Two Fellowships?

[kruppe]

---

Members do not see this ad.

I plan on doing two fellowships in no particular order. Would it appear odd to apply to two different fellowships at the same institution for the same year to see which I get? or is that bad form?

 

[lipomas]

It depends on why your are doing them. If they are different fellowships like GI and Heme, or derm and cyto, for example, then you will have to be prepared for numerous questions about your level of seriousness for each. If they are more related or you have a specific reason or goal in mind then it's better.

 

[KCShaw]

I know (rare) people who did this, except didn't really know if they wanted to do 2 fellowships -- just hadn't really decided which they wanted most, and it seems to have turned out alright for them. If you have a good rationale for what you're doing, I imagine most will be accepting of it. But I agree that some fellowships just don't seem to mesh, so be prepared to explain. I'd recommend being up-front with them about it when you initially apply. While very large institutions might not talk as much amongst themselves about their fellow applicants, at some point it's going to become evident. If you're lucky they compete over who gets you first.

 

[2121115]

Is the general opinion these days that you need two fellowships to be competitive in the job market or are residents just doing 4 years of AP/CP then 1 fellowship then getting a job? Is that why you're planning to do 2 fellowships up front?

I agree that as long as they are somewhat related (i.e. surgpath then GI path) then it shouldn't be a problem.

 

[Anfield rd]

I plan on doing two fellowships in no particular order. Would it appear odd to apply to two different fellowships at the same institution for the same year to see which I get? or is that bad form?

The belief that more fellowships is better is wrong.

If you want to land a private practice, partnership track job, then the most important thing you can do is to be a master of bread and butter surgpath. Affability, availability, ability, like mikeishere said. If you have a fellowship under your belt, that's great, but don't expect it to be anything else than icing on a cake.

The groups care if you can do the job. The job usually consists of surgpath with sprinkle of other stuff. While you might get a job based solely on your fellowship-acquired skills, you will be much more marketable if you have SOLID surgpath skills instead.

 

[KCShaw]

I don't disagree, but it begs the question of what fellowship(s) are/should be considered the most marketable (if any)? By that argument, sounds like surg path (no certification) and/or cytology. Forgetting for a moment that people should do what interests them most, of course.

And, certainly, there are groups looking for individuals to fill specific niches, either because they happen to have a contract with a hospital/office that does a lot of breast/neuro/heme/pediatric/etc., or because their strategic plan is to have a bunch of generalists with also enough specialty coverage that they can compete with perhaps larger or more established groups. But perhaps ironically a fellowship could also make you -less- suitable for a specific job if perchance the group in the location you most want already has a fellowship trained GI pathologist and they don't want to split that work with you.

Honestly, I'd try not to overthink it, and return to what interests you most. You're more likely, I believe, to be successful at it and be able to promote yourself at it, while doing a good job and enjoying it.

 

[ScotchBonnet]

I am a large program where few people have had trouble getting a job..i.e. my following comment is based on a sample size greater than 1 or 2. Those folks headed to private practice have all done a fellowship. They appear as if they will be viewed by their groups as being capable of signing out all bread and butter surg path + being the go-to individual when one of the other partners has a problematic case in the area of their fellowship. So, while I certainly agree that becoming (highly) competent at general/bread and butter surgical pathology is mandatory, I think being able to offer additional expertise in an organ system is a sought after skill and helpful in landing a job (assuming of course you are a good teammate, speak English well, etc.).

 

[lipomas]

No, that (the opinion that you need to do >1 fellowship) is not a general opinion. It may very well be a general opinion of current residents who have not yet tried out the job market. But it is not the opinion of people doing hiring. Generally when people are hired they are hired to fill a specific need - sometimes that is a general pathologist who may happen to have expertise in some area. Sometimes it is someone with expertise in an area (like heme) who can also do general stuff. Rarely it will be someone with expertise in multiple areas. The generalist need not have done a fellowship, but it helps your candidacy. Doing extra does not usually help your chances.

The best fellowship you can do is the one that makes you a good communicator and effective member of a group. But people don't do those fellowships.

 

[2121115]

No, that (the opinion that you need to do >1 fellowship) is not a general opinion. It may very well be a general opinion of current residents who have not yet tried out the job market. But it is not the opinion of people doing hiring. Generally when people are hired they are hired to fill a specific need - sometimes that is a general pathologist who may happen to have expertise in some area. Sometimes it is someone with expertise in an area (like heme) who can also do general stuff. Rarely it will be someone with expertise in multiple areas. The generalist need not have done a fellowship, but it helps your candidacy. Doing extra does not usually help your chances.

The best fellowship you can do is the one that makes you a good communicator and effective member of a group. But people don't do those fellowships.

Good point. However, I am referring to two fellowships of general surgpath plus something else (heme, cyto, etc, etc), rather than two markedly different boarded fellowships (cyto and derm, etc). In summary I am curious if a general surgpath fellowship is seen widely as necessary to practice general pathology in a community practice. If it isn't, I am curious what the experience of those in practice is with new hires who have done 4 years plus a subspecialty fellowship versus 5 years (or 4 plus gen surg) plus a subspecialty fellowship.

In short, today someone with AP/CP plus 2 fellowships has the same amount of training that someone with AP/CP plus 1 fellowship did 10 years ago. What do old timers think of new hires who have 1 less year of training than they did when they were starting out? Is there an appreciable difference?

 

[yaah]

From my perspective, a general surg path fellowship is not necessary to practice in the community. But good general skills are necessary. This is why many groups want to hire someone with experience. A surg path fellowship almost always improves your skills. But for some people it is unnecessary. It very much depends on the individual.

 

[deleted314957]

Good point. However, I am referring to two fellowships of general surgpath plus something else (heme, cyto, etc, etc), rather than two markedly different boarded fellowships (cyto and derm, etc). In summary I am curious if a general surgpath fellowship is seen widely as necessary to practice general pathology in a community practice. If it isn't, I am curious what the experience of those in practice is with new hires who have done 4 years plus a subspecialty fellowship versus 5 years (or 4 plus gen surg) plus a subspecialty fellowship.

In short, today someone with AP/CP plus 2 fellowships has the same amount of training that someone with AP/CP plus 1 fellowship did 10 years ago. What do old timers think of new hires who have 1 less year of training than they did when they were starting out? Is there an appreciable difference?

I assume you are referring to the previously required "transitional" year or internship. Its original intent was to provide a solid year of clinical, patient oriented experience. It was often bastardized by "clinical" research. I fully believe that a year of more of clinical training (eg. rotating internship) produces a better pathologist. Further clinical practice helps more. Never forget that we serve as consultants to clinicians and I assure you that you will be held in more esteem and be more appreciated by them when they know you were in their shoes for however briefly.
That being said, I am sure the idea is about as popular as a fart in a space-suit.

 

[lipomas]

I disagree with the above. It doesn't produce a better pathologist. It can help some people become a lot better though. To me, that's what fourth year of med school is for. I know a lot of people like to use fourth year of med school as a fun time where they do next to nothing and take as much time off as possible, but you can use it to do rotations in areas that will help you make those connections better. If you do this there is even less reason to do a clinical year. If you don't and instead do 4 months of "independent study," two months of research, two months of international travel, etc, then obviously it's going to help you more.

I suspect your idea has as much traction as convincing clinicians that doing a year of pathology would make them better clinicians. It probably would, especially now that pathology the way it is practiced is getting closed to ignored in med school.

 

[KCShaw]

Having done an intern year, and spent time with residents who did and did not have post-med-school clinical experience, I feel pretty good about saying those with the additional experience had a better grasp of the big picture and what clinicians face (and therefore need/expect from pathology). Being a little more armed with that information than the average resident to at least junior attending, in my opinion, has made me and those individuals with that experience "better" at the overall job of a pathologist -- all other things being more or less equal. I also think it makes communicating with clinicians easier up front, and that's a big part of the job of a pathologist.

Most likely that difference fades with time and experience. I dunno if it applies with the same force to someone who's been an attending for several years. And, certainly, some individuals have a better grasp of the big picture up front. But I feel you learn different things when you have more responsibility (as an intern, etc.) than you do as a med-student, no matter how hard-core your rotations might be.

I'm not advocating a return to the Old Ways, nor some major paradigm shift to the Current Ways. But I do think there's something to be said for more clinical experience, and wouldn't be against a rotation or two through internal medicine or surgery or whatever, just as I wouldn't be against OTHER residencies requiring a rotation or two through pathology, at least in principle.

 

[2121115]

My understanding is that even in the recent past, no one really did clinical years for their 5th year requirement. Most residents did an extra year of pathology, often a surgpath fellowship, for their 5th year. For instance, they would do 4 years of residency, a 5th year "surgpath fellowship" then a 6th year of subspecialty fellowship (heme, cyto, etc). Those residents finished training with 6 years of training, 1 being a general surg fellowship (which was technically the final year of residency) and another being a subspecialty. These days there is one less year of pathology training (not one less clinical year).

I am wondering if this is reflected in the quality of recent trainees and wondering if those doing the hiring prefer candidates to have 2 fellowships, a surgpath fellowship plus another, in order to have equivalent training to what they had.

 

[KCShaw]

In practical terms I think that's pretty accurate, for how the credentialing year was usually handled. But even when I was applying for residency not THAT long ago, some of the websites were claiming they recommended a clinical year. I don't recall anyone telling me face-to-face I should do a clinical year, though.

I thought there was a survey of employers out there somewhere which addressed this, actually (5th credentialing year vs none, fellowship vs none) -- I just can't recall for sure.

 

[lipomas]

Most likely that difference fades with time and experience. I dunno if it applies with the same force to someone who's been an attending for several years. And, certainly, some individuals have a better grasp of the big picture up front. But I feel you learn different things when you have more responsibility (as an intern, etc.) than you do as a med-student, no matter how hard-core your rotations might be.

The difference can fade with time and experience, but not always. Depends on the person. There are some pathologists who are very good at communicating with clinicians and they learn through discussion and observation and all that what is important and what is not. Someone with a year of clinical medicine I agree has more of an understanding when they start their career, but that difference fades in my experience.

I am wondering if this is reflected in the quality of recent trainees and wondering if those doing the hiring prefer candidates to have 2 fellowships, a surgpath fellowship plus another, in order to have equivalent training to what they had.

I highly doubt it's based on "equivalent training" since so many doing the hiring did zero fellowships or one fellowship.

In my impression a lot of the impetus for doing extra fellowships comes primarily from residents, not from whoever is doing the hiring. Residents think they have to do more (in part by paying far too much attention to rantings on sites like this one) training to make themselves more competitive. In actuality it's not MORE training that is the answer - it is quality of training and your general skills as a pathologist and an individual. But hey, it's easier for many people to just focus on more training than to focus on weaknesses that are harder to address. To be sure, timing is a huge factor as to whether you are suited for a certain job and their needs.

If someone with two boarded or subspecialty fellowships, for example, is looking for jobs, most interviews will probably be granted because of one of those two fellowships, not because of both. Which one it is depends on the group and the circumstances. And likely some interviews will not be granted because they did two discordant fellowships and seem like they might be confused. So sure, you might be able to technically "maximize" your chances for getting a job by doing more fellowships, but the difference is not that significant in the great scheme of things and becomes negligible if your true job interest is a job that is well suited for you and not just because it's an available job in a specific city.

 

[deleted314957]

I disagree with the above. It doesn't produce a better pathologist. It can help some people become a lot better though. To me, that's what fourth year of med school is for. I know a lot of people like to use fourth year of med school as a fun time where they do next to nothing and take as much time off as possible, but you can use it to do rotations in areas that will help you make those connections better. If you do this there is even less reason to do a clinical year. If you don't and instead do 4 months of "independent study," two months of research, two months of international travel, etc, then obviously it's going to help you more.

I suspect your idea has as much traction as convincing clinicians that doing a year of pathology would make them better clinicians. It probably would, especially now that pathology the way it is practiced is getting closed to ignored in med school.

Your second paragraph is interesting. A lot of academic places like mass general and mayo, back in the days of Halstead, surgeons had to do 6 months to a year of pathology.

 

[lipomas]

Your second paragraph is interesting. A lot of academic places like mass general and mayo, back in the days of Halstead, surgeons had to do 6 months to a year of pathology.

Indeed. And in the days of Halsted a lot of pathologists were actually surgeons. Or other specialties. Hey, I think everyone in med school should get more exposure to path these days. They keep cutting it down and watering it down in order to allow students more time to "study" and more time to go to clinics or whatever. But yet I am forced to do three months of surgery.

 

[HbyHA]

Indeed. And in the days of Halsted a lot of pathologists were actually surgeons. Or other specialties. Hey, I think everyone in med school should get more exposure to path these days. They keep cutting it down and watering it down in order to allow students more time to "study" and more time to go to clinics or whatever. But yet I am forced to do three months of surgery.

i completely agree. i rotated through your specialty in med school for 4-12 weeks (in the case of Medicine... ugh) yet you get to ignore and belittle mine, even when it would behoove you to actually know a thing or two about it. Good idea.

Case in point: My father told me last night at dinner that he was talking to a cardiologist who has been practicing for about three years and when he mentioned that I was a pathologist, this guy actually asked him "What's that? What does she do?"

I cried a little for him. Idiot.

 

[KluverB]

Again, some of this is probably "our", ie. pathologists', own fault. Given the choice of teaching and not teaching med students, residents, etc, pathologists probably lean towards not teaching. And so, specialties that have a stake in producing new, outstanding talent win out (surgeons, obgyns, cardiologists, etc); whereas we're on here bitchin' about the job market and the erosion of our specialty. It all comes down to marketing and selling your-(our-)self.

Pathology is disappearing from the curriculum because there are fewer and fewer advocates for our specialty to push back against "the system" that is reducing medical education to a series of clinical vignettes. You would think that's a good thing, because that should restore us (pathologists) as the doctor's doctors, giving our expertise to help interpret lab and histo results for other physicians. Alas, if they don't know who we are, isn't it much easier for them to defer to the pretty report, with explanation and references, that they get from Mayo, Quest, Ameripath, etc?

 

[Entgegen]

I guess my med school is different...we are systems based, and spend our first year in anatomy and physiology of the different systems, while second year is a recap of all the systems from a pathological standpoint. So in second year, half of each system's course is the all the pathology associated with it and is taught by a pathologist. The second half of each course is the clinical side of the diseases of the system and management thereof, and is taught by clinicians.

Needless to say, everyone that goes through our curriculum is aware of what a pathologist is and has a reasonable idea of what they do.

 

[gschl1234]

I guess my med school is different...we are systems based, and spend our first year in anatomy and physiology of the different systems, while second year is a recap of all the systems from a pathological standpoint. So in second year, half of each system's course is the all the pathology associated with it and is taught by a pathologist. The second half of each course is the clinical side of the diseases of the system and management thereof, and is taught by clinicians.

Needless to say, everyone that goes through our curriculum is aware of what a pathologist is and has a reasonable idea of what they do.

My medical school was the same, and although we *technically* had "pathology" in second year, you end up coming out having no clue to what a pathologist does day to day (even if you might *think* you do).

 

[KCShaw]

Yeah, as a med student we had some lectures/labs on "pathology" taught by a "pathologist," which (with one definite exception) usually turned out to be a PhD or grad student who may as well have been teaching some version of undergrad cell biology or physiology. Later as a resident we, and some of our attendings, occasionally helped out with the med student labs/lectures, but again almost always just addressing a basic science component of whatever they were supposed to be learning at the time, with some pathologic anatomy thrown in. Which is all well and good, but didn't address what an MD-pathologist "does."

When I started making noises about doing pathology, pretty much everyone asked the same thing -- "do you know what they really do?" And if I asked a pathologist, "you should do a rotation with us so you can see what we really do." Unfortunately for medical student general education, that was good advice.

 

[dermpathlover]

I plan on doing two fellowships in no particular order. Would it appear odd to apply to two different fellowships at the same institution for the same year to see which I get? or is that bad form?

I applied to derm and heme but did heme first as to kill a year before the dpath fellowship.

I am really happy with my choices...my new job starts in a few weeks and it will involve signing out derm and running my group's flow lab as my major responsibilities. We are located in the SE. The starting salary is more than I ever expected and the partrnership is given after two years. Supposedly my salary will be about 2.5x as much after partnership.

Doing two fellowships didn't hurt me at all.

 

[2121115]

Just an observation... Pathoutlines and the CAP website are overflowing with jobs requiring 3 - 5 years of experience. I was wondering if this reflects the lack of sufficient training in the 4 year system. It seems like many practices aren't even considering new graduates.

 

[KCShaw]

Was it ever -not- that way? Personally I tend to think most practices want someone young enough to be molded and not gripe about how they've always done it differently, but experienced enough to not worry about. In pathology, for the most part fellowships still mean a lot of oversight, and even 2 or 3 fellowships in different things aren't the same as signing out on your own for a few years.

As a lot of people who've been out working seem to say (myself included), whether it's internal medicine, pathology, or whatever, you feel like you learn more in the first couple of months of actual work than you ever did in "training."

 

[yaah]

Many residents are quite qualified when they finish their training. Many are not. Many private groups have been burned by the latter. It can be hard to evaluate because as said, many programs don't provide much graduated responsibility and many residents do not go the extra mile to make themselves better.

 

[deleted314957]

Just an observation... Pathoutlines and the CAP website are overflowing with jobs requiring 3 - 5 years of experience. I was wondering if this reflects the lack of sufficient training in the 4 year system. It seems like many practices aren't even considering new graduates.

when i was a hiring partner (1992-1996) we never considered someone fresh out of a residency or fellowship. It was the lack of the "out of the womb" independent experience. As I have alluded to on other threads , the post residency and/or fellowship experience that I and my colleagues in the military is what landed all of us jobs. It is not so much the lack of sufficient training. As a matter of fact, if someone with 3 fellowships applied we would wonder what the hell was wrong with this person.

 

[yaah]

I got my job at a place that had never hired anyone out of fellowship. They said they were taking a chance but had done their homework and knew I wasn't going to be doing much administrative stuff for a few years anyway so it was a good opportunity.

 

[2121115]

Interesting. I have heard differing things on this issue. I've have also been told that groups are reluctant to hire someone who has been at a different job already because it means they likely aren't working out or they might be malcontents or whatnot. Basically that if they were a good pathologist they'd have either gotten a better job (if the job they are in is suboptimal) or maybe they are not working out where they are for some reason or another (i.e. maybe they aren't competent).

That seems to be the opposite of the general consensus here in this thread. I guess it just varies a lot based on the individual.

 

[KCShaw]

People are sometimes absurdly cautious. Every employer is a little different, and has a slightly different idea of what they consider to be the ideal new hire. Potential employers might look at you and see certain things as strengths or weaknesses, different to how another employer sees things. I don't think one can out-think them and please every potential new employer; work hard, learn to do what you like least about path at least competently and what you like most very well, and the chips will fall where they may.

Kinda like romance. You might dig a certain person but they just never come around no matter what you try, and the harder you try the more obvious it is that you're desperately failing. Some people like the shy sorts. But most people are attracted to someone who's comfortably confident with what they're doing in life, without being arrogant or stand-off'ish, who also show a little desire in becoming involved.

 

[lipomas]

Interesting. I have heard differing things on this issue. I've have also been told that groups are reluctant to hire someone who has been at a different job already because it means they likely aren't working out or they might be malcontents or whatnot. Basically that if they were a good pathologist they'd have either gotten a better job (if the job they are in is suboptimal) or maybe they are not working out where they are for some reason or another (i.e. maybe they aren't competent).

That seems to be the opposite of the general consensus here in this thread. I guess it just varies a lot based on the individual.

The last sentence is most appropriate. I know groups who will hire new fellowship grads, but look at them more carefully and talk to more references. I suspect there are groups who ONLY hire new fellowship grads and attempt to take advantage of them. Some groups won't hire certain experienced pathologists because they have a reputation or they are working at a low-quality place (and therefore must be low quality themselves, I guess). It's all individual and variable. If you are a good pathologist with good training you may very well find that a group that hires you says they don't normally hire new grads but they will with you.

 

[deleted314957]

Probably as germane is the fact that the few people we canned over a number of years all got jobs in a pretty quick time frame within an approximately 75 mile radius or less and the folks who quit for one reason or another all had immediate employment which I assume had been pre-arranged. So it seems termination or quitting are certainly not the kiss of death as others have suggested they may be.

 

[Sulfinator]

That seems to be the opposite of the general consensus here in this thread. I guess it just varies a lot based on the individual.

Indeed. I hope, 2121115, that you will share with those of us here on SDN as you begin the job hunting process. What are your thoughts/feelings right now about your future job or career? Are you optimistic, pessimistic, or somewhere in-between? Do you wish you had chosen another specialty?

 

[lipomas]

Probably as germane is the fact that the few people we canned over a number of years all got jobs in a pretty quick time frame within an approximately 75 mile radius or less and the folks who quit for one reason or another all had immediate employment which I assume had been pre-arranged. So it seems termination or quitting are certainly not the kiss of death as others have suggested they may be.

I have found the same thing - it's always what puzzles me about all the job market threads. People who have been fired - fired, not quit - more than once keep showing up at different jobs in the same area. My group would be very unlikely to hire someone who was fired from another local institution. Sometimes places just need a warm body and that is the best they can do, which sounds odd given the whining on this forum and the supposed surplus of all these extremely talented unemployed pathologists. It doesn't make sense to me, but I guess a lot of it is regional. Lots of our majorly disgruntled posters seem to be californians and maybe it's a different world out there.