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Survive without a hematopathologist?

Discussion in 'Pathology' started by Natita, Nov 8, 2018 at 7:30 AM.

  1. Natita

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    Rural community hospital gets 2-3 bone marrows/month and about 5 peripheral bloods. Ability to send things out. It' seems most hematopathologists don't do a lot of general surgpath/cytology. 3 person group. how would you staff it?

    a. 3 - general surgical pathologists
    b. 2 - general and 1 hemepath
     
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  3. musom

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    A. for sure. Unless you've got a pissy heme/onc group that demands you to perform the bx's. Most rural community hospitals don't have much local heme/onc/radiation coverage anyway. We send our onc to the larger regional groups. It's certainly not low-hanging fruit considering the volume. I could easily perform 3-5 bone marrow biopsies a month, but thankfully I am busy enough with a general surg path volume to have zero interest in heme.
     
    Natita likes this.
  4. coroner

    coroner Peace Sells...but who's buying?
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    Why not 2 general + 1 cyto? Even if you did have good cytotechs, that would be just as useful for non-gyns and even moreso if you did ROSE.

    There's only 30 marrows/yr. I covered a small community hospital with exactly that amount and we decided it wasn't worth the revenue, so we sent them all out to a reference lab. As far as the 5 bloods/mo., that doesn't need a hemepath on staff. It should be basic enough for anyone who went to a halfway decent residency program.

    Regardless, I don't think the volume is high enough which would necessitate having a particularly subspecialty on site. It really doesn't matter how you staff it as long as all three pathologists are competent and can do the bread & butter as well as cover whenever one person is on vacation.
     
  5. AZpath

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    It depends on how much you like Heme.
    Lots of non-fellowship trained punt these.
    Other groups read them all.
     
  6. LADoc00

    LADoc00 There is no substitute for victory.
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    Why would you not do B if the Hemepath person also signed general surg/cyto?

    Here is the problem: There is a list of medical malpractice pitfalls for small groups. They include the usual suspects such as melanoma vs. atypical nevus, breast ADH vs. DCIS, prostate carcinoma vs. atrophy but also includes several heme entities such as Dx of APL specifically, identification of peripheral blasts etc.

    Of ALL the pitfalls, the one area where you cannot lean on outside consultation in a timely fashion is heme. You cannot lean on academic consultation for APL, it's too late. You cannot run global outside flow in time for pediatric blasts as that usually buys you a same day ER visit helo ride to a pediatric hospital.

    You can call in air support for lots of stuff in rural pathology, but some stuff you have to man up on.
    [​IMG]

    If you generalists are weak in heme, you will fail.
     
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  7. yaah

    yaah Boring
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    You don't need a hemepath fellowship to do heme. But you do need sufficient training and volume to stay on top of things. And it helps to have a point person in the group. Hemepath trained folks who are good at general path are invaluable.
     
  8. LADoc00

    LADoc00 There is no substitute for victory.
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    Lets clarify that: You dont need ANY fellowship. None. Zero. A trainee who is highly intelligent, motivated and adaptable will succeed. As long as your training program has adequate exposure to heme in general. Not all do. Same with dermpath. Almost all big academic programs have all subspec areas in depth you can get needed exposure, some small ones do not.
     
  9. WEBB PINKERTON

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    No one should be doing cytopath anymore. This isn't the 1990s. Anyone should be able to do ROSE straight out of training.

    Hearing anyone recommend cytopath brings out the Thrombus in me.
     
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  10. AZpath

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    I can't agree more. Most areas can be done well without an extra year or two in fellowship.
    Medicine is getting crazy with all the subspecialties. It is not just pathology.
     

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