Define by what you mean “good” future in your poll? Do you mean testing will be more prevalent? Fellowship training will get you the big bucks? Pathologists will capture a market which may go to PhD’s improving the demand for our field in general? Or patient’s will benefit with meaningful information to give a better clinical profile of their disease process to allow clinicians to provide better tx and prognostic information?
In regards to reimbursement for molecular tests, the future is uncertain. There are CPT codes out there; however, the rates have yet to be finalized for NGS and other emerging molecular tests as these are still relatively new.
You can bet reimbursement rates will drive who gets to interpret these like most testing in medicine. Word on the street is that the professional won’t be that high, so don’t be surprised if it goes the way of PhD’s.
Sales reps are trying to push their equipment e.g. Illumina’s MiSeq into whatever markets they can and hospitals say they don’t have a molecular pathologist to interpret the results, but I’m not so sure a fellowship would be necessary for it. Remember these companies are trying to sell a product. It’s difficult to say how prevalent your average mid-size community hospital will need them in the future.
That being said, there will be an uptick in the utility and frequency of molecular testing taking place. I don’t think it will be as centralized as EM or flow which have become obsolete at small community hospitals. On the other hand, it won’t be as ubiquitous as IHC either.
As far as fellowships, I think a combo of heme+molecular would be a home run. Molecular only and heme only will certainly give you opportunities, but the two of them complement each other and gives a pretty unique skillset that few have. Besides, 50% of graduating residents are doing two fellowships anyway, so why not do something that makes you stand out more than…say surg + cyto (still useful though).
Lastly, FISH and PCR will absolutely be relevant even with the burgeoning molecular field. NGS and molecular arrays are imprecise for detecting balanced translocations and only measure DNA/RNA whereas FISH targets specific chromosomes and can detect balanced translocations more specifically. Think of it like IHC 40 yrs. ago: a lot of people thought histopathology would become obsolete and all these new stains would be the wave of the future. It certainly was a game-changer but it acted as an adjunct to morphology, not a replacement. Much as molecular testing will be used as an adjunct to come up with a patient’s clinical profile; though, and not a replacement either.
