Transplant fellowship?

[hzma]

So what's the deal for transplant fellowships? Marketable, not, competitive, not. Any good ideas as to which programs to apply to? And how important is CP then? Thanks.

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[pathstudent]

So what's the deal for transplant fellowships? Marketable, not, competitive, not. Any good ideas as to which programs to apply to? And how important is CP then? Thanks.

Pitt is probalby the place to go for a transplant fellowship. But I have never met someone who just does "transplant pathology". Usually the heart guys do heart transplant, the lung guys do lung transplant, the liver guys do liver transplant, the gi goes do small bowel transplant, and the renal guys do kidney. That being said I think you can get a great background in transplant pathology by doing a subspecialy fellowship or even a surgpath fellowship at a large transplant center.

I imagine that and some other area of expertise would make you very marketable at any place that did transplants.

 

[LADoc00]

So what's the deal for transplant fellowships? Marketable, not, competitive, not. Any good ideas as to which programs to apply to? And how important is CP then? Thanks.

there is no point whatsoever to do a full on transplant fellowship. Whoever thought of that should be dragged behind a shed and shot.

 

[yaah]

Pitt is probalby the place to go for a transplant fellowship. But I have never met someone who just does "transplant pathology". Usually the heart guys do heart transplant, the lung guys do lung transplant, the liver guys do liver transplant, the gi goes do small bowel transplant, and the renal guys do kidney.

Except at Pitt! The GI path guys don't do Liver txp biopsies there. The transplant person does. I tend to agree, not much use for it because at most places the GI guy would read the liver txp biopsy, etc etc.

So it is really probably less marketable than any other fellowship within surgical path.

 

[AJD74]

All fellows completing our Transplant Pathology Fellowship have secured positions before the end of their fellowship. The vast majority are faculty at large academic medical centers, which is the location of most large transplant centers. Attractive proficiencies gained during the fellowship include an understanding the underlying immunology of host-graft interactions, tissue typing and donor-specific antibody testing, and being able to cover multiple organs, as well as native liver and kidney pathology. There is also considerable flexibility in emphasis, which enables the faculty and fellow to target specific needs.

UPMC Tx Path Faculty

 

[LADoc00]

What would hours be for a guy/gal doing that FT?

Sounds fairly rough if you ask me.

Why not just do one of the dozens and dozens of GI or GU fellowships out there.

 

[WEBB PINKERTON]

A Progeria Pathology Fellowship is about as useful.

 

[yaah]

I suspect transplant pathologists would be stoked by the arrival of slide scanners with ability to access the images from the web. Then they don't have to be in the office at weird hours and such. So hours would probably be normal with lots of potential on call I guess.

 

[LADoc00]

I suspect transplant pathologists would be stoked by the arrival of slide scanners with ability to access the images from the web. Then they don't have to be in the office at weird hours and such. So hours would probably be normal with lots of potential on call I guess.

Okay but is that norm now?

I see you getting up at 2am to go in and sign out an 88331 and then go home as the routine.

See folks an 88331 is around 68 bucks and change via CMS. Driving in and performing the FS and then cleaning up is probably around an hour, perhaps closer to 90 minutes if you live further out. That would then be around 45 bucks an hour. Oh and you just were woken out of dead sleep for that 45 bucks.

It will take all of 6 months for a medical center's bean counters to tabulate you bring in WELL less than 50K per year in pro fees reading Transplant Path but somehow are costing them north of 300K.

That is a very bad situation to be in. My guess also is the transplant team will want to share exactly NONE of their fees with you to make up for the craptastic situation they have put you in. They will quite happy with you drinking a tall glass of "STFU" and slowly watching your pay erode to half of what a transplant team nurse makes.

 

[royal blue]

Sounds cool, but a tad too specialized. Obviously not for everyone.

 

[yaah]

We currently evaluate some specimens remotely from home at night. It is already happening. We don't evaluate organs for transplant rejection though. Scanners are getting cheaper. We don't typically do it for frozens because the gross can be important and there may not be a PA onsite, plus currently scanning the slides takes several minutes, probably as long as it takes for me to drive in, for example. When the few minutes are critical, it's not as relevant.

I suspect one way some centers will utilize their transplant pathologists is to remote read biopsies (via scanner) from outside institutions where normally the local path who never sees many would make an educated guess and then send it for consult. Consult via scanner I suspect will become more important and prominent in the future, the question is how will it be billed and/or reimbursed.

Anyway, doing transplant pathology is, as said above, unlikely to be really useful or lucrative outside of highly specialized high volume centers.

 

[pathstudent]

Okay but is that norm now?

I see you getting up at 2am to go in and sign out an 88331 and then go home as the routine.

See folks an 88331 is around 68 bucks and change via CMS. Driving in and performing the FS and then cleaning up is probably around an hour, perhaps closer to 90 minutes if you live further out. That would then be around 45 bucks an hour. Oh and you just were woken out of dead sleep for that 45 bucks.

It will take all of 6 months for a medical center's bean counters to tabulate you bring in WELL less than 50K per year in pro fees reading Transplant Path but somehow are costing them north of 300K.

That is a very bad situation to be in. My guess also is the transplant team will want to share exactly NONE of their fees with you to make up for the craptastic situation they have put you in. They will quite happy with you drinking a tall glass of "STFU" and slowly watching your pay erode to half of what a transplant team nurse makes.

Our group does this all the time. Any douche general pathologist can look at liver and kidney explants and quantify sclerotic glomeruli and hepatic steatosis.

Also no government or private insurance company will reimburse for biopsies done on a dead man's organs before they are transplanted into the recipient. So the donor organization pays for it.



I don't know how you run your practice but for us it is pretty fair deal. First off our hospital provides a histo tech on call and the O.R. Is instructed to contact her first. The histo tech doesn't contact me until the liver and both kidneys are ready. Once in a blue moon they will also want a frozen of a lung. She "chucks up" the biopsies and cuts them so when I walk in the door they are ready to read. I spend 3 minutes looking at them and then deliver my frozen section diagnosis and then I go home while the tech cleans up. Round trip is 45 minutes. The donor organization pays us 88361x3, 88305x2 and 88307x1 for the frozens and final report which simply mirrors the frozen interpretation. In the end they pay us our full price for those cpt codes and that is way over what Medicare pays us for what amounts to 45 minutes of my time in the middle of the night. It is our only true fee for service payer

But having said that i absolutely hate going in for it and wouldn't care if they never did another donor at my hospital ever. It sucks but the hospital makes a lot of money off the donor organization using our ORs so I don't think it will change. I've asked the donor organization reps if they wouldn't mind not calling us to evaluate the organs and call the pathologist when it gets to the hospital where it will be transplanted. So far it hasn't changed.

Where transplant pathologists really make their money is all the biopsies for rejection with lots of special stains and immunos etc... To me it was super boring pathology like counting lymphocytes in a bile duct and I think it is a misguided fellowship as even at the busiest of transplant centers it is typical for the sub specialty pathologists to handle the cases, and moreover Pitt is taking away the experience for their own sub specialty fellows.