Surg Path fellowships in general
Started by deschutes
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deschutes said:
Let me say this one more time: Many if not MOST private practices you will be grossing. Re-read that. Grossing is an important skill set, in fact arguably more than being able to accurately separate out atypical lipomatous tumor from well diff liposarc, as you can always send those out. You cannot however send out a tough specimen for a grossing consult!
Stop whining, put on a loose fitting shirt, an apron and turn up the ipod, it aint that bad folks. You will have vastly more problems with hemorroids if you only sit down 10 hours a day at the scope. You want a big anal hemorroid?!
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Easy, tiger. The reason I ask is this line from the MSKCC fellowship thread which goes: "downside: it *is* hard work and you still have to gross (although i heard that this year they are trying to make the grossing as painless as possible)."LADoc00 said:
Which to me begged the question, "Can there be ANY place where surg path fellows DON'T gross?" (I know that's certainly not the case at my home institution.)
I dont particularly enjoy grossing either, but there is no way around it, if you want to be a good surgical pathologist. Signing-out cases is more than just getting the diagnosis right. At least for cancer specimens, you have to keep in mind two other things, which make a big difference in patient management: margins and staging. And a good grossing technique is essential in getting them right. If you lack experience grossing, or just have not grossed many complex specimens, you are more likely to miss or misinterpret findings, or will just be painfully slow during sign-out. This is particularly true for the general subspecialties like GI, GU and GYN.deschutes said:
Good surgical pathology fellowships are those where you will be responsible for managing a large volume of complex specimens, from the frozen section, to gross, to sign-out. And ideally you should not be required to routinely print your own cassettes or gross hernia sacs and ganglions.
For the most part, subspecialty fellows are expected to have good experience in grossing specimens from the particular subspecialty, and at most programs are generally not required to do any grossing.
That's what I thought. Aside from the requisite "how much you get is how much you put into it", I was wondering how these objectives you speak of are achieved, and how prospective applicants can evaluate the training capabilities of a fellowship program.torero said:
My thoughts were that if SP fellowships are not board-certified and cover such an extensive and variable knowledge base (e.g. tertiary referral +/- transplant/cancer centres), then it follows that there possibly exists a variation in SP training programs greater than that seen in other subspecialties.
NOBODY in the entire wide-world world likes grossing. It's gross. Boring. Arguably the worst part of pathology. However, have to agree with LADOC, that it's an important skillset, and I have a hard time imagining ANY surg path Fellowship that wouldn't include it.
If you don't like to gross, there's other options out there, where you'd be guaranteed not to do it. Just go for fellowships in Dermpath, Heme or Cyto, and you're home free...
If you don't like to gross, there's other options out there, where you'd be guaranteed not to do it. Just go for fellowships in Dermpath, Heme or Cyto, and you're home free...
Now that we're all on the same page about grossing, can we move on? 😛
How do you ensure you get enough scope time during a SP fellowship?
How do you ensure you get enough scope time during a SP fellowship?
LADoc00 said:
I totally agree! Learning gross pathology is essential to formulating an initial approach to any case. Everyone should take full advantage of gross-show conferences. Alot of times, on frozen section, the gross pathology is the most important to coming up with a diagnosis. Programs that have PA training programs really don't offer any benefits to resident training.
I was finally told about a place where the SP fellows don't gross. Gee thanks you guys. 😛
deschutes said:
I really believe that the days of a general surg path year are over. Unless you simply want to tack on another year of training, the added "opportunity cost" of that (around $200K) and the humiliation of being a glorified resident, I would opt for a subpeciality area even if its not board certifiable: GU/prostate would probably be my no1, followed by GI.
pathdawg said:
I totally agreed with you....before I had to work the biz side of pathology. Depending (big depending there) on your private practice set up, often GI biopsies and bone marrows are done in same day procedure suites that exist on your hospital grounds (assuming your base of operations is a hospital-based path practice). Now you have an exclusive contract with hospital that will require most community GI and hemepath to already go to you, whether you are BC in heme or not. Prostate and skins on the other hand are usually office based and although those practitioners have staff privs at your hospital, can send stuff anywhere. This is where the fellowship comes in, by my calcs a single full time dermatologist can generate over 15K net to a path practice per month, a full time urologist do prostate Bx's might be near the same ballpark. Having a fellowship in those will allow you to retake alot of that outpatient biz, which in doing the math is vastly better than the inpatient volume even when GI is thrown into the mix. Yet Prostate Pathology isnt and will never be a BC'd by the ABMS.
See the hemepath and GI are basically (for most of us!) already locked in, the marketing aspect of the fellowship year would be best used in bring in stuff going to large commercial labs or academic centers. Why I also recommend GI is that now you see lots of GI practices trying to bring in their own pathologist, if you can claim domination in this area you will less vulnerable to having your biz stolen (or at least that is the concept).
As you can see success has absolutely nothing to do with what you are interested in...no one will ever care you are a great neuropathologist, cytologist or did an obscure fellowship in CP....at least in private prac.
C
Cesar
LADoc00 said:
How about hemepath, dermpath, cytopath, or gyn.
Do you recommend these?
Cesar said:
I would recommend only: GU focused on prostate, GI with a non-liver focus and derm. Of those, currently the most useful by far is derm but I think a true entrepreneur could become very wealthy with a GU fellowship from Hopkins (pretty much the no.1 place). Oddly I walked away from this some years ago, much to the anger of my current accountant, attorney and GF. Aside from that, most everything else is a toss with hemepath probably coming out ahead because you can work up nodes and intepret flow. Another often unmentioned fellowship is IPOX/IHC. This obscure beast in the right hands could also be a goldmine especially if you are trained at a top notch IHC lab like Stanford, MSKCC, MDA, UW, WashU or Harvard.(not sure if all those places have a year formal program in IHC anymore tho...)
PS- Cyto CAN be a good investment in the right hands, once again in the right hands is key. Just having cyto and doing general surg path and an occasional non-gyn cyto is a total waste! The true masters are the few who can open outpatient FNA clinics, get ultrasound guidance certification, portable US equipment and essentially operate as a referral center for endocrine, ENT and general surgeons.
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I essentially agree with LADoc. Personally, I find a Surg Path fellowship pretty much a waste of time and effort, unless:
A. You feel that you aren't really ready to fly solo, perhaps because you had a less-than-optimal residency experience.
B. You feel pretty confident that a surg path fellowship can land you your dream subspec fellowship at MGH, BWH, JHU, MDA, MSKCC et al.
I completely agree with LADoc on choice of subspec. There's tons of pathologists who lead long and happy lifes in community practise being a jack-of-all-trades. However, I'd personally recommend focusing on one, perhaps two, subspecs. My top choices would also be Derm, GI and GU (Prostate). IPOX/IHC isn't really that common anymore. If you're headed in that direction, molec path would have more of a future. Just remember, that it's still only really useful clinically in relation to heme.
Also, I really wouldn't be concerned if your fellowship gives a piece of paper to put on the wall or not. In the long run, the important thing is your reputation among peers and referring physicians, not if your particular training is board-certifiable.
A. You feel that you aren't really ready to fly solo, perhaps because you had a less-than-optimal residency experience.
B. You feel pretty confident that a surg path fellowship can land you your dream subspec fellowship at MGH, BWH, JHU, MDA, MSKCC et al.
I completely agree with LADoc on choice of subspec. There's tons of pathologists who lead long and happy lifes in community practise being a jack-of-all-trades. However, I'd personally recommend focusing on one, perhaps two, subspecs. My top choices would also be Derm, GI and GU (Prostate). IPOX/IHC isn't really that common anymore. If you're headed in that direction, molec path would have more of a future. Just remember, that it's still only really useful clinically in relation to heme.
Also, I really wouldn't be concerned if your fellowship gives a piece of paper to put on the wall or not. In the long run, the important thing is your reputation among peers and referring physicians, not if your particular training is board-certifiable.
Hi everyone. Longtime lurker here...
I've not seen pedi path fellowships discussed much on this board. What are your opinions of the work itself, and of career prospects? Is it pretty much limited to children's hospitals and academic settings? Would it be very helpful in a private practice setting?
Thanks.
I've not seen pedi path fellowships discussed much on this board. What are your opinions of the work itself, and of career prospects? Is it pretty much limited to children's hospitals and academic settings? Would it be very helpful in a private practice setting?
Thanks.
Click Here! said:
Pediatric path is not that popular among residents. There are quite a few fellowships out there, but usually a lot of them do not fill. We had a resident here going into that and he basically had his pick around the country. Of course, he's a stellar resident, but that is beside the point. As another resident here said, "You could be a turd wearing a top hat and get a pediatric pathology fellowship." In general you are limited to academic jobs, because most community settings do not have many complicated pediatric specimens. Other than that, pediatric path is very complicated and full of many esoteric things, and it sometimes seems to me as though every case is one that you will never see again.
On the surg path fellowship bit - I was talking to a young attending here the other day about this and my career prospects, etc. She said surg path fellowships are not really necessary if you are doing another fellowship and you are training at a good institution. If your residency program is not that busy, a surg path fellowship can help because you simply won't have the volume or experience to feel comfortable. But for me, at our program, we see so much stuff that a surg path fellowship would simply be overkill. What a lot of people do is combine a surg path fellowship with a subspecialty like breast or GYN, so they do 6 months on one, 6 months on the other, etc. What she said was that if I make good use of my fourth year, a surg path fellowship would pretty much be a waste of time, unless it was my only fellowship.
Click Here! said:
There might be a rare private job out there where they would have use for a peds path person, but if you want to only do peds path, you gotta go to BCH, CHOP, etc..
Could anyone please clarify what is meant by an ACGME "Selective Pathology" fellowship? I was looking at the GYN fellowship offered at BWH and noticed that it is now ACGME accredidated, but under this title (according to the ACGME site). Thanks! 🙂
SLUsagar said:
I admit, its a gamble BUT I will say from my own billings I generate huge revenues from IHC (although Im forgetting at the moment what the CPT is for the professional portion of that). IF and only if, an IHC year gives you an admin. experience to be able to open up a freestanding outpatient IHC lab or a significant rep for local referral IHCs, you could really have something to market. Lots of large groups (and even smaller ones) are always looking for a fresh IHC expert to expand their own menu of antibodies, both the patients' benefit and to the pocket book of the group. But yes, its not at the same level as doing GU/GI/Derm/Heme(GGDH). Those are a much safer bet. Its something to be examined closer tho, Ive found the biggest gap between the old and young pathologist crowd is the knowledge of IHC (and not necc. the molecular stuff which is really limited and always a send out anyway). That is something you can exploit to gain an advantage as a new associate in a group setting...and trust me, you need every advantage you can get.
Yes overall tho I would stick with the G.G.D.H.
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