical pathology resident to be called back to help. A new office staff member has been added to the team as well, who also helps accession/maintain the grossing room. Histology could use one or two more people still, and one or two more attendings would be helpful, but things are nicely on their way.

Although the department might benefit from a few more staff, it's a solid program, with a wide variety of good cases, excellent faculty, and attentive leadership.