Surgical Pathology Fellowship - to do or not to do?

[bioguy]

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I've heard mixed opinions about taking this step. How worthwhile is a year of fellowship in SP? Some seniors say that plus/minus the fellowship your first year in job will be nerve-wracking anyway. Some say it is just a glorified, year-long SP residency rotation. I understand there are several other factors to consider, like the program, practice setting, personal strength in SP etc. But in general, what are the reasons to recommend doing or not doing this fellowship.

 

[KCShaw]

It's probably "worthwhile" to employers, who are probably only looking at it as a year of experience beyond residency. It can be "worthwhile" in the sense that it's often easier to get an SP fellowship at a name-brand place than it is to do a residency at a name-brand place, again in terms of its appearance to employers. I doubt it's any more worthwhile to individual skillz than getting a job with some decent and experienced surrounding support who are willing to help you through that first year or two -- particularly if your residency gave you any real opportunity to work things up and make decisions on your own, which I think is talked about more than done. I don't think I would say that it's definitely the Thing To Do, as despite taking program differences into account in many cases it may be little more than another year of training wheels which you've got to get off of sooner or later.

 

[2121115]

I've heard mixed opinions about taking this step. How worthwhile is a year of fellowship in SP? Some seniors say that plus/minus the fellowship your first year in job will be nerve-wracking anyway. Some say it is just a glorified, year-long SP residency rotation. I understand there are several other factors to consider, like the program, practice setting, personal strength in SP etc. But in general, what are the reasons to recommend doing or not doing this fellowship.

Depends on what kind of SP fellowship it is. If you are signing out cases during the fellowship, then it is probably worthwhile. If not, then not worthwhile.

 

[Euchromatin]

My 2 cents - As other posters have mentioned, unless you are actually signing out cases yourself OR you had to do it in order to get a really competitive fellowship at the same institution the following year (i.e. dermpath, GI, GU, etc.) OR your residency had some serious surg path deficiencies, I would think that having a year of actual practice experience under your belt would be more valuable than a generic, non-boarded "surg path" fellowship.

 

[Tissue issue]

Bioguy- Are you trying to decide between a surg path fellowship versus a different fellowship (hemepath, etc.) or are you considering a surg path fellowship versus finding a job right after residency?

 

[mlw03]

In the years I was in training I saw no one obtain a job right out of residency. At a minimum, residents were completing an additional 1 year surg path fellowship.

 

[2121115]

In the years I was in training I saw no one obtain a job right out of residency. At a minimum, residents were completing an additional 1 year surg path fellowship.

I never saw this either; however, I never saw anyone try.

 

[sirenomelia]

IMO one of the focused AP fellowships (ie GU, GI, GYN) are the smartest investment from an employability/ marketability standpoint.

 

[GlassPusherJack]

IMO one of the focused AP fellowships (ie GU, GI, GYN) are the smartest investment from an employability/ marketability standpoint.

i am not understanding the difference (besides a serious decrease in cash) between a fellow signing out surg path by oneself and an assistant professor position...

And word on the street is that there is talk of GI path becoming board certified. anyone have details/ heard of this?

 

[sirenomelia]

i am not understanding the difference (besides a serious decrease in cash) between a fellow signing out surg path by oneself and an assistant professor position...

And word on the street is that there is talk of GI path becoming board certified. anyone have details/ heard of this?

The assistant professor does the fellowship before he/she can get the assistant professor position.

 

[bioguy]

Bioguy- Are you trying to decide between a surg path fellowship versus a different fellowship (hemepath, etc.) or are you considering a surg path fellowship versus finding a job right after residency?

I will be doing fellowship in Cytopath. Should I do an additional year of SP or not is whats bugging me.

 

[Tissue issue]

As others have mentioned, in the current environment coupling a surg path fellowship with an additional year of subspecialty (GI, GU, GYN, lung, etc.) is best for marketability. Doing a surg path fellowship in addition to cytopath won't hurt your marketability but won't dramatically increase it. I'd base that decision more on how ready you feel to sign out surg path on your own. I'd recommend doing the surg path first then the cytopath if you do both.

 

[Torsed]

IMO one of the focused AP fellowships (ie GU, GI, GYN) are the smartest investment from an employability/ marketability standpoint.

Love the children quote. Future scholars.

 

[Torsed]

I will be doing fellowship in Cytopath. Should I do an additional year of SP or not is whats bugging me.

I did a year of cyto and my first year in practice IS my surg fellowship, don't know why people squander in multiple fellowships, unless they can't find an ideal job (which I must admit is somewhat of a struggle).

 

[mlw03]

I did a year of cyto and my first year in practice IS my surg fellowship, don't know why people squander in multiple fellowships, unless they can't find an ideal job (which I must admit is somewhat of a struggle).

So in such a case are your colleagues like your attendings for any case that you're uncomfortable with your diagnosis?

 

[2121115]

So in such a case are your colleagues like your attendings for any case that you're uncomfortable with your diagnosis?

Essentially yes, but not like an attending and a first year resident. More like a fellow and an attending, more collegial and they are essentially confirming your thoughts to make you feel better about it or suggesting subtle points to fine tune things (rather than just telling you what it is). If you are uncomfortable making a diagnosis on your own then you show it to someone before you sign it out for confirmation. This is wise and does not show weakness. Sometimes this will even make clinicians feel better too since if you are new they don't know you (i.e. trust you) and it may prevent a phone call later.

There is NO PATHOLOGIST who is straight out of training who will not need to show some cases. Hell, experienced pathologists show cases all the time (you just may not see it in residency since they usually will not tell you they are going to share the case with a more senior pathologist after you leave sign out). Even if you have done a surgpath fellowship, it doesn't make you Juan Rosai and the same rules apply. To not do so is reckless. If a group hires someone straight out of training they expect this. In fact, I would say if you hire a new graduate and they are not showing cases then be very afraid, and also be concerned that they are not worried about the quality of their work. Moreover, in many private practice groups there are even certain cases that, as a rule, get automatically shown to another group member for confirmation regardless of who is signing it out (at my place it is breast needle core biopsies and most pancreas cases).

 

[deleted314957]

Essentially yes, but not like an attending and a first year resident. More like a fellow and an attending, more collegial and they are essentially confirming your thoughts to make you feel better about it or suggesting subtle points to fine tune things (rather than just telling you what it is). If you are uncomfortable making a diagnosis on your own then you show it to someone before you sign it out for confirmation. This is wise and does not show weakness. Sometimes this will even make clinicians feel better too since if you are new they don't know you (i.e. trust you) and it may prevent a phone call later.

There is NO PATHOLOGIST who is straight out of training who will not need to show some cases. Hell, experienced pathologists show cases all the time (you just may not see it in residency since they usually will not tell you they are going to share the case with a more senior pathologist after you leave sign out). Even if you have done a surgpath fellowship, it doesn't make you Juan Rosai and the same rules apply. To not do so is reckless. If a group hires someone straight out of training they expect this. In fact, I would say if you hire a new graduate and they are not showing cases then be very afraid, and also be concerned that they are not worried about the quality of their work. Moreover, in many private practice groups there are even certain cases that, as a rule, get automatically shown to another group member for confirmation regardless of who is signing it out (at my place it is breast needle core biopsies and most pancreas cases).

I have been actively involved in path for 30 years and i will regularly show cases to my colleagues via internet ( video images, i am "solo" in my hospital) and will certainly send the glass if it is needed.) It is not a sign of "weakness". and i know that my clinicians appreciate it when I tell them that , although I may be pretty comfy with a dx, that it is an uncommon/rare case that deserves the attention of "someone who sees these a couple times a week". I've been the medical director at the same place for 21 years and this has stood me in good stead.

 

[coroner]

.....If a group hires someone straight out of training they expect this. In fact, I would say if you hire a new graduate and they are not showing cases then be very afraid, and also be concerned that they are not worried about the quality of their work. Moreover, in many private practice groups there are even certain cases that, as a rule, get automatically shown to another group member for confirmation regardless of who is signing it out (at my place it is breast needle core biopsies and most pancreas cases).

From what I've surmised on the job market trail and speaking with one of my attendings recently, there's a fine line for new hires between showing cases around and too much hand holding. Specifically when it comes to private practice, some places frown on newbies constantly going back and forth to senior staff for questions. This is especially the case if you did a subspecialty fellowship, and they hired you to be the go-to-guy for the group.

As mentioned, your work will be overshadowed in the first few months, but that's on their time and part of their QA/QC process which is different. A lot of groups place an emphasis on turnaround time and do not want to be delayed by you nor have your cases not signed out in a timely manner. Yes, they want quality work, but they want it done efficiently and if not, they can always use it as an excuse to not vote you in as partner and/or terminate your contract. Although if they really didn't want you as a partner in the first place, they could use any number of reasons; but, you don't want put yourself in a position to give them any extra fuel if this were to happen down the road.

Bear in mind, expectations and the initiation process can vary from place to place and some people will be massaged in gently while others may feel they jumped off the Titanic without a lifejacket. As said, the above applies more to private practice because they don't want anything that'll jeopardize their reputation or profit margin lest they lose their precious contracts to other local pathology groups. In general, places such as academic institutions and VA's will be more forgiving and wean newbies more tolerantly. The best thing is to know what are the expectations at any place before you take on a position and know what you're comfortable with.

 

[bioguy]

So I am getting a general vibe that a planned SP fellowship is not needed, but can be kept as a backup if I don't get a job right out of my cytopath fellowship.

 

[mlw03]

So I am getting a general vibe that a planned SP fellowship is not needed, but can be kept as a backup if I don't get a job right out of my cytopath fellowship.

It seems like a lot of people do this, which is why there are always lots of "unexpected openings" come mid-spring for fellowship positions, especially those in the less competitive areas such as general surg path.