Hottest fellowship in pathology

[2121115]

i'm wondering if most people who plan on signing out general SP feel that they NEED to do some sort of fellowship training? ... For some reason, residents at my program (big name east coast) seem to feel like our SP training MUST be supplemented with a SP fellowship... some of the same people seem to feel that to get a good job, if they do a cyto fellowship they HAVE to follow that up with a SP fellowship.

I plan on signing out general surgpath and I'm not doing a gen surgpath fellowship. The residents at my program (east coast, supposedly a "big" name I guess) have only rarely done gen surgpath fellowships and I don't know anyone who has not ended up in a good job. Our surgpath training is strong and the attendings here definitely hold your feet to the fire during residency so that we are ready when we finish. Responsibility and working independently are emphasized from early on in residency (within reason) not just in surgpath but also cyto, heme, etc. This can certainly be stressful early on in residency, but as a senior resident looking back I can say that it paid enormous dividends.

General surgpath fellowships were basically a creation of the 5 year system and consitituted the 5th year of training. The prevailing thought here is that doing a general surgpath fellowship is like a general surgery resident doing a general surgery fellowship or a internal medicine resident doing a general medicine fellowship. What were they doing during residency anyway? I would recommend to someone considering a gen surgpath fellowship that they should rather get a job as an employee in a practice or work in surgpath at an academic center for a year (or do locum tenens work or whatever) and sign out cases. Then apply to jobs that you want with a year of experience under your belt.

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[BierstiefelAndy]

General surg path fellowship, IMO, is not the best way to spend a year. There are two learning curves in pathology. The first hump involves transforming yourself from an incompetent resident to an efficient resident who knows the basics about surgical pathology. The second hump involves learning how to actually sign out cases and learn the "art" of pathology, which happens most when you are starting off as an attending. Enduring this second hump happens mainly through learning from your mistakes. Whether you have a general surg path fellowship or not, you will make rookie mistakes. Nobody is immune from this. Hence, I think you would be better off spending a year in a marketable fellowship where you learn a specific skill set. One should do a general surg path fellowship if the quality of the surgical pathology training in a particular residency program was FAIL.

Doing a general surg path fellowship seems to be a bigger deal for AP only folks who then need to do an extra 1/2 year of AP to be certified. For instance, it used to be that one could simply do 2 yrs of AP and then go into the lab. The ABP messed it all up for those folks by changing the rules to require 2.5 yrs of AP as a minimum. So people would fill in that extra half year by doing a whole year of gen surg path to round out the academic year. OK fine. FFS though, you're better off spending that extra half year doing a fellowship in a marketable, non-board certified fellowship such as GI. Of course, folks who do AP/Heme and AP/Neuro are exempt from this silly 0.5 extra year AP rule.

 

[HbyHA]

all the relpies to my post pretty much confirmed what I suspected. thanks guys.

 

[booboochicken]

There is no mention of forensics and pediatric pathology?

 

[yaah]

There is no mention of forensics and pediatric pathology?

No. Pediatric path fellowship spots routinely go unfilled. And forensics is the biggest "niche" area in pathology (i.e., people mostly do it because generally they want to do only or primarily forensics with their career). So they are not "hot" necessarily. But lots of people are interested and want to do them. Doesn't mean they aren't interesting careers or fellowships, just means they aren't as popular or as competitive.

 

[pathstudent]

How about chemical pathology. I saw on a past ABP newsletter that 3 people took the exam which is offered once every two years and all three passed. That's hot!

 

[Hector]

I realize I am swimming upstream (alone) on this one. But before people discount general surgical pathology fellowships, let me just contribute my two cents.

I trained at a very strong academic program with excellent AP and CP. Their surg path training is very demanding (in some ways brutally so, especially in the past). But it has become very clear to me that I owe my awesome private practice job to my general surgical pathology fellowship.

From a personal standpoint, it was the best and most thrilling year in my professional life. I became a "real" pathologist during our hot seat months in which the fellow reviews up to 600 slides per day. Running a busy consultation service taught me how to quickly handle recurring challenges. Doing rotations as a fellow is undeniably different from doing them as a resident (no matter the enthusiasm). The army motto is something like "train like you fight, and fight like you train." My job requires the same kind of high level broad experience that a general surg path fellowship prepares you for. Residency provides the baseline level of training but the fellowship provides an extra feather.

It's not just that I have more confidence (which I do). It's also the strong track record at my institution of job recruitment. With few exceptions, AP/CP + surg path = great job. Without surg path, it takes many additional fellowships to obtain the same level of job offers.

I figured I probably gained about 5 years of experience in that one year of fellowship. Even if I had worked as a junior attending for a year, it would not have made the same job impact as my fellowship.

I'm pretty good in hemepath and dermpath, and I'm continually learning. But even after ten years of experience with marrows and inflammatory skin, I think a hempath or dermpath fellowship-trained person will still benefit from unique insights learned during their fellowship that I will never attain. In the same way, I will continue to benefit from durable experiences unique to my fellowship that others will approach in time, but not surpass.

Of course residencies, fellowships, and individual trainees are not all created equal. But there you have it.

 

[2121115]

I realize I am swimming upstream (alone) on this one. But before people discount general surgical pathology fellowships, let me just contribute my two cents.

I trained at a very strong academic program with excellent AP and CP. Their surg path training is very demanding (in some ways brutally so, especially in the past). But it has become very clear to me that I owe my awesome private practice job to my general surgical pathology fellowship.

From a personal standpoint, it was the best and most thrilling year in my professional life. I became a "real" pathologist during our hot seat months in which the fellow reviews up to 600 slides per day. Running a busy consultation service taught me how to quickly handle recurring challenges. Doing rotations as a fellow is undeniably different from doing them as a resident (no matter the enthusiasm). The army motto is something like "train like you fight, and fight like you train." My job requires the same kind of high level broad experience that a general surg path fellowship prepares you for. Residency provides the baseline level of training but the fellowship provides an extra feather.

It's not just that I have more confidence (which I do). It's also the strong track record at my institution of job recruitment. With few exceptions, AP/CP + surg path = great job. Without surg path, it takes many additional fellowships to obtain the same level of job offers.

I figured I probably gained about 5 years of experience in that one year of fellowship. Even if I had worked as a junior attending for a year, it would not have made the same job impact as my fellowship.

I'm pretty good in hemepath and dermpath, and I'm continually learning. But even after ten years of experience with marrows and inflammatory skin, I think a hempath or dermpath fellowship-trained person will still benefit from unique insights learned during their fellowship that I will never attain. In the same way, I will continue to benefit from durable experiences unique to my fellowship that others will approach in time, but not surpass.

Of course residencies, fellowships, and individual trainees are not all created equal. But there you have it.

Good post. The bolded comments might even sum up much of the pathology job market debates.