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Of course you know you are going to have everyone curious which program you are at
What is going on? How many conferences do you have a day? We have a lot higher volume (50,000+) than that and half the coverage (9 for the entire program)- I don't understand- Yesterday I grossed 4 colons, a couple oriented breasts, a couple mastectomies, some oriented melanomas, a couple thyroid cancers, a ton of frozens and smalls and I was still out the door by 8- Thankfully I didn't get any arms or legs- What is nice is that we don't have a lot of conference obligations- I used to think that I liked conferences but now I am glad we only have about one a day- I used to be all about university but am glad I am here, learning-
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yeah, i wanna know too. part of the appeal of path is that you can get home in time to take the dog for a walk during daylight hours. please share with us what program you're at that has such a grueling schedule?
All I know is that I would be miserable at your program.
We roll 32K at one hospital and 27K at our other hospital. We get plenty of great frozens. We get more rare cancers and other wacky stuff than I anticipated (primarily because we are one of the major military referral centers). We do 14 months of surg path, plus we spend at least 6 months rotating through different departments at the AFIP.
Four day rotation at each hospital during surg path. Typically 4 residents on surg path at each hospital per month.
Day 1: gross (one resident runs the gauntlet of grossing per day; )
Day 2: sign-out biopsies (25-40 cases on average) (grossed by a PA usually)
Day 3: sign out gross (20-30 cases average)
Day 4: sign-out derms and cover Frozens
This translates into 24 hrs+ with our slides prior to signout which is absolutely kick-ass for study/time-to-read up on cases. This is probably the single thing I love most about our program.
My general schedule on surg-path is 6am-5 (or 6)pm. 2 hours of that is probably self-directed study (reading up on cases, or preparing for unknown conferences).
All of the residents divide up the tumor board conferences, so you probably have to prepare about 1-2 per week. We have a daily hour-long conference.
Our program probably isn't the best for research/academic-oriented pathologists (doing research can be a PITA in the military), but we churn out a lot of great community/private pathologists. Our board pass rates are above 95%.
We roll 32K at one hospital and 27K at our other hospital. We get plenty of great frozens. We get more rare cancers and other wacky stuff than I anticipated (primarily because we are one of the major military referral centers). We do 14 months of surg path, plus we spend at least 6 months rotating through different departments at the AFIP.
Four day rotation at each hospital during surg path. Typically 4 residents on surg path at each hospital per month.
Day 1: gross (one resident runs the gauntlet of grossing per day; )
Day 2: sign-out biopsies (25-40 cases on average) (grossed by a PA usually)
Day 3: sign out gross (20-30 cases average)
Day 4: sign-out derms and cover Frozens
This translates into 24 hrs+ with our slides prior to signout which is absolutely kick-ass for study/time-to-read up on cases. This is probably the single thing I love most about our program.
My general schedule on surg-path is 6am-5 (or 6)pm. 2 hours of that is probably self-directed study (reading up on cases, or preparing for unknown conferences).
All of the residents divide up the tumor board conferences, so you probably have to prepare about 1-2 per week. We have a daily hour-long conference.
Our program probably isn't the best for research/academic-oriented pathologists (doing research can be a PITA in the military), but we churn out a lot of great community/private pathologists. Our board pass rates are above 95%.
When do your slides come out? When is the cut off time for grossing specimens the same day it is received? Do you have to be present for the fellow's or other resident's signout? And 10-15 biopsies means 10-15 trays of biopsies?
Im completely mystified what is going on. Previewing 20-30 cases should take you an hour, max. Signing out that many should take maybe an hour, grossing in maybe another 90 minutes. You average workday would leave me twiddling my thumbs by 11am.
All I can say is things will change.
I sign out over 6K surgical cases, over 250 marrows, 150 peripheral bloods, 50 transfusion reactions and 150 nongyn cytologies/year. Attend 1 committee meeting a week. And do all the business aspects that the above require. Meaning, I spend 1 hour with my primary attorney and 1 hour with an accountant each week. Then I spend like occasionally all day with my partners' attorneys, accountants and hospital admin.
All that and I can say most days I can get done by 10am, seriously. I do start at 7:30am usually tho. Today I took a 4 hour lunch for example.
Ironchef - there are other programs out there like yours - especially on surgpath - especially for the first year residents in their first couple months. The details of the schedule may differ, but overall it's the same deal. Contrary to the stereotype, path residents do find themselves working their tails off. In my first couple months, 18-hour days were not uncommon and I often worked both days of the weekend to keep my head above water. The other first years were in the same boat, which was a comfort. Don't despair. You'll get faster. It can be extremely painful at first though.
I was talking to a surgery resident a couple months ago and he said, "Wow, I've heard you path residents here work really hard, is that true?" Since he was genuinely impressed, and not trying to get smart, I took it as a compliment.
I was talking to a surgery resident a couple months ago and he said, "Wow, I've heard you path residents here work really hard, is that true?" Since he was genuinely impressed, and not trying to get smart, I took it as a compliment.
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Well, I'm at the Brigham where we have 60000+ specimens (that's the last number I heard floating around). Our schedule is complex in that we do different rotations each week whereas most programs have residents do month long rotations. We have a week-by-week schedule to ensure that residents get the 4 week-long vacations of their choice and all the work can still get covered.
1. We have 3 residents on a given week dealing with large general surgical specimens (and yeah, they can get quite complex as some of the specimens you mention, ironchef. In fact, some of these specimens you'll never see again if you go into private practice. But quite educational nonetheless.) We have a 3 day cycle basically where one receives specimens during the afternoon on the first day. You basically take basic measurements and then dunk the thing in formalin. The second day, you gross and submit sections and dictate. The processors get loaded by 6 pm so you finish grossing by then. On the third day, you receive slides and you preview. On the fourth day, you signout and you receive specimens. There are a few more elements to this formula (i.e., PAs grossing specimens from the morning OR runs and those cases being distributed to one of the 3 residents on a particular given day) but that's the overall structure.
N.B. General surgical pathology does NOT include gyn specimens. Gyn is its own separate world (more later).
2. We have one resident dealing with general surgical pathology small specimens (prostate biopsies, head and neck biopsies, cardiac specimens, lung wedge resections, etc....but NOT GI biopsies). This resident does no grossing. You receive slides on a given day, preview them, and sign out the cases the next morning. Rinse and repeat. Pretty easy.
3. We have one resident dealing with GI biopsies exclusively. No grossing here either. Just preview and signout cases. Pretty easy. This person also carries the backup general surg path frozen pager (usually frozens are done by the 2 autopsy residents but if they get a bunch of posts, then GI-boy takes over...but only during the afternoon. It is rare for GI-boy to get pulled for frozens but it has happened a few times this year).
4. Large Gyn specimens (hysterectomies, salpingo-oophorectomies)- this can get busy depending on the number of Gyn-Onc surgeons operating in a given day...and only one resident is on this service. Here you gross, preview, and signout each day. The week starts off light but the end of the week can get busy. But we have PA backup where on the busy days, they will gross in the benign specimens so that we can concentrate on grossing the interesting cancer specimens.
5. Gyn biopsies - one resident on this service. No grossing. Just preview and signout. Carry gyn frozen section pager in the afternoon. Relative to the general frozen pager, this pager doesn't go off too frequently. Sometimes I'll just take slides to the frozen room and preview there while I'm waiting for specimens to arrive for frozen section consultation. Pretty easy rotation.
Overall, we're done signout by noon. A few can take longer but I've never heard of signout lasting until 6 pm. We do have to take some cases and show them around but for me, that means, I put it in the "Derm box", "GU box", "Pulm box", etc and that's it. I refuse to run around cuz it's a waste of my time and I value efficiency. And I didn't go into pathology to violate work hours dammit! If I wanted to work more than 80 hours, I would've gone into medicine.
The work load here is quite well compartmentalized. But ironchef, you hear these comments like "Brigham guys work harder" for a reason. Volume is high and we only get 9 new residents per year. Like I said in a previous post, our program is not a cupcake program but you see a lot and you learn a ton.
I heard Hopkins folks work hard too...but I don't know what their hours are like (but I know a fellow there and I'm gonna get the dirt when we next chat). There's plenty of gossip out there...hell, I love gossip!...but much of what I hear do not belong on this forum.
I haven't heard much about Penn folks working long hours so your posts were quite an eye-opener for me. What I am aware of at Penn though is that, when I applied, I heard how they were opening up a bunch of new OR's. I asked how that would impact volume and workload...the faculty and PD seemed to skirt around the issue...look, I'm not stupid, I knew exactly what the implications would be...wasn't a big fan of where things were heading. A bunch of my colleagues interviewed at Penn and we got that same impression. How exactly is that working out? Has there been a huge sudden increase in volume? Just curious since it's been a few years.
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Yeah, hours get much better when you become more efficient. Sure, the first year residents don't wanna be hearing this but yes, everyone gets faster and will start to see the light at the end of the tunnel.
I used to work until 10 pm on occasion (busiest days) when I first started on general surgicals. Now, I start to get a little pissy if it's approaching 7 pm and I'm still in the hospital.
Many residents in other residency programs probably think we're a bunch of lazy bums and get shocked when we tell them how much we actually work. I take this as a compliment too. I don't care though...at least there's no overnight call and I have regular hours. And I don't even come close to hitting 80 hours whereas most of those folks frequently break 80 hours. Yes, I like my lifestyle. Thank you.
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Oh shut up!
We wouldn't wanna have LADoc00 miss his noon manicure appointment!
OK...Screw the number of cases! OK...20-30 cases...how many slides and what kind of cases? Yeah, if most of the cases are biopsies with 1-2 slides/case, fine...well under an hour. Hell, throw in a couple of lipomas for kicks.
Now, even for the larger resection cases, there are efficient ways to approach a case. I like the approach of "how can I make this worse for the patient" instead of obsessing over every weird little thing on every little slide. "OK we've seen the bad cancer and the LVI and the PNI." Fly through the rest of the slides just looking at margins and see if the cancer invades through more structures...blah blah blah. Scan for lymph node mets (those you don't wanna miss!).
I dont doubt you, just like every other facet of education its rarely the best pathologists end up as junior faculty at a med school. They either are very very good at one thing like GI and suck at most other things (typically are AP only as well) or simply lack diagnostic confidence. I occasionally loose patience with other pathologists I do/have worked with simply due to how long they stare at high power, I fear many pathologists simply space out. (Ive caught people spacing big time).
Also realize there is NO incentive for a academic junior guy to be efficient, he/she is salaried and job is likely to depend more on publishing than clinical work. Strange that the people who are destined to sign out in a private high-demand high-efficiency setting are trained by these types, isnt it?
SO'ing quickly depends alot on how much you have read, the less youve read the more time and uncertainty you face. Thankfully you can read pretty much every major text in pathology in almost no time, maybe 3-4 months if you devote 3-4 hours a night to it. Even an ADD sufferer can pull down 400 pages of reading a week! Everyone should be able to read at least Essentials of AP in the first month or so (you cant possibly have met enough people to start hardcore partying yet) Plus reading gives you ammunition for minutae to pimp slow junior faculty, stuff like....."What, in your experience, is percentage of atypical Burkitt's that are bcl-2+"? or "What criteria do you use in your practice to differentiated membranous adenomas from canalicular adenomas of the parotid??"
trust me you will love the 'WTF?!' look they shoot back...
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Wow that sounds vaguely criminal to me... take your first paragraph and that time is spent doing the exact same thing by the secretaries here. If I was ever asked to spend a third to half of my day sorting paper and matching codes to procedures, before I read (and I wonder how many of the rest of you are doing the same thing) your experience, I'd have looked at the attending like (s)he was crazy. wow. To me you spend 33% of your time at the very least doing what everyone here would consider scut work. Not that it isn't important to know how to do those things, quite the contrary, however I think it would take a month or two in the beginning of your job after residency to know how those sort of things were done. It just seems like that is a long time doing what is close to zero educational value.
I'm sorta suprised .. there is no excuse for taking that long to sign a days work out. I guess that's why the new attendings from academic programs are sometimes here until 10pm. (8 full time and 2 part time attendings to split 50k surgical and all the other work). It's as if some universities teach you that if you stare at something for 90 minutes the cells will rearrange themselves into a pattern you're familiar with. The best attendings know who and when to ask for help or what stains to order after looking at a slide for a very maximum of 60 seconds and more often for 10 seconds or less, (if they don't know what it is after approx 5). I guess though that most attendings at a university have their research to tend to as well though.
One hour didactic twice a week seems like a light conference load... what do you do in your 60-90 minute q&a.. that sounds pretty interesting.
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We have ~60k surgicals per year, not including some of the derm stuff that comes from private labs (we only see the slides, don't gross them).
Our surgicals are split up into subspecialties (GI, GU, Breast, GYN, Derm), plus "Room I" which consists of frozens and otherwise everything else that doesn't fit into an above category (i.e. lungs, thyroid, soft tissue, etc). GI and Room I are the busiest, but Room I is now on a different schedule such that it is a bit different from the other subspecialties.
Our days:
8-9am conference (AP half the time, CP half the time)
9am-anywhere from 10:30 to 3pm (rarely longer), signout. Usually finishing time is around noon except for busy GI days and rarely in other rooms.
We generally then gross and preview from end of signout until end of day. For some people, this is 9pm or even later. For others, it is 5-6pm. We have afternoon conference twice a week also (AP).
Room I now has two residents, one of which is assigned to gross and one to preview, and they alternate days. The surg path fellow does frozens from 8am-1pm, and one of the residents does frozens from 1pm-5pm.
This means that basically every case has a three day turnaround. Day 1: case arrives and is grossed. Day 2: Case is processed and cut by histology, slides come out anywhere from 9am-5pm depending on priorities, and then is previewed. Day 3: Signout. For some large cases that come in later and need to fix overnight, it can be grossed on day two and everything is delayed a day. For rush cases or critical diagnoses, etc, things are sped up obviously and we preview and sign out the same day.
Our surgicals are split up into subspecialties (GI, GU, Breast, GYN, Derm), plus "Room I" which consists of frozens and otherwise everything else that doesn't fit into an above category (i.e. lungs, thyroid, soft tissue, etc). GI and Room I are the busiest, but Room I is now on a different schedule such that it is a bit different from the other subspecialties.
Our days:
8-9am conference (AP half the time, CP half the time)
9am-anywhere from 10:30 to 3pm (rarely longer), signout. Usually finishing time is around noon except for busy GI days and rarely in other rooms.
We generally then gross and preview from end of signout until end of day. For some people, this is 9pm or even later. For others, it is 5-6pm. We have afternoon conference twice a week also (AP).
Room I now has two residents, one of which is assigned to gross and one to preview, and they alternate days. The surg path fellow does frozens from 8am-1pm, and one of the residents does frozens from 1pm-5pm.
This means that basically every case has a three day turnaround. Day 1: case arrives and is grossed. Day 2: Case is processed and cut by histology, slides come out anywhere from 9am-5pm depending on priorities, and then is previewed. Day 3: Signout. For some large cases that come in later and need to fix overnight, it can be grossed on day two and everything is delayed a day. For rush cases or critical diagnoses, etc, things are sped up obviously and we preview and sign out the same day.
