Pathology is the world's most civilized residency

[BlondeDocteur]

You people have the most amazing gig in the world. The balance of service: learning is like 1:100. When the pager goes off, even senior residents look like deer in headlights-- whatever is that mysterious shrill noise? It's damn interesting and you get to know everything and interface with everybody, except patients who either narrate last week's soap opera plotlines when you're trying to get an H&P, or insinuate as you're trying to sew up their face that they will follow you to your car from the ER and rape you behind the dumpsters (true story bro).

I finally get the negativity on this board. Drop the portcullis, batten down the hatches, protect the golden land of milk and honey that lies within the castle walls from the invading barbarian hordes.

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[deleted314957]

You people have the most amazing gig in the world. The balance of service: learning is like 1:100. When the pager goes off, even senior residents look like deer in headlights-- whatever is that mysterious shrill noise? It's damn interesting and you get to know everything and interface with everybody, except patients who either narrate last week's soap opera plotlines when you're trying to get an H&P, or insinuate as you're trying to sew up their face that they will follow you to your car from the ER and rape you behind the dumpsters (true story bro).

I finally get the negativity on this board. Drop the portcullis, batten down the hatches, protect the golden land of milk and honey that lies within the castle walls from the invading barbarian hordes.

How funny! To the end of my career I would occasionally be confused and startled if my pager went off! ( only had call 4-8 weeks/year depending on staffing)

 

[Mad Jack]

If only there were jobs to go with the residencies, path would be near the top of my list for a lot of reasons. Dat job market tho...

 

[Crossed Path]

You people have the most amazing gig in the world. The balance of service: learning is like 1:100. When the pager goes off, even senior residents look like deer in headlights-- whatever is that mysterious shrill noise? It's damn interesting and you get to know everything and interface with everybody, except patients who either narrate last week's soap opera plotlines when you're trying to get an H&P, or insinuate as you're trying to sew up their face that they will follow you to your car from the ER and rape you behind the dumpsters (true story bro).

I finally get the negativity on this board. Drop the portcullis, batten down the hatches, protect the golden land of milk and honey that lies within the castle walls from the invading barbarian hordes.

I understand that the first few weeks of residency are exciting - oh, to be young and see life as full of potential again! But, we're really not trying to protect some magical secret land. Only in academics does the gig appear to consist of service:learning 1:100 (and actually in academics it's more like service:teaching, plus committees, publishing, dept politics, publishing, etc.). In the world of community pathology, it's a 1:10 ratio of service work:fighting to keep your business/hoping the hospital doesn't decide to issue an RFP and replace your a$%. Mind you, the service work isn't light to begin with, and there are no residents to do it for you. I wish you luck and hope that things work out well for you in the end - maybe you'll marry well (that's not a gender comment - I wish I had married well).

 

[icpshootyz]

Hopefully you end up as happy in your final job as I am and the love of the field continues I see all my frazzled clinical colleagues running around and there's zero envy whatsoever. Sure there are fields like Derm where you can work 3 days a week and rake in the money, but actually practicing dermatology looks about as exciting as watching paint dry to me. I like almost every slide I see, and all of them have something interesting. Here's to hoping you stay happy in path, Blondie!

 

[DermViser]

If only there were jobs to go with the residencies, path would be near the top of my list for a lot of reasons. Dat job market tho...

Pathology could use a lot of quality control in weeding out their residencies.

 

[DermViser]

Hopefully you end up as happy in your final job as I am and the love of the field continues I see all my frazzled clinical colleagues running around and there's zero envy whatsoever. Sure there are fields like Derm where you can work 3 days a week and rake in the money, but actually practicing dermatology looks about as exciting as watching paint dry to me. I like almost every slide I see, and all of them have something interesting. Here's to hoping you stay happy in path, Blondie!

Um, have you even done a Dermatology rotation? You know there are Dermpath fellowships, right?

 

[icpshootyz]

Um, have you even done a Dermatology rotation? You know there are Dermpath fellowships, right?

Hahaha, I sure do! I'm a full time dermpath. I even do some PC work for a local derm practice podlab. I love dermpath, but actually practicing clinical dermatology? No thanks. I like what they biopsy, not the 90+% that doesn't get biopsied.

 

[BlondeDocteur]

There are many reasons why I think it might be advantageous to reinstitute a clinical internship before path residency, but chief among them is that after doing one you would simply realize how good you have it. I'm not talking just about hours or lack of call or the lifestyle/laziness factors, but rather how maturely you're treated and how optimal the workflow is. Do you have any idea how many times in surgery I would just pray for 30 uninterrupted minutes to actually get some work done? Or how you were rewarded for being an efficient multitasker, but not for being a smart doctor?

In path you can work whenever you get the slides-- if you want to stay late previewing and writing up your findings, and saunter in the next morning at 9 AM, you can. You're treated deferentially by faculty and consulting services (I have been *shocked* by this thus far). Vacations are scheduled, not assigned. You can take an afternoon off to go to the dentist or take your kid to the pediatrician. These might sound like small things but they are utterly anomalous (obviously you can't round on your patients 'the night before,' or see the next day's clinic patients ahead of time). The learning is incredible-- and you have the luxury of being able to be interested in something, read about it, and actually attend your lectures & didactics without the pager going off 100 times or needing to get your notes done or whatever. And of course the field is both very broad and very deep.

If you're someone who loves learning, who loves the cerebral side of medicine, who wants to be treated as an adult and have the rights & privileges accorded to most other kinds of jobs, who likes the idea of knowing everything and being consulted as an expert by everybody, then this is the most amazing field in medicine.

And I couldn't have appreciated it as deeply as I do unless I'd seen the other side.

 

[turtle1966]

There are many reasons why I think it might be advantageous to reinstitute a clinical internship before path residency, but chief among them is that after doing one you would simply realize how good you have it.

I have advocated this before, albeit for different reasons.

I'm not talking just about hours or lack of call or the lifestyle/laziness factors, but rather how maturely you're treated and how optimal the workflow is.

In private practice, the situation is reversed.

Residents are somewhat "abused" because they are plenty and "cheap'. Once in private practice, you are the doctor, the boss, the chief, and spreader of butter and most employees know which side of bread the butter is spread on.

The lowest of clinicians rules over the best of the pathologists because he/she spreads the "butter". A simple cold reality.

 

[LADuck00]

I have advocated this before, albeit for different reasons.


In private practice, the situation is reversed.

Residents are somewhat "abused" because they are plenty and "cheap'. Once in private practice, you are the doctor, the boss, the chief, and spreader of butter and most employees know which side of bread the butter is spread on.

The lowest of clinicians rules over the best of the pathologists because he/she spreads the "butter". A simple cold reality.

 

[AZpath]

You could have a poor residency program if life is that easy.

Truthfully residency is a lot easier than practice. You have zero clinical responsibility.

Some people find pathology quite stressful. Usually that hits on your first job.


Many practices have a greater workload than you are seeing apparently.
I have see practices in which the pathologist were working 12 hours a day and six to seven days a week to make ends meet.

One of these was an academic practice. They refused to hire new people for quite some time.

 

[Thrombus]

You must have poor residency program if life is that easy.

I couldn't agree more. No wonder some of these people think they need 3 fellowships to be competent. Residency training has become one big joke in many places. Academic$ $till need more re$ident$ though.

 

[BlondeDocteur]

B**** please. I have an awesome program (and I'm not saying that as a GME naif). Nowhere in my post did I say I'm leaving each day at 3; in fact I've been working till roughly 8 PM. But the quality of what I'm doing while here is about a thousand-fold better than what I was doing as a clinical resident.

 

[icpshootyz]

B**** please. I have an awesome program (and I'm not saying that as a GME naif). Nowhere in my post did I say I'm leaving each day at 3; in fact I've been working till roughly 8 PM. But the quality of what I'm doing while here is about a thousand-fold better than what I was doing as a clinical resident.

Having fun yet Blonde? Isn't this forum just a breath of fresh, positive air? Hahaha! You're handling it well, so keep it up

 

[WEBB PINKERTON]

You could have a poor residency program if life is that easy.

Truthfully residency is a lot easier than practice. You have zero clinical responsibility.

Some people find pathology quite stressful. Usually that hits on your first job.


Many practices have a greater workload than you are seeing apparently.
I have see practices in which the pathologist were working 12 hours a day and six to seven days a week to make ends meet.

One of these was an academic practice. They refused to hire new people for quite some time.

12 hours a day 6 to 7 days a week? My god, that is not exactly good for your health. Emboli hurt like a bitch I have found.

Lesson to anyone entering this field. NEVER put your work before your health. If you have your health, you have everything. Find another career before letting your employer put your health at risk.

 

[pathstudent]

There are many reasons why I think it might be advantageous to reinstitute a clinical internship before path residency, but chief among them is that after doing one you would simply realize how good you have it. I'm not talking just about hours or lack of call or the lifestyle/laziness factors, but rather how maturely you're treated and how optimal the workflow is. Do you have any idea how many times in surgery I would just pray for 30 uninterrupted minutes to actually get some work done? Or how you were rewarded for being an efficient multitasker, but not for being a smart doctor?

In path you can work whenever you get the slides-- if you want to stay late previewing and writing up your findings, and saunter in the next morning at 9 AM, you can. You're treated deferentially by faculty and consulting services (I have been *shocked* by this thus far). Vacations are scheduled, not assigned. You can take an afternoon off to go to the dentist or take your kid to the pediatrician. These might sound like small things but they are utterly anomalous (obviously you can't round on your patients 'the night before,' or see the next day's clinic patients ahead of time). The learning is incredible-- and you have the luxury of being able to be interested in something, read about it, and actually attend your lectures & didactics without the pager going off 100 times or needing to get your notes done or whatever. And of course the field is both very broad and very deep.

If you're someone who loves learning, who loves the cerebral side of medicine, who wants to be treated as an adult and have the rights & privileges accorded to most other kinds of jobs, who likes the idea of knowing everything and being consulted as an expert by everybody, then this is the most amazing field in medicine.

And I couldn't have appreciated it as deeply as I do unless I'd seen the other side.

I agree with you and the flexibility of pathology training was one of the draws for me

Slides and specimens don't get impatient. As long as you get it all done by the end of the day, you are good.

 

[deleted314957]

There are many reasons why I think it might be advantageous to reinstitute a clinical internship before path residency, but chief among them is that after doing one you would simply realize how good you have it. I'm not talking just about hours or lack of call or the lifestyle/laziness factors, but rather how maturely you're treated and how optimal the workflow is. Do you have any idea how many times in surgery I would just pray for 30 uninterrupted minutes to actually get some work done? Or how you were rewarded for being an efficient multitasker, but not for being a smart doctor?

In path you can work whenever you get the slides-- if you want to stay late previewing and writing up your findings, and saunter in the next morning at 9 AM, you can. You're treated deferentially by faculty and consulting services (I have been *shocked* by this thus far). Vacations are scheduled, not assigned. You can take an afternoon off to go to the dentist or take your kid to the pediatrician. These might sound like small things but they are utterly anomalous (obviously you can't round on your patients 'the night before,' or see the next day's clinic patients ahead of time). The learning is incredible-- and you have the luxury of being able to be interested in something, read about it, and actually attend your lectures & didactics without the pager going off 100 times or needing to get your notes done or whatever. And of course the field is both very broad and very deep.

If you're someone who loves learning, who loves the cerebral side of medicine, who wants to be treated as an adult and have the rights & privileges accorded to most other kinds of jobs, who likes the idea of knowing everything and being consulted as an expert by everybody, then this is the most amazing field in medicine.

And I couldn't have appreciated it as deeply as I do unless I'd seen the other side.

No question the lifestyle is better than what you have seen. I did a surgical internship back in the days of 36 hrs on-12 off and it is/was hell. What you are seeing now is a bit of a fantasy compared to what you will see in PP ( although i cannot speak too dogmatically about academics). You will work much harder and the pressure will be much greater. I am quite sure that your income and retirement package will be par-to-mediocre compared to ( for example) a NYC police captain/fire captain, urban public or private school principal, community hospital admin at the senior VP level, etc. This is happening to all physicians. I am taking into account education cost, deferred income, deferred investment income, etc. For example, $100,000 invested at 7% at age 25 will have one doubling time advantage compared to that same money invested at age 35. By the time you are 65 that is lots of money. You have already lost many years in that savings formula.

I admire your interest and energy but there is no land of milk-and-honey ahead for you or any of my successors. If you can be content with a middle-to upper -middle class income, pretty intense work environment, forgoing things that we used to take for granted ( kids elite education, nice travel, nice home, generous retirement, etc) and crushing regulation, than go for it. But, please, we don't need to be told how "amazing our gig is".
I no longer have an ax to grind- I am retired.

 

[vistaril]

B**** please. I have an awesome program (and I'm not saying that as a GME naif). Nowhere in my post did I say I'm leaving each day at 3; in fact I've been working till roughly 8 PM. But the quality of what I'm doing while here is about a thousand-fold better than what I was doing as a clinical resident.

We'll as a clinical resident you weren't being trained to do something where you would be completely dependent on others.....so there is that. He who controls the tissue controls the world.....

 

[rollwithit]

I admire your interest and energy but there is no land of milk-and-honey ahead for you or any of my successors. If you can be content with a middle-to upper -middle class income, pretty intense work environment, forgoing things that we used to take for granted ( kids elite education, nice travel, nice home, generous retirement, etc) and crushing regulation, than go for it. But, please, we don't need to be told how "amazing our gig is".
I no longer have an ax to grind- I am retired.

BlondeDoc has as much right to call path an amazing gig as you do implying pathologists have to give up nice things bc of middle class incomes.

 

[deleted314957]

BlondeDoc has as much right to call path an amazing gig as you do implying pathologists have to give up nice things bc of middle class incomes.

Certainly she does---your point being??

 

[Crossed Path]

No question the lifestyle is better than what you have seen. I did a surgical internship back in the days of 36 hrs on-12 off and it is/was hell. What you are seeing now is a bit of a fantasy compared to what you will see in PP ( although i cannot speak too dogmatically about academics). You will work much harder and the pressure will be much greater. I am quite sure that your income and retirement package will be par-to-mediocre compared to ( for example) a NYC police captain/fire captain, urban public or private school principal, community hospital admin at the senior VP level, etc. This is happening to all physicians. I am taking into account education cost, deferred income, deferred investment income, etc. For example, $100,000 invested at 7% at age 25 will have one doubling time advantage compared to that same money invested at age 32. By the time you are 65 that is lots of money. You have already lost many years in that savings formula.

I admire your interest and energy but there is no land of milk-and-honey ahead for you or any of my successors. If you can be content with a middle-to upper -middle class income, pretty intense work environment, forgoing things that we used to take for granted ( kids elite education, nice travel, nice home, generous retirement, etc) and crushing regulation, than go for it. But, please, we don't need to be told how "amazing our gig is".
I no longer have an ax to grind- I am retired.

This.

 

[icpshootyz]

He who controls the tissue controls the world.....

Says the counselor of divorced housewives. Only tissue you control is the one you cry into since your sugar mamma left you. Go back to the psych forum.

 

[rollwithit]

Certainly she does---your point being??

Being both of your statements are purely subjective. I just picked up a touch of condescension in yours. "We don't need to be told it's a nice gig, you can't get wealthy any longer!". Maybe I'm misinterpreted both opinions. I don't care.

 

[rollwithit]

Says the counselor of divorced housewives. Only tissue you control is the one you cry into since your sugar mamma left you. Go back to the psych forum.

Burrrnnnnnnn!!!! Well done.

 

[vistaril]

Says the counselor of divorced housewives. Only tissue you control is the one you cry into since your sugar mamma left you. Go back to the psych forum.

lmao....you don't know much about me if you think taking a jab at psychiatry bothers me. But as bad as psych is in terms of career and financial prospects, at least we have easy access to patients and don't have to beg other specialties for them.

 

[AZpath]

For the record,

I am with Blond Dr. My path residency was a blast. I also learned what I need to know.
I love my current job too.

 

[icpshootyz]

lmao....you don't know much about me if you think taking a jab at psychiatry bothers me. But as bad as psych is in terms of career and financial prospects, at least we have easy access to patients and don't have to beg other specialties for them.

Don't care. Go back to the psych forum.

 

[vistaril]

Don't care. Go back to the psych forum.

well then here is a tip for the future: if you don't care about something, don't respond to it.

 

[icpshootyz]

well then here is a tip for the future: if you don't care about something, don't respond to it.

Don't care about any advice from a psychiatrist in a pathology forum. Go back somewhere your opinion may (or may not) be relevant, the psych forum.

 

[vistaril]

Don't care about any advice from a psychiatrist in a pathology forum. Go back somewhere your opinion may (or may not) be relevant, the psych forum.

After much deliberation, I've chosen to decline your request. I've always posted according to the rules of the forum... Whether you like it or not, these forums are not closed to people from other specialties. And that's just something you will have to deal with.

 

[icpshootyz]

After much deliberation, I've chosen to decline your request. I've always posted according to the rules of the forum... Whether you like it or not, these forums are not closed to people from other specialties. And that's just something you will have to deal with.

And I'll keep reminding you how useless your opinion is on here. Might as well be Paris Hilton commenting on the pathology market.

 

[vistaril]

And I'll keep reminding you how useless your opinion is on here. Might as well be Paris Hilton commenting on the pathology market.

My memory is just fine, but knock yourself out if you want.

 

[Leo Aquarius]

Don't care about any advice from a psychiatrist in a pathology forum. Go back somewhere your opinion may (or may not) be relevant, the psych forum.

We don't want him. I'm embarassed he's one of us.

(BTW, psychiatry having bad career prospects makes no sense whatsoever. Career prospects means 1. job security, 2. job satisfaction, 3. demand, and 4. growth potential (I have a business background). Psychiatry is near the top in terms of demand, satisfaction, and security. Growth potential is hard for me to gauge but I imagine you get better as you age and can charge more with more experience as my more senior attendings do.)

 

[yaah]

I always thought pathology was a humane residency. It can be busy, but it is more like a real job than any other residency. ER maybe since it's shift work but you have to do rotations in other fields and hours are pretty long. Pathology residents clock in typically well under the 80 hour limit, although for me personally there were definitely months where I pushed or exceeded that. But you sleep at home almost every night.

Of course, since the GME work hours stuff, I have no idea what a regular residency is like now. Do residents in other fields still do 36 hour shifts? Just on weekends? Just surgery? When I was finishing med school "being on call" in IM meant staying later until maybe 10pm. The night person was a separate rotation who worked 8-8 or something.

 

[Pollux]

We don't want him. I'm embarassed he's one of us.

(BTW, psychiatry having bad career prospects makes no sense whatsoever. Career prospects means 1. job security, 2. job satisfaction, 3. demand, and 4. growth potential (I have a business background). Psychiatry is near the top in terms of demand, satisfaction, and security. Growth potential is hard for me to gauge but I imagine you get better as you age and can charge more with more experience as my more senior attendings do.)

Let's not forget that Psychiatry is the specialty in medicine (if you consider it real medicine) with the highest rate of suicide and divorce.

 

[Leo Aquarius]

Let's not forget that Psychiatry is the specialty in medicine (if you consider it real medicine) with the highest rate of suicide and divorce.

Get your facts straight and don’t insult my specialty. You’re talking about a study done in the 1960s that was disproved.

First off, a review of those 1960 studies show they were wrong. Rose and Rosow took a look at the evidence gathered by Blachly et al, as well as their own review of death certificates in California, and found that differences in suicide among specialties were not statistically significant. Craig and Pitts studied more than 8,000 physician deaths reported to the AMA and also found no clear differences in suicide rates between specialties. What is true is that female physicians appear to be especially vulnerable. Suicide rates for women physicians are approximately four times that of women in the general population.

Second, thanks to a compassionate psychiatrist Dr. Balint, we now have groups for struggling physicians. Used primarily in family medicine programs is Balint Groups. Michael Balint was a psychiatrist in England who identified the need for physicians to have group discussions about doctor-patient relationships. This approach has been found to be helpful for increasing both self-awareness and understanding of patients and has been applied in many family medicine programs.

Third, psychiatric illnesses are intertwined in medical disease and disorders across nearly all specialties. We even have a fellowship dedicated to the medicine of psychiatry called Psychosomatic Medicine. Medical disorders are a continuum. You can't say this illness is completely isolated from that one.

Fourth, surveys show we are the happiest and one of the most in-demand doctors. I know I’m happy as well as all my colleagues.

 

[Leo Aquarius]

my computer had an error.. sorry for the odd second post here folks.

 

[Leo Aquarius]

The troubles of this world all come from ignorance my friend and the unwillingness to listen.

Sorry path folks for the derailment... now back to our scheduled program.

 

[BlondeDocteur]

I always thought pathology was a humane residency. It can be busy, but it is more like a real job than any other residency. ER maybe since it's shift work but you have to do rotations in other fields and hours are pretty long. Pathology residents clock in typically well under the 80 hour limit, although for me personally there were definitely months where I pushed or exceeded that. But you sleep at home almost every night.

Of course, since the GME work hours stuff, I have no idea what a regular residency is like now. Do residents in other fields still do 36 hour shifts? Just on weekends? Just surgery? When I was finishing med school "being on call" in IM meant staying later until maybe 10pm. The night person was a separate rotation who worked 8-8 or something.

Since you asked-- rules cap PGY-1s at 16 hours on at a time, max. Everyone else can work 24 + 6 (24 hours of continuous on-duty time plus 6 hours where they're no longer responsible for patient care but instead are rounding, writing up notes and the like). In actuality this is stretched considerably. The most continuous hours of duty I recall were about 40. On a few surgical services you take 'power weekends' of call, where you're on call from Friday at 5 till the next Monday at 8, and you can easily spend a very large portion of that in the hospital.

But again the difference is not quantity but quality.

 

[vistaril]

Since you asked-- rules cap PGY-1s at 16 hours on at a time, max. Everyone else can work 24 + 6 (24 hours of continuous on-duty time plus 6 hours where they're no longer responsible for patient care but instead are rounding, writing up notes and the like). In actuality this is stretched considerably. The most continuous hours of duty I recall were about 40. On a few surgical services you take 'power weekends' of call, where you're on call from Friday at 5 till the next Monday at 8, and you can easily spend a very large portion of that in the hospital.

But again the difference is not quantity but quality.

That must explain why path residents are so much more prepared to go out in the community and work without fellowships after their 4 year residency than surgeons after their 5 year residency....oh wait.

 

[LoaLoa]

That must explain why path residents are so much more prepared to go out in the community and work without fellowships after their 4 year residency than surgeons after their 5 year residency....oh wait.

If I required the services of any type of physician, I'd prefer to use someone with a few years of post-residency work experience.

 

[vistaril]

If I required the services of any type of physician, I'd prefer to use someone with a few years of post-residency work experience.

Sure....and for most of a clinicians career after he finishes training that will be the stage of his career.

 

[cmz]

Sure....and for most of a clinicians career after he finishes training that will be the stage of his career.

So let's go back to the 5-year residency in pathology, with the last year acting as junior faculty with independent sign-out for the last six to nine months (after a period of co-signing by program faculty).

Pathology does coddle their residents more than any other field, but it is a necessity. I don't care if you're the most amazing resident in pathology... until you actually sign your own cases out, you'll never treat the cases you preview in the same fashion even if you are told, "OK R3 in pathology, you're an upper level now, so here are your cases for today. Treat these as if you're the one signing them out. No mistakes."

Non-pathologist physicians coming right out of residency could not possibly be prepared for EVERY single thing that comes their way (in fact, who does?). I feel like you're selling pathology residents short with your comment. I suppose it is because non-path residents have more autonomy for a longer period of time than their path counterparts and they feel "more prepared" once they leave the so-called "nest/hive." That's called confidence. As a pathologist, this takes a lot longer to build once you're in the driver seat for the first time. And why not? You're the one the non-pathologist physician looks to for THE answer.

 

[LoaLoa]

Sure....and for most of a clinicians career after he finishes training that will be the stage of his career.

Correct. So is your point that pathology residency training in particular is inadequate? I (and apparently, the American Board of Pathology) think that as long as you're going to be practicing a general pathologist, four years is fine. Of course, if you're going to be in a high-stress solo job with nobody to ask for help, a fellowship sure wouldn't hurt.

 

[vistaril]

Correct. So is your point that pathology residency training in particular is inadequate? I (and apparently, the American Board of Pathology) think that as long as you're going to be practicing a general pathologist, four years is fine. Of course, if you're going to be in a high-stress solo job with nobody to ask for help, a fellowship sure wouldn't hurt.

You know that's not the reason every pathologist now does at least one fellowship.....

 

[LoaLoa]

I'm not disagreeing that some trainees do fellowships because they feel unprepared. I'm simply wondering why you personally think pathology residency is not adequate to train a competent general pathologist. Did you feel unprepared when you started signing out cases? (or are you still in training?)

 

[Pathman1000]

I'm not disagreeing that some trainees do fellowships because they feel unprepared. I'm simply wondering why you personally think pathology residency is not adequate to train a competent general pathologist. Did you feel unprepared when you started signing out cases? (or are you still in training?)

He wouldn't know. He's a psychiatrist.

 

[mlw03]

So let's go back to the 5-year residency in pathology, with the last year acting as junior faculty with independent sign-out for the last six to nine months (after a period of co-signing by program faculty).

Pathology does coddle their residents more than any other field, but it is a necessity. I don't care if you're the most amazing resident in pathology... until you actually sign your own cases out, you'll never treat the cases you preview in the same fashion even if you are told, "OK R3 in pathology, you're an upper level now, so here are your cases for today. Treat these as if you're the one signing them out. No mistakes."

Non-pathologist physicians coming right out of residency could not possibly be prepared for EVERY single thing that comes their way (in fact, who does?). I feel like you're selling pathology residents short with your comment. I suppose it is because non-path residents have more autonomy for a longer period of time than their path counterparts and they feel "more prepared" once they leave the so-called "nest/hive." That's called confidence. As a pathologist, this takes a lot longer to build once you're in the driver seat for the first time. And why not? You're the one the non-pathologist physician looks to for THE answer.

I think these comments are a good summary of the main issue here. As an FP, the first DC I signed myself made me nervous, and certainly the first homicide I completed did likewise. Because pathologists provide an answer, rather than active patient management, there's really no in-between. Maybe the best analogy would be working up a tumour and deciding what immunos to order... you can get to the diagnosis of mesothelioma via multiple roads, but the diagnosis is what it is, and someone is signing that report.

 

[DermViser]

There are many reasons why I think it might be advantageous to reinstitute a clinical internship before path residency, but chief among them is that after doing one you would simply realize how good you have it. I'm not talking just about hours or lack of call or the lifestyle/laziness factors, but rather how maturely you're treated and how optimal the workflow is. Do you have any idea how many times in surgery I would just pray for 30 uninterrupted minutes to actually get some work done? Or how you were rewarded for being an efficient multitasker, but not for being a smart doctor?

In path you can work whenever you get the slides-- if you want to stay late previewing and writing up your findings, and saunter in the next morning at 9 AM, you can. You're treated deferentially by faculty and consulting services (I have been *shocked* by this thus far). Vacations are scheduled, not assigned. You can take an afternoon off to go to the dentist or take your kid to the pediatrician. These might sound like small things but they are utterly anomalous (obviously you can't round on your patients 'the night before,' or see the next day's clinic patients ahead of time). The learning is incredible-- and you have the luxury of being able to be interested in something, read about it, and actually attend your lectures & didactics without the pager going off 100 times or needing to get your notes done or whatever. And of course the field is both very broad and very deep.

If you're someone who loves learning, who loves the cerebral side of medicine, who wants to be treated as an adult and have the rights & privileges accorded to most other kinds of jobs, who likes the idea of knowing everything and being consulted as an expert by everybody, then this is the most amazing field in medicine.

And I couldn't have appreciated it as deeply as I do unless I'd seen the other side.

Anything is better than a surgery residency.