Route to Neuropathology

[NeuroKid5]

My name is James, and I am a first year medical student. I am very intrigued by pathology and definitely want a career in the field. Specifically, I would like to go into neuropathology. I have been looking at residencies and fellowship programs, and I noticed that most programs for neuropathology training are AP/NP joint programs, with two years for each. I want to do a 4-year AP/CP program and then do the NP fellowship. I know that this is an unconventional route to take but I want to know if is possible to do AP/CP then NP. Also, would it be a good idea to do AP/NP and then CP?

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[deleted314957]

My name is James, and I am a first year medical student. I am very intrigued by pathology and definitely want a career in the field. Specifically, I would like to go into neuropathology. I have been looking at residencies and fellowship programs, and I noticed that most programs for neuropathology training are AP/NP joint programs, with two years for each. I want to do a 4-year AP/CP program and then do the NP fellowship. I know that this is an unconventional route to take but I want to know if is possible to do AP/CP then NP. Also, would it be a good idea to do AP/NP and then CP?

Most neuropaths I have known have done AP/CP then a 2 year NP fellowship.

 

[Autopsy Sweet]

My name is James, and I am a first year medical student. I am very intrigued by pathology and definitely want a career in the field. Specifically, I would like to go into neuropathology. I have been looking at residencies and fellowship programs, and I noticed that most programs for neuropathology training are AP/NP joint programs, with two years for each. I want to do a 4-year AP/CP program and then do the NP fellowship. I know that this is an unconventional route to take but I want to know if is possible to do AP/CP then NP. Also, would it be a good idea to do AP/NP and then CP?

James,

You can do AP (3 yrs) then NP (5 yrs total), AP/NP (4 years total), or AP/CP then NP (6 years total). You can also do neurology then NP or psych then NP, but that's a different beast altogether! What you choose to do should be dependent upon what you ultimately want your career to look like, but keep in mind that these are generalizations. If you want to do academic medicine and do both surgipath and neuropath sign out, you should consider doing the full AP residency (it's hard to become proficient in AP in 3 yrs much less 2). Most academic institutions won't expect you to be CP trained if you do surgipath and neuropath sign out. If you plan to do research and NP (no surgipath), then AP/NP is fine. If you want to do private practice, you probably won't find a job that is NP only right out of training, and having CP would make you more marketable.

As far as doing AP/NP and then CP, I wouldn't advise it, and this is why: to be eligible for the AP/CP boards, you have to have completed the requirements for both AP and CP. To be eligible for the NP boards, you need to have passed your primary boards (whether AP or AP/CP). If you know going in that you will ultimately do CP at the end, you will not be eligible to sit for the AP/CP boards until all of that training is finished. Then, once you have passed, you could sit for the NP exam. It would put a huge amount of time between your AP/NP training and the exam which isn't ideal. The best bet, if you want to do AP/CP is to do them in 4 yrs then do NP. If you aren't sure if you want to do CP when you start residency, then communicate that to your program director in the beginning to make sure that you don't exceed the allowed number of electives in CP before you decide. In other words, you can do up to 12 months of electives in an AP residency and still be board eligible, but more than that may delay your boards. Of course there are always exceptions to the rules put forth by the ABP, but these are the basics regarding the exams.

Best of luck!

 

[Thrombus]

You should do Psych and NP then when you can't find a job doing NP you can do Psych otherwise you will have to see a Psych

 

[whiteriver2014]

I just matched to a busy path program this year. Intended for AP/NP, but have scared with the job perspective, want to find a better training arrangement to be more marketable.

By the way, I am new to this forum. Please share your thoughts.

 

[deleted314957]

I just matched to a busy path program this year. Intended for AP/NP, but have scared with the job perspective, want to find a better training arrangement to be more marketable.

By the way, I am new to this forum. Please share your thoughts.

if "marketability" is a main concern, you should go the AP/CP route

 

[NeuroKid5]

Thanks for the advice everyone, and I think that I have a better understanding of the different paths when it comes to NP. As far as my career goes, I am interested in forensic neuropathology as well as academic medicine with neuropath and surgipath signouts. I have been advised to do AP/CP then the NP & FP fellowships; however, I would like to know if it would make more sense to do AP/NP then FP. I am not really interested in going into private practice, yet I would like to have the option open to me. I also need to do more research on forensic pathology as a career and figure out if being certified in CP is really needed. I would like to be as "marketable" as possible but I don't want to get training in CP and not really use it, especially if I can get more training in AP within that same time frame.

 

[Entgegen]

Thanks for the advice everyone, and I think that I have a better understanding of the different paths when it comes to NP. As far as my career goes, I am interested in forensic neuropathology as well as academic medicine with neuropath and surgipath signouts. I have been advised to do AP/CP then the NP & FP fellowships; however, I would like to know if it would make more sense to do AP/NP then FP. I am not really interested in going into private practice, yet I would like to have the option open to me. I also need to do more research on forensic pathology as a career and figure out if being certified in CP is really needed. I would like to be as "marketable" as possible but I don't want to get training in CP and not really use it, especially if I can get more training in AP within that same time frame.

My mentor in forensics had told me that it's a good idea to have CP board certification for the following reason: say you're testifying on a case in which toxicology played a decisive role in your ruling of cause/manner of death. While on the stand, the opposing attorney gets up and says, "Dr. NeuroKid, given that toxicology is within the realm of clinical pathology and you're not CP board certified, are you truly qualified to interpret these toxicology results?"

Ignore the fact that most residents get minimal to no exposure to toxicology as part of their CP training, that nearly all practical toxicology knowledge is gained during the FP fellowship, and that you may well have had a PhD toxicologist performing the testing and result interpretation. This is just a small technicality that the opposing legal team can throw at you in order to try to discredit you and your testimony in front of a jury. I have no idea how much of an impact this would really have on your credibility in court or how often this realistically happens, but this is the advice of an (AP/CP/FP board certified) ME with more than a few years under his belt.

 

[BrainPathology]

I am not really interested in going into private practice, yet I would like to have the option open to me.

Without CP that option would be virtually closed to you. And if you take the general consensus about jobs on this board seriously (which is up to you), you may want to have as much advantage as possible.

If you do AP/NP/FP though I think you'd have a fairly secure path into forensics for a long time.. and you'd have to convince a lot of private groups what an FP fellowship would add for them anyway, handy maybe but FP/NP doesn't let you in on the rotation for the call schedule. And if I'm honest that's the reason CP is essential, not because you know anything more than anyone else - because you will be relearning EVERYTHING you need to know in CP by the time you get back to it after at least 3 years away for NP/FP. The only reason you have to have CP is to share call. But try getting a job with a private group where you'll never cover call for the lab. Won't be happening.

If you go to a private group covering a hospital with lots of neurosurgeons the NP will come in handy. That particular brand of surgeons print money for the hospital and more and more demand that their specimens be signed out by NP's. It's not as useful as often to a group as Derm, Heme, Cyto, or some others but it's not without its uses in the right situations (obviously I'm not objective about that).

 

[NeuroKid5]

So it sounds like the best route of me is to do AP/CP followed with fellowships in NP & FP. I guess my next concern involves having enough experience with surgipath so that I can be able to do other signouts besides neuropath. Is this experience provided with extra time (i.e. surgipath fellowship) or more so the residency program I'm in? I have been told that I don't need to do a surgipath fellowship and that I will get more experience when I actually start working, post-training.

Also, thanks for the responses everyone!

 

[malchik]

Are you OK with AP/CP/NP/FP = 7 years of training? At some point one has to stop adding things for the sake of some theoretical marketability and get out and start practicing. If you say you want to do forensics, neuropath and academics, that right there is plenty on your plate. If time is a concern, I recommend AP/NP then forensics = 5 years.

 

[Circumflex]

As a forensic pathologist, I have never had any questions regarding CP qualifications in court. Clinical toxicology is different from postmortem toxicology. A clinical toxicologist is not necessarily qualified to interpret postmortem toxicology results. The same goes with microbiology - postmortem specimens are a different beast. That is why training in toxicology is required as part of the FP fellowship and well-covered on the board exam.

However, if you are unsure of what you want to do, I would start out as AP/CP and see what you like.