Which programs should be shut down?

[CDX-2]

I hope youre not in pathology residency yet.

To be fair, I'm curious too, and I'm a pathology registrar (resident)...

At the moment in Australia, we don't "have to" do AP fellowships after AP training as the AP training program alone is already 5 or 6 years.

This might change with the job market in the future though.

I've heard of people working as a "Fellow" for 1 year in a public hospital, but this is essentially like a "junior consultant / attending" role,
but with the salary of a senior registrar / resident, with no official guarantee of getting an actual public consultant job afterwards (AFAIK).

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[SunBakedTrash]

Some notable combinations I’ve seen:

Derm and blood bank
Forensics and blood bank
Cytology and blood bank
Surg path, blood bank, micro
Derm and chemistry
Renal and molcular
Hemepath and renal


I’m sure some of this may reflect needing to wait for a fellowship to be available or a genuine change of preference since we’re forced to choose a fellowship so early. Also the phenomenon of not getting a job and needing to scramble into a fellowship is all too real. Nevertheless, multiple fellowships that don’t relate to one another (unlike heme/molecular or blood bank/HLA) show indecisiveness and insecurity in my opinion.

 

[Autopsy101]

Red Flags (continued) IMO -

Errors in cover letter or body of emails.

Applying for a currently advertised job when you are a 4th year resident and telling me your date of availability is 2 years or more in the future - almost no one hires 2 years in advance. I needed someone dictating my backlogged cases yesterday, not 2 years from now when you've completed your planned academic path.

Listing in-service exam scores on CV

Listing "meeting attendance" on your CV - Don't do this - If you didn't present (poster or platform), it's just filler.

Listing the title of every medical student lecture/lab you ever gave - instead of just putting "Pathology course, teaching assistant, med school X, (2015-2016).

Having your famous references (who I don't know personally) call me randomly, awkwardly start up a conversation to name drop you, and ask if I saw your application.

Send out emails dictating to me when your application/interview season opens and closes - this is not the match, the employer dictates when and if you interview - and that behavior will earn you a hard pass from me.

Complain about my choice of hiring practices in your cover letter - had someone complain that they didn't expect to see the job listed on PathOutlines and went on about it for 2 paragraphs in the cover letter...hardest of passes.

 

[CDX-2]

Some notable combinations I’ve seen:

Derm and blood bank
Forensics and blood bank
Cytology and blood bank
Surg path, blood bank, micro
Derm and chemistry
Renal and molcular
Hemepath and renal


I’m sure some of this may reflect needing to wait for a fellowship to be available or a genuine change of preference since we’re forced to choose a fellowship so early. Also the phenomenon of not getting a job and needing to scramble into a fellowship is all too real. Nevertheless, multiple fellowships that don’t relate to one another (unlike heme/molecular or blood bank/HLA) show indecisiveness and insecurity in my opinion.

Interesting, I didn't realize blood bank was that popular...

Are people allowed to just stay on as a senior resident in general surgical pathology (ie becoming a 5th year resident) if they can't find an appropriate / preferred fellowship?

It sounds like the fellowship choices might backfire!

 

[pathology1234]

Interesting, I didn't realize blood bank was that popular...

Are people allowed to just stay on as a senior resident in general surgical pathology (ie becoming a 5th year resident) if they can't find an appropriate / preferred fellowship?

It sounds like the fellowship choices might backfire!

There are general surgical pathology fellowships, which basically are an extra year of residency but without CP rotations.

 

[YH5]

U. of South Alabama, Accession #11,000 with 13 residents... Those figures look totally absurd.

Is there any way to find out of those 13 residents, how many are rotated to AP at any time?

I presume all of them are training in AP/CP.

Even if it was 4 residents on AP at a time (with the other 9 on CP/Autopsy/Forensics), that's still really cushy in terms of grossing (even if they had didn't have a PA)...

Also how many attendings would there be to report that histology volume (#11,000)?

I get the impression that there are more residents than attendings!!!

The accession numbers at South Alabama are much higher than 11,000, but making assumptions from these accession numbers is laughable anyway. It doesn't tell you anything about the complexity of the cases, whether there are PA's working there, and whether there are other hospitals where the residents rotation on surgical pathology.

In simplified terms: South had four residents on surg path at one time. One resident each week is on derm path only, leaving three residents to cover surg path. One resident is on preview, leaving two residents for grossing. One resident is also covering frozen sections, leaving one full time grossing resident.

There were also additional surg path rotations as the sole resident at a private hospital with double the accession numbers.

Post-residency, I am quite confident that my surg path training, compared to my peers, was well above average.

CP training is what should really be used to determine which programs are shut down.

 

[Unty]

The accession numbers at South Alabama are much higher than 11,000, but making assumptions from these accession numbers is laughable anyway. It doesn't tell you anything about the complexity of the cases, whether there are PA's working there, and whether there are other hospitals where the residents rotation on surgical pathology.

In simplified terms: South had four residents on surg path at one time. One resident each week is on derm path only, leaving three residents to cover surg path. One resident is on preview, leaving two residents for grossing. One resident is also covering frozen sections, leaving one full time grossing resident.

There were also additional surg path rotations as the sole resident at a private hospital with double the accession numbers.

Post-residency, I am quite confident that my surg path training, compared to my peers, was well above average.

CP training is what should really be used to determine which programs are shut down.

Yup some CP training at most programs are laughable.

Me: Hi Dr. X, I’m on (fill in CP rotation).

Attending: just go study.

Me: OK, (chuckle to myself thinking about this nice mini-vacation I’m getting and getting paid for it).

CP rotations are the easiest part of any residency in all of medicine. It can be used to separate the real training programs aka both strong AP/CP from the rest.

With all the “weak candidate” talk applying for jobs on here, there is a lot of sh$t programs training sh&t candidates.

 

[gbwillner]

Some notable combinations I’ve seen:

Derm and blood bank
Forensics and blood bank
Cytology and blood bank
Surg path, blood bank, micro
Derm and chemistry
Renal and molcular
Hemepath and renal


I’m sure some of this may reflect needing to wait for a fellowship to be available or a genuine change of preference since we’re forced to choose a fellowship so early. Also the phenomenon of not getting a job and needing to scramble into a fellowship is all too real. Nevertheless, multiple fellowships that don’t relate to one another (unlike heme/molecular or blood bank/HLA) show indecisiveness and insecurity in my opinion.

You got to be careful with this, because as you state, this is often the unavoidable consequence of matching to the fellowship of choice but being forced to wait a year. This probably should not be held against the applicant. The concern is that you are looking at a candidate that may take two or more random fellowships because this is de facto employment and they cannot secure a real job.
Let's break down your examples and guess the true cause:

1. Derm and blood bank or chemistry. This is probably the easiest do decipher. First, this person was at a program with a blood bank fellowship, so a good chance it was a good CP program. Derm is the hardest fellowship to get. The most likely scenario here is they matched to derm at their home institution but had to wait in line for a year. They took an easy fellowship to fill the time. But you could easily trust this person to handle CP call or even serve as medical director right out of training. So I wouldn't hold any of this against the applicant on its own.

2. Renal and molecular. This likely reflects a hyperspecialized applicant who decided to bail on academia. The concern is that they are from a program that has these fellowships but can't fill them, but this is not as likely IMO.

3. Surg path plus 2 CP fellowships. This looks like the biggest red flag to me. This reads like: went to a crap program and matched to a decent program for surg path to improve skills and raise their marketability. But they were not good and needed a fellowship, and all they could get was a CP one. Afterwards they were unemployable and had to do another. Cytology and blood bank seems similar to me to a lesser extent.

4. Forensics and blood bank. This is the toughest one... this person is totally unemployable, having picked 2 specialties where there is clear demand and still can't get a job, or they committed to one and simply wanted a career change.

How'd I do?

 

[SunBakedTrash]

You got to be careful with this, because as you state, this is often the unavoidable consequence of matching to the fellowship of choice but being forced to wait a year. This probably should not be held against the applicant. The concern is that you are looking at a candidate that may take two or more random fellowships because this is de facto employment and they cannot secure a real job.
Let's break down your examples and guess the true cause:

1. Derm and blood bank or chemistry. This is probably the easiest do decipher. First, this person was at a program with a blood bank fellowship, so a good chance it was a good CP program. Derm is the hardest fellowship to get. The most likely scenario here is they matched to derm at their home institution but had to wait in line for a year. They took an easy fellowship to fill the time. But you could easily trust this person to handle CP call or even serve as medical director right out of training. So I wouldn't hold any of this against the applicant on its own.

2. Renal and molecular. This likely reflects a hyperspecialized applicant who decided to bail on academia. The concern is that they are from a program that has these fellowships but can't fill them, but this is not as likely IMO.

3. Surg path plus 2 CP fellowships. This looks like the biggest red flag to me. This reads like: went to a crap program and matched to a decent program for surg path to improve skills and raise their marketability. But they were not good and needed a fellowship, and all they could get was a CP one. Afterwards they were unemployable and had to do another. Cytology and blood bank seems similar to me to a lesser extent.

4. Forensics and blood bank. This is the toughest one... this person is totally unemployable, having picked 2 specialties where there is clear demand and still can't get a job, or they committed to one and simply wanted a career change.

How'd I do?

i agree, you are right. I try not to make a judgments until I meet them, but I strongly prefer candidates with one fellowship. If a surgery resident can learn what they need to know in 5 years, I figure pathology residents who apply themselves could also manage to be competent enough to function with a whole residency and a fellowship.

1. i believe this was the case. The person wanted to be marketable as the ultimate private practice candidate. makes sense, i suppose, but seems like overkill to me.

2. Claimed they liked renal but felt molecular would be the wave of the future. wanted to have a leg up on joining skynet when it inevitably takes over.

3. Saw this one in training. completely gun shy and unable to commit to anything. Masochistic enough to truly enjoy the fellowship merry-go-round.

4. not sure, heard about this one indirectly. My guess is they didn’t like microscopy and forensics ended up being too gruesome.

 

[gbwillner]

The devil's in details sometimes. Here are 2 individuals with 3 fellowships that I know personally. See if you can guess the circumstances:

1. Surg path, derm, heme
2. Surg path, neuropath, peds path

 

[deleted314957]

The devil's in details sometimes. Here are 2 individuals with 3 fellowships that I know personally. See if you can guess the circumstances:

1. Surg path, derm, heme
2. Surg path, neuropath, peds path

They could not get a good job out of a 4 year ap/cp residency because the training today is inadequate and neither had EVER had any INDEPENDENT responsibility?


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[gbwillner]

They could not get a good job out of a 4 year ap/cp residency because the training today is inadequate and neither had EVER had any INDEPENDENT responsibility?


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Nope. There are 2 people here with different circumstances. You can probably derive some degree of correctness imo by looking at the fellowships.

 

[canadapath]

The devil's in details sometimes. Here are 2 individuals with 3 fellowships that I know personally. See if you can guess the circumstances:

1. Surg path, derm, heme
2. Surg path, neuropath, peds path

Research interests in cutaneous lymphomas and pediatric brain tumours?

 

[gbwillner]

Research interests in cutaneous lymphomas and pediatric brain tumours?

Ok, that's a good guess. You win the prize for candidate 1.

Candidate 1. Excellent resident at top program. During last year of residency, program asks him to step up for a surgpath fellow who bailed at the last minute. Split duties with another resident, and at the end, the program gave him recognition for the fellowship even though it was done during residency. Had interest in skin lymphomas as mentioned. Had to wait a year for the derm fellowship, so he did heme in the meantime. Has had a successful academic career with research focus on skin lymphomas.

2. Middling residency, gets surgpath fellowship at top program. Does 2 year neuro fellowship at same institution, but does not want to relocate for a job, and no positions available at home institution. Also does not do significant research. Needs employment and does peds path, which fills maybe 50% of the time. Has a hard time getting employment, although she does get something decent eventually in PP.

 

[potato51]

This should be a sticky on this forum. 60 applicants for a job ad. Does primary care get 60 applicants for a job?

this is important to know for medical students.
What are examples of red flags you saw? What do you mean by respectable references? What examples of CVs have you seen that did not reflect a degree of professionalism? What do you mean by good training experiences? As in good programs? This information can shed light on the type of weak applicants\graduates that employers are seeing.

When people say that they only see a handful of good applicants that suggests one thing. Weak applicants getting into pathology, weak training programs or a combination of both. Weak applicants can only be due to one thing....Too many programs training weak candidates who flood the job market looking for jobs.

I wish academics like Karchner And Hoda could read this and add it to their next job market publication.

Red flags:
- Poor writing ability on CV and cover letter
- Long lapse between residency and passing AP/CP boards
- No explanation of time gaps
- Too much jumping between jobs in a short period of time
- Vague cover letter ("I was exposed to 1000s of surgical cases." - great! "exposed" means nothing - did you actually learn anything? and are you aware dozens of others are writing the same thing you're writing?)
- Lackluster references and more importantly, non-references that I can call up
- A reference list mostly of people who are probably your friends (like senior residents who just became faculty)
- More than 2 fellowships (unless I can tell there's an unusual circumstance)
- Odd interactions on phone interview
- Poor behavior on social media (you'd be surprised)
- A rarity but a favorite: Trying to mislead us where you did residency. No need to tell me you trained at 'Weill Cornell' when I can clearly tell the PD you listed is from Houston Methodist Hospital which is affiliated with WCMC (and HMH is a good program anyway, what the heck). Also saw this from someone who trained at Ball Memorial Hosp in Indiana, and the applicant simply listed "Indiana University." Not on my watch...

 

[Unty]

HMH is a good program. Lol just be yourself no matter where you train. If you are confident in your abilities no need to name drop that you went to a brand name program instead of your real program.

 

[CellularTherapist]

Some programs should be closed or reduced. However, those numbers are not accurate. My program on there has the wrong number of residents, accessions, and the pass rate is actually listed higher than the actual...

They could not get a good job out of a 4 year ap/cp residency because the training today is inadequate and neither had EVER had any INDEPENDENT responsibility?


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I agree with mikesheree, residencies need to change what they are doing. Actual graduated responsibility with true prelims should be a thing. Radiology found a way. It can be done.

 

[DoctorCancer]

I am the FMG you guys love to hate

I finished my residency in a "****-hole" country before coming here. Even we produce more confident junior pathologists compared to the US. I see young staff straight out of big name fellowship programs who run around like headless chickens for consults when they are on frozen desks.

I agree people don't get sued that much in developing countries and you can always cite lack of resources as an excuse for inefficiency but come on! I had never seen such under-confident new pathologists before coming here. There is no graduated responsibility for residents (and even fellows) in 99% of programs. Pathology residents can't even sign out benign uteri and gallbladders or hernia sacs while their surgical counterparts are comfortably chopping them off.

All I have learnt in my residency here in 4 years is how to give out ambiguous diagnoses and waste a lot of resources in the process. The problem is that when I will go back to my "own" country now (and not adding to another person looking for a job), I will be 1/8th as confident and 8 times more wasteful with resources compared to other pathologists there. I hope I could do something for myself with the "US tag".

 

[Unty]

I talked to the president of a 3 person group today in a 250 bed hospital. She said one of their new hires a few years ago wanted her to look at EVERYTHING. I mean everything. He didn’t do a fellowship. She mentioned that the first year of work is NOT supposed to be an additional year of residency or fellowship. She said by looking at all his cases, you don’t get reimbursed twice.

She mentioned that he was from a bad training program when I asked her what she thought was the reason for his lack of confidence.

Inadequate training and making sure residents can work independently and write coherent surgical pathology reports is a SERIOUS issue in Pathology training that I think academics should also focus on in addition to the challenging job market.

I’ve heard this from multiple people. New grads can’t work independently in practice because pathology programs allow them to fall thru the cracks. They don’t assess residents and they go thru training and graduate. They go into practice and can’t function. Sh%t in sh$t out.

 

[hurrycane]

New grads can’t work independently in practice because pathology programs allow them to fall thru the cracks. They don’t assess residents and they go thru training and graduate. They go into practice and can’t function. Sh%t in sh$t out.

If (senior) residents were allowed to actually s/o cases and call FS, it would stimulate them to LEARN how to be competent. Screwing up (or the fear of screwing up) is one of the best motivation stimuli. That could improve even sh*ty programs IMO. In my residency nobody gives a damn if your diagnosis is right or not. If you grossed the case, checked the history, and put paperwork in the right order for attendings, you are golden.
Why doesn't ACGME allow signout fellowships? I know only a handful exist in the country (like Hopkins, Columbia, MassGen) and they have to make up some positions to make it happen. I think they should require all fellows to signout cases to get certificate. One can't learn how to be responsible from books.

 

[Unty]

I understand what you are saying. My residency program was kind of like that. Like if you missed something major, they wouldn’t hold you accountable or bring it up to you right there at signout. Attendings can give feedback in a manner that is not demeaning like saying You missed this, it’s major mistake, be careful next time. Some attendings in my experience may not care (serious) or just don’t want to say anything.

Communication is so important between attendings and residents. Attendings have to hold residents accountable for diagnoses as they go on in residency. Some places don’t do that. Residents should be trying to make frozen section diagnoses as early as second year. If you don’t know what it is at least you put yourself on the spot and the attending can give you feedback based on what you think. Is it malignant or benign?

Assessing a residents diagnostic abilities and knowledge (across all specialties) is absent in programs out there and that’s why there are weak candidates out there looking for jobs.

You have to take it upon yourself to make sure all your diagnoses are in the system before signout with the attending. All the Synoptics are in there. Everything should be ready to be signed out without the attending doing anything. Of course this is to be expected of someone closer to 4th year.

If your attending won’t give you feedback you can ask him or her to. They usually write something in your eval. But really you have to take it upon yourself to be hard on yourself. If they don’t do it, you got to do it on your own.

You can always ask them questions. Some attendings won’t bother to go out of their to tell you or teach you things.

Look/preview at as many cases as possible. If you make a mistake that’s when you learn. The more you do the better off you will be. The less you do the worse off you will be.

ACGME won’t allow it probably because they wouldn’t trust programs to allow their graduates to signout cases on their own. One missed diagnosis of cancer you are seriously f%cked.

The best way to learn is to preview a case, put in your diagnoses/synoptic and sit with the attending and learn from your mistakes. If you need to order stains, know write up a list of stains you would order and compare to what the attending orders.

Some attendings could care less how good you are as a diagnostician. Sadly they just want their cases signed out.

 

[Iceman24]

No pathology residency in US will let resident call frozen to OR or write a report available to clinicians independently, without faculty looking at it first.
It doesn't matter what people on this forum think about it, it is just never going to be changed.

 

[Unty]

All it takes is one misdiagnosis.

 

[moosepatrol77]

The accession numbers at South Alabama are much higher than 11,000, but making assumptions from these accession numbers is laughable anyway. It doesn't tell you anything about the complexity of the cases, whether there are PA's working there, and whether there are other hospitals where the residents rotation on surgical pathology.

In simplified terms: South had four residents on surg path at one time. One resident each week is on derm path only, leaving three residents to cover surg path. One resident is on preview, leaving two residents for grossing. One resident is also covering frozen sections, leaving one full time grossing resident.

There were also additional surg path rotations as the sole resident at a private hospital with double the accession numbers.

Post-residency, I am quite confident that my surg path training, compared to my peers, was well above average.

CP training is what should really be used to determine which programs are shut down.

This is directly from the University of South Alabama website:

 

[deleted314957]

No pathology residency in US will let resident call frozen to OR or write a report available to clinicians independently, without faculty looking at it first.
It doesn't matter what people on this forum think about it, it is just never going to be changed.

Things used to be MUCH different. In the 80’s (and i assume before) senior residents in last months of surg path had complete independence. Laws were different then. no payor or clia problems and it was the navy.

Back then, your first week out of residency in the navy and you may be the sole pathologist at a place like groton naval hospital (example may be dated)


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[gbwillner]

No pathology residency in US will let resident call frozen to OR or write a report available to clinicians independently, without faculty looking at it first.
It doesn't matter what people on this forum think about it, it is just never going to be changed.

This is patently false. I did both as a resident.

 

[Alteran]

This is patently false. I did both as a resident.

How long ago was that? No program I know of would allow a resident to do that for medical-legal reasons. The best you can hope for in a modern ACGME accredited program is an adequacy on ROSE, as either a senior resident or fellow.

 

[deleted314957]

How long ago was that? No program I know of would allow a resident to do that for medical-legal reasons. The best you can hope for in a modern ACGME accredited program is an adequacy on ROSE, as either a senior resident or fellow.

No wonder no one can get out of the pathology womb and need fellowship(s) and STILL can’t function on their own.


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[Iceman24]

This is patently false. I did both as a resident.

When was that?

 

[Iceman24]

No wonder no one can get out of the pathology womb and need fellowship(s) and STILL can’t function on their own.

I agree with that but it's not a fault of current trainees, but rather whole pathology medical education, don't you think so?
And that would never happened without silent or active approval of people like gbwillner.
Otherwise, it sounds like a group of aliens threatened program directors/faculty/hospital administrators to implement those changes against their wishes.

 

[deleted314957]

I agree with that but it's not a fault of current trainees, but rather whole pathology medical education, don't you think so?
And that would never happened without silent or active approval of people like gbwillner.
Otherwise, it sounds like a group of aliens threatened program directors/faculty/hospital administrators to implement those changes against their wishes.

I wholeheartedly agree it is the system. Too many agencies, too many payers, too much scrutiny, too many inspectors and inane regulations.

It used to be that post grad medical training was like an apprenticeship/journeyman situation. Nobody interfered with it. It was almost a black box. But we turned out people who could practice good medicine from day 1. Did we
ever f*** up along the way? Sure. I’VE been a big time patient and have been f***ed up ON MYSELF but that is how we go from rookies to confident experts.


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[octopusprime]

The difference between a path resident making a mistake and a gen surg resident making a mistake is the latter's problems occur in real time and can be (ideally) remedied real time and occur in the setting of anesthesiologists (or anesthesiology residents), PAs, nurses, etc OR staff...you let some resident diagnosis gallbladders, appendices, skins, and they miss a malignancy, it's different. Technically, while lots of PGY4-5 surgical residents PERFORM procedures on their own, there is still usually technically immediate availability from an attending, even if only on paper. Plausible deniability. Hard to sign out surgical cases in the same manner.

I admit this lack of responsibility & ownership is key to the problem, but I don't see how that is easily--or even painfully--solved in today's medical climate. It would still require concurrent double scoping or ex post facto review by attendings. And this will never happen.

 

[Thr0mbus]

I don't see how that is easily--or even painfully--solved in today's medical climate. It would still require concurrent double scoping or ex post facto review by attendings. And this will never happen.

post facto review should be REQUIRED of these LAZY, SELFISH ACADEMICS who all want to enjoy the government welfare check that is attached to a resident but want none of the RESPONSIBILITIES.

 

[Unty]

Check out this Job ad-

Is this a way to save costs and hire a young board certified pathologist, who has already done a surgical pathology fellowship, to work for you?

Looks like another surgical pathology fellowship year in addition to the one you already did but you get paid higher than a fellow but less than what academia would pay you.

Ladies and gentlemen, introducing an “Anatomic pathology instructor”.

Anatomic Pathology Instructor
2021-2022​

LOS ANGELES, CALIFORNIA (USA). Applications are invited for Anatomic Pathology Instructor positions in the Department of Pathology and Laboratory Medicine at Cedars-Sinai Medical Center. The successful candidates will join a subspecialized anatomic pathology division supporting the clinical and academic missions of an internationally recognized department. One year of prior fellowship training in surgical pathology or a surgical pathology subspecialty is preferred. Eligibility for California licensure and for appointment to the Cedars-Sinai Medical Staff is required.

These positions are one year in duration with graduated independent sign-out, coupled with responsibilities in resident/gross room teaching, an active intraoperative consultation service and part- time research. The first half of the year will have a heavy emphasis on rapid development of independent growth, with time divided between sign-out of cases from core specialties and intraoperative and gross room consultation. By the end of the second quarter, the Instructor will be expected to be capable of independent sign out, with earlier granting of sign-out responsibility possible.

Instructors will also have 4 weeks of elective time, which may be used to complete research projects or for subspecialty rotations of personal interest.

Instructors will be employed by Beverly Pathology, an independently contracted pathology group under the Cedars-Sinai Medical Foundation providing exclusive pathology services to the Medical Center. Cedars-Sinai Medical Center, located at the junction of Los Angeles and Beverly Hills, is an 886 licensed bed quaternary medical care facility and is the largest private not-for-profit provider of health care on the West Coast, treating more cancer patients than any other medical center in Southern California.

The Department, with its 50 faculty, oversees a clinical operation of over approximately 5 million laboratory tests, robust outreach and consultative referral practices. The Division of Anatomic Pathology processes over 58,000 surgical and 25,000 cytologic cases annually.

Interested applicants should submit a curriculum vitae, letter of interest, and the names of three references to:

Rania Bakkar, MD
Program Director
Department of Pathology and Laboratory Medicine
Cedars-Sinai Medical Center
8700 Beverly Blvd., Suite 8717
Los Angeles, CA 90048
Fax: (310) 423-1610
Email: [email protected]

 

[Alteran]

Check out this Job ad-

Is this a way to save costs and hire a young board certified pathologist, who has already done a surgical pathology fellowship, to work for you?

Looks like another surgical pathology fellowship year in addition to the one you already did but you get paid higher than a fellow but less than what academia would pay you.

Ladies and gentlemen, introducing an “Anatomic pathology instructor”.

Anatomic Pathology Instructor
2021-2022​

LOS ANGELES, CALIFORNIA (USA). Applications are invited for Anatomic Pathology Instructor positions in the Department of Pathology and Laboratory Medicine at Cedars-Sinai Medical Center. The successful candidates will join a subspecialized anatomic pathology division supporting the clinical and academic missions of an internationally recognized department. One year of prior fellowship training in surgical pathology or a surgical pathology subspecialty is preferred. Eligibility for California licensure and for appointment to the Cedars-Sinai Medical Staff is required.

These positions are one year in duration with graduated independent sign-out, coupled with responsibilities in resident/gross room teaching, an active intraoperative consultation service and part- time research. The first half of the year will have a heavy emphasis on rapid development of independent growth, with time divided between sign-out of cases from core specialties and intraoperative and gross room consultation. By the end of the second quarter, the Instructor will be expected to be capable of independent sign out, with earlier granting of sign-out responsibility possible.

Instructors will also have 4 weeks of elective time, which may be used to complete research projects or for subspecialty rotations of personal interest.

Instructors will be employed by Beverly Pathology, an independently contracted pathology group under the Cedars-Sinai Medical Foundation providing exclusive pathology services to the Medical Center. Cedars-Sinai Medical Center, located at the junction of Los Angeles and Beverly Hills, is an 886 licensed bed quaternary medical care facility and is the largest private not-for-profit provider of health care on the West Coast, treating more cancer patients than any other medical center in Southern California.

The Department, with its 50 faculty, oversees a clinical operation of over approximately 5 million laboratory tests, robust outreach and consultative referral practices. The Division of Anatomic Pathology processes over 58,000 surgical and 25,000 cytologic cases annually.

Interested applicants should submit a curriculum vitae, letter of interest, and the names of three references to:

Rania Bakkar, MD
Program Director
Department of Pathology and Laboratory Medicine
Cedars-Sinai Medical Center
8700 Beverly Blvd., Suite 8717
Los Angeles, CA 90048
Fax: (310) 423-1610
Email: [email protected]

Translation: Because the applicant pool of recent fellowship trained graduates is saturated with sub-par trained pathologists, we have created positions for quasi-attendings with limited responsibility to do lots of billable though tedious work at minimal cost to us. We do want to point out to you that while you will be working at the prestigious Ceder-Sinai medical center, your actual employer is a private practice group we contract with who could drop you at the flick of the wrist should you be less than equitable to the group's finances.

 

[Spikebd]

Translation: Because the applicant pool of recent fellowship trained graduates is saturated with sub-par trained pathologists, we have created positions for quasi-attendings with limited responsibility to do lots of billable though tedious work at minimal cost to us. We do want to point out to you that while you will be working at the prestigious Ceder-Sinai medical center, your actual employer is a private practice group we contract with who could drop you at the flick of the wrist should you be less than equitable to the group's finances.

LADoc has mentioned he took one of these positions when he was a younger pathologist. Maybe a redshirt year where you make $150k ain’t so bad if it gets you to baller status a few years later like LADoc

 

[Med Director New England]

Check out this Job ad-

Is this a way to save costs and hire a young board certified pathologist, who has already done a surgical pathology fellowship, to work for you?

Looks like another surgical pathology fellowship year in addition to the one you already did but you get paid higher than a fellow but less than what academia would pay you.

Ladies and gentlemen, introducing an “Anatomic pathology instructor”.

Anatomic Pathology Instructor
2021-2022​

LOS ANGELES, CALIFORNIA (USA). Applications are invited for Anatomic Pathology Instructor positions in the Department of Pathology and Laboratory Medicine at Cedars-Sinai Medical Center. The successful candidates will join a subspecialized anatomic pathology division supporting the clinical and academic missions of an internationally recognized department. One year of prior fellowship training in surgical pathology or a surgical pathology subspecialty is preferred. Eligibility for California licensure and for appointment to the Cedars-Sinai Medical Staff is required.

These positions are one year in duration with graduated independent sign-out, coupled with responsibilities in resident/gross room teaching, an active intraoperative consultation service and part- time research. The first half of the year will have a heavy emphasis on rapid development of independent growth, with time divided between sign-out of cases from core specialties and intraoperative and gross room consultation. By the end of the second quarter, the Instructor will be expected to be capable of independent sign out, with earlier granting of sign-out responsibility possible.

Instructors will also have 4 weeks of elective time, which may be used to complete research projects or for subspecialty rotations of personal interest.

Instructors will be employed by Beverly Pathology, an independently contracted pathology group under the Cedars-Sinai Medical Foundation providing exclusive pathology services to the Medical Center. Cedars-Sinai Medical Center, located at the junction of Los Angeles and Beverly Hills, is an 886 licensed bed quaternary medical care facility and is the largest private not-for-profit provider of health care on the West Coast, treating more cancer patients than any other medical center in Southern California.

The Department, with its 50 faculty, oversees a clinical operation of over approximately 5 million laboratory tests, robust outreach and consultative referral practices. The Division of Anatomic Pathology processes over 58,000 surgical and 25,000 cytologic cases annually.

Interested applicants should submit a curriculum vitae, letter of interest, and the names of three references to:

Rania Bakkar, MD
Program Director
Department of Pathology and Laboratory Medicine
Cedars-Sinai Medical Center
8700 Beverly Blvd., Suite 8717
Los Angeles, CA 90048
Fax: (310) 423-1610
Email: [email protected]

This is not new
Happening for a decade plus and ongoing at many places on the east coast. These jobs are a 1 yr contract - no guarantee after that.

Brilliant business move by the academic department. I know someone will shout out academics don’t care about the budget - but the chairs do. The chair makes more $ if the dept has a surplus.

this is a real squeal like a pig moment for new grads.

 

[Alteran]

LADoc has mentioned he took one of these positions when he was a younger pathologist. Maybe a redshirt year where you make $150k ain’t so bad if it gets you to baller status a few years later like LADoc

I did locums for a few months myself right out of fellowship because, surprise surprise, no one was hiring my particular year. As it turns out that was the right decision and it set into motion a series of events that landed me into the good place I'm at now. By no means do I knock temporary work, but blatantly abusive or exploitative positions deeply frustrate me as they cheapen the field overall.

 

[gbwillner]

When was that?

This was 9 years ago. As a senior resident I called in frozen section results on my own. When the attending was present they oversaw, but after hours I was on my own most of the time. Senior residents would also run certain "low-risk" services independently. However, this was at a "top" program, so don't let it interfere with the narrative.
It hasn't been stated in detail but the main force behind not allowing independent sign-out is billing. Residents can't bill for services, and unlike other specialties, the sign-out is largely the only billable event.

 

[deleted314957]

This was 9 years ago. As a senior resident I called in frozen section results on my own. When the attending was present they oversaw, but after hours I was on my own most of the time. Senior residents would also run certain "low-risk" services independently. However, this was at a "top" program, so don't let it interfere with the narrative.
It hasn't been stated in detail but the main force behind not allowing independent sign-out is billing. Residents can't bill for services, and unlike other specialties, the sign-out is largely the only billable event.

EXACTLY! It is a HHS regulation just like all the rest of the crap burdened upon us(you, but my heart is still there).
The financial attestation for this nonsense is unbelievable and their attention to the REAL problems is non existent.


Sent from my iPad using Tapatalk

 

[hurrycane]

This was 9 years ago. As a senior resident I called in frozen section results on my own. When the attending was present they oversaw, but after hours I was on my own most of the time.

I know that in some “top” programs (with blue shield arms) they let residents handle frozens. Sounds good to me. I am not sure how they’d go with the billing.

 

[KeratinPearls]

Easy. Have a pathologist read the frozen WITH THE RESIDENT WHILE THE RESIDENT DOES THE WORK.

Hey Academic Pathologists, GET YOUR LAZY REAR IN GEAR AND TRAIN THE RESIDENT CORRECTLY OR GET THE HELL OUT OF THE GAME.

Thrombus chill bro. We want your input in Pathology but we don’t want you banned again lol!

 

[WEBB PINKERTON]

You can't chill Thrombus

He needs a relaxation app.

 

[Iceman24]

This was 9 years ago.

Ok, this explains a lot.
If this happened so long ago then it's irrelevant for now.

Residents can't bill for services, and unlike other specialties, the sign-out is largely the only billable event.

I still don't get how other specialties can get around it and let residents do an actual MD level work.

 

[Med Director New England]

Ok, this explains a lot.
If this happened so long ago then it's irrelevant for now.



I still don't get how other specialties can get around it and let residents do an actual MD level work.

When I was in training in the early / mid 2000s at a top tier program I had a lot of independence. Esp at night. When I trained attending DIDNT TAKE NIGHT CALL at all- the best you could get after hours or weekends for a frozen, stat biopsy read, ROSE was a fellow. Many of there “fellows” were actually upper level residents. The only exception was renal transplant service and even this one was largely delegated to the fellows after hrs. Anyhow knowing you were on the hook for after hours work was enough fire in the belly to really study, work up your cases and learn to think independently.

anyways if the big three in Boston, Hopkins, etc do this all of the mid tiers and lower also need to figure out a way to do this. In my opinion the elite programs who esp turn the hospitals over to upper level residents and fellows at night is the proper way to train. But this assumes that you have capable trainees to run the show at night.

Radiology programs everywhere operate this way...

 

[SunBakedTrash]

One of the biggest problems in my opinion is the laziness and lack of work ethic I see in pathology trainees, even those from fancy programs. Now before anyone says OK Boomer to me, realize I am within 5 years of starting practice and many people I trained with fit into this category. The supposed “lifestyle factor” and lack of an intern year flood the specialty with knuckle-draggers and mouth-breathers who all want to work bank hours and make 500k. And I’m guessing they won’t be excited by nor diligent about being up all night cutting and reading frozens by themselves.

 

[path19]

The supposed “lifestyle factor” and lack of an intern year flood the specialty with knuckle-draggers and mouth-breathers who all want to work bank hours and make 500k.

As opposed to all those derm residents who enter the specialty because they're so passionate about the epidermis and dermis?

 

[path19]

Ok, this explains a lot.
If this happened so long ago then it's irrelevant for now.



I still don't get how other specialties can get around it and let residents do an actual MD level work.

I can think of 3 reasons. First, what we do really is more important. An incorrect pathology report will lead to all sorts of negative consequences, usually far beyond what happens when a medicine or surgery resident messes something up. Secondly, our mistakes are there to be seen and reviewed for years after the fact. The majority of specialties, when a resident (or attending) screws something up, there is no record set in stone that documents said mistake like there is in pathology. So our mistakes are noticed and amplified. And lastly, no one else can do what we do. This is what distinguishes us from radiology residents. Not many surgeons (or oncologists, etc) will act upon a radiology report without actually reviewing the films themselves. The same is not true of pathology. And radiology reads are typically less definitive in the first place, so there is a lot of wiggle room for radiology residents who aren't entirely comfortable with a case, and this helps them to stay out of trouble.

 

[SunBakedTrash]

As opposed to all those derm residents who enter the specialty because they're so passionate about the epidermis and dermis?

Would you disagree that your average medical school applicant to dermatology is significantly more competitive than your average pathology applicant? Getting into dermatology is very difficult and requires much harder work than telling some academic pathologist you like looking at pretty colors and being a doctor’s doctor. I have no business questioning whether their applicants are truly passionate about smearing cream on acne. We could afford the same cherry-picking if we limited spots and took only the cream of the crop into pathology.

 

[Med Director New England]

Radiology residents make calls independently all the time at night that if they are wrong could be clinically impactful. Head CTs for acute bleeding, etc. they don’t do it on day one but they do actually do these things prior to finishing training.