PSF Questions

[Dr. Pepper]

Hello there,

I'm interested in applying to PSFs next year. I'm in the third year and I am deciding between medicine and path. I have just finished my medicine rotation and I have rotated for 3 weeks in my 2nd year through surg path and hemepath.

I'll lay out my pros and cons for each below:

Things I like about medicine:
- I enjoy rounds, discussing and presenting patients and coming up with a plan.
- I enjoy conferences.
- I enjoy working with (most) patients, but there are times when it can get frustrating/depressing.

Things I dislike:
- All of the paperwork.
- Somewhat of a malignant atmosphere in my opinion (this might be because of third year, but a lot of nerves in terms of presenting well, writing a good note, getting a good history, getting along with the team, etc.)
- Running around all day to get things done, it can be exhausting.
- Sometimes, feels as if patients are not getting better and we aren't doing too much to help. Particularly in critical care scenarios (MICU).

Things I like about Path:
- Everyone I meet in path is very nice and very curious.
- I enjoy the subject matter, but I particularly enjoy the conferences as they make sense and are inherently interesting.
- I'm interested in the research quite a bit, particularly identifying new diagnostic tests and also new genetic targets.
- I enjoy being able to work by myself and focus. I've enjoyed the first 2 years more than the 3rd primarily for this reason.

Things I dislike about Path:
- First, I have limited exposure, which inherently makes me uneasy about Path.
- I'm concerned about lack of patient contact, but mostly due to what I feel is Path's isolation. Path is involved in so many clinical fields, yet I feel that very few clinicians know or acknowledge path. This is probably more of an ego thing, to be honest.
- I'm concerned about the job market and not being able to find a job. Also, since path does not see patients, it is hard to have your own patient base.

From what I have heard from mentors, I would be a good fit for either. This is encouraging me to do a PSF. However, I wanted to get your take on it. Also, for those who did perform a PSF but decided against pathology ultimately, would you say that the year was still worth it?

Thanks so much for your help.

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[yaah]

A lot of people say PSFs are more beneficial for those who aren't going into pathology. I know a few people who did it who ended up in other fields, they all have essentially nothing negative to say about the experience. I didn't think I wanted to do pathology but ended up liking it.

Don't decide about it based on whether you think you need or don't need patient contact. That's something that med students really don't understand anyway. Patient contact is not the only kind of interpersonal contact.

 

[gbwillner]

Don't do it. Just do a couple surg path electives.

I was in a similar position as you- deciding between medicine and Path. My likes/dislikes were pretty much the same. I was weary of loss of patient contact as my primary concern.

Ultimately I chose path. Part of the reason was I had a lot of friends who went into medicine, and they constantly complained about how routine everything became and that the endgame for every patient stops being able to "help" them and really becomes getting them discharged so they are no longer your problem. This may have been a skewed view of the practice- as a pathologist I have close contact with other physicians and those in medicine seem to still enjoy what they do. For me it really came down to seeing cool, new, and rare things every day taking priority over maintaining patient contact (which I missed probably for about a year and a half). Then that feeling waned.

Re: the job situation, as long as you are a good pathologist you will not have a problem. Because it is a much smaller field, like Rad Onc and others, there are limited opportunities in different cities, such that you may be forced to move to get the job you want in the subspecialty you want. But that's life in Path. It also helps to go to a top training program, so if you land one you will be A-OK.

 

[lipomas]

I think it really depends on how fast you want to get through with med school. It's an extra year, no matter how you look at it. It isn't really going to improve your applications that much (maybe marginally). It will educate you a lot, sure, and help you in whatever career you are in, but by itself it isn't going to make you a better clinician. It would make you a better pathology resident on day 1 but after a couple of months it won't matter anymore.

So it really depends on why you would do it. If you can afford the extra year financially and the time, then it's not a problem.

You can probably learn enough about path in a couple of early electives if your goal would be to decide on a field.

 

[mlw03]

I'm confused by the fact that you said you're a 3rd year student, but considering a PSF. I thought they were only available between the MS2 and MS3 years. In any case, I do think a PSF would help someone like you make the choice between medicine and pathology, but I also agree with the points lipomas made about it being a time and financial cost many do not have the luxury of being able to (or wanting to) afford.

 

[Dr. Pepper]

I'm confused by the fact that you said you're a 3rd year student, but considering a PSF. I thought they were only available between the MS2 and MS3 years. In any case, I do think a PSF would help someone like you make the choice between medicine and pathology, but I also agree with the points lipomas made about it being a time and financial cost many do not have the luxury of being able to (or wanting to) afford.

PSFs are traditionally done between the 2nd and 3rd year. However, most programs, from what I understand, allow the fellowship between 3rd and 4th year (Post junior fellow would be more accurate).

Thanks for all the comments guys.

 

[DIce3]

"Things I like about medicine:
- I enjoy rounds, discussing and presenting patients and coming up with a plan.
- I enjoy conferences.
- I enjoy working with (most) patients, but there are times when it can get frustrating/depressing.

Things I dislike:
- All of the paperwork.
- Somewhat of a malignant atmosphere in my opinion (this might be because of third year, but a lot of nerves in terms of presenting well, writing a good note, getting a good history, getting along with the team, etc.)
- Running around all day to get things done, it can be exhausting.
- Sometimes, feels as if patients are not getting better and we aren't doing too much to help. Particularly in critical care scenarios (MICU)."


These pros and cons apply for the three short years as an internal medicine resident but really not at all for the thirty years as a practicing internist. You will bill for most of the paperwork that you fill out. The patient become your sole focus and you will work alone, regardless of the size of your group. You will not round and or go to conferences (maybe once a year). Instead, you will be the doctor for your patient in and out of the hospital. It will not be malignant and there is an enormous amount that a general internist can do for a patient, including make him/her comfort care in futile cases. I find that M3s really don't understand how it feels to practice internal medicine after the clerkship because they usually see cynical interns griping about drug addicts and homeless people with sub-optimally treated chronic diseases. Practicing traditional inpatient/outpatient internal medicine feels very different to me than my M3 internal medicine clerkship did at the county hospital inpatient teaching service.

 

[MintChocolateChip83]

Hi all,

Im in a similar position to Dr. Pepper and have already sent out some applications to the various post sophmore fellowships that are available. One of the programs has already invited me for an interview, and I was wondering if there was any advice that you would give for the interview?

Thanks

 

[MintChocolateChip83]

Hi all,

Im in a similar position to Dr. Pepper and have already sent out some applications to the various post sophmore fellowships that are available. One of the programs has already invited me for an interview, and I was wondering if there was any advice that you would give for the interview?

Thanks

anybody?

 

[icpshootyz]

I don't think there's any specific advice for a PSF interview than most other interview situations. Show enthusiasm for pathology (meaning you know what it is and why you're interested in it), make sure you read up on their program ahead of time and have good questions to ask them, know your resume and think of questions they might ask from it, dress well (suit, etc), and be punctual. I did a PSF, but I did it at my med school where they already knew me pretty well so it was a laid-back interview. I haven't heard about the interviews at other places being that harsh.

 

[lipomas]

Are people really treating PSFs like major job or residency interviews? In my experience they weren't that competitive and the "interview" was more to explain to you what it was and find out why you want to do it, and answer your questions. A lot of people don't really understand what it is.

I would say that if you're trying to get it with the major reason being you think it will help your career out, then don't do it.

 

[GoodNewsEvery1]

I did a PSF because I thought it would help me decide what I wanted to do. When I applied, the director told me to only do it if you want to go to a big name path program or possibly to help getting into a competitive field like derm. While it did help me get interviews where I might not have otherwise and I did match my top choice, I'm not sure if it really helped all that much. I was certainly ahead of the other residents when we started but it started to even out as the years progressed. Then I think that I basically lost a year of practice by doing it also.

If I went back, I don't know if I would do it again. It wasn't bad. It was just painful to be a year behind where you would be otherwise. It did help in building confidence that I lacked previously because I learned I could function just fine as a resident (they treated PSFs the same as residents where I was).

If you are having extreme difficulty, you may be just as well off to do a year of research as that may help your residency application more no matter what field choose. If you do decide on a PSF, make sure you get dedicated research time as that will be beneficial if you decide on a different field. And I think I wore nice clothes (slacks and a button down shirt, no tie) to the interview but definitely not a suit.

 

[pathstudent]

I don't see any rational justification for doing a PSF.

There is no PSF for derm, radiology, anesthesia, rad-onc, plastics, ent, or any specialty which one doesn't get much exposure to as a third year resident. What makes pathology so special that it needs one.

Plus think about the economic impact. It costs you a year of earnings. That's 200-500k that you will never see. That's full expenses for 2kids going to private university. It is enough to pay the rest of your vacations for the rest of your life.

Could you use it to publish and make yourself competitive for derm or plastics? Sure. But the overwhelming majority of people that match into competitive specialties didn't do a PSF.

 

[KCShaw]

..snip..

There is no PSF for derm, radiology, anesthesia, rad-onc, plastics, ent, or any specialty which one doesn't get much exposure to as a third year resident. What makes pathology so special that it needs one.

..snip..

I agree that it shouldn't need one. I had hardly heard of such a thing until I started residency, and even then thought little of it other than being a research wanna-be sidebar of almost no practical utility to most people. On the other hand, real world AP/CP pathology isn't taught in medical school -- it's been bastardized into the basic sciences, where students are being misinformed or are misunderstanding about the "pathology" they are having to learn. If you don't burn an elective on a pathology rotation, or worse, a whole year on a PSF, you'll never have a real idea of what it means. Personally, I wouldn't recommend someone do a path PSF unless it's fashioned in such a way as to get a LOT of research time with expected publications, and research is one's goal. If you're just trying to figure out if you like pathology, do a month elective, or hell, two! Seriously, a year just to sort that out? One might be better off starting a residency and swapping if it's that bad.