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US applicants up 19%, IMG applicants down 6%.
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This is a good thing as long as they aren’t overwhelming the socially inept types that occasionally get shunted this way.
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As long as good strong candidates enter this field. Along the way I’ve seen some crazies, asperger (I don’t talk to anyone in the department) types get into pathology because they don’t interact well with human beings.
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Federal funding has been capped but residency spots have expanded massively over the years they are just funded by the hospitals (a resident is cheaper than an NP and you can work them harder)
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They heard about the job market improving.
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Perhaps, but it still isn't all that great. We recently posted for a pathologist job and we literally found our pathologist in about 48 hours of posting. Also, this is not a town on most people's radar at all. More worrisome is that about half the applicants were pathologists already in practice wanting to ditch their current gig for ours. Even if there are more jobs out there, I don't think they're quality positions based on what I gathered from the folks we interviewed.
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Has anyone heard any thoughts from the PDs on how the absence of a numerical STEP 1 score is going to play into this? We of course have basically been a pass/fail specialty as any passing score would get you into pathology, historically speaking. But I am curious if this will cut down on the use of pathology as a backup specialty by the unenthused and mediocre.
Good thing? Not for them it isn’t. However, if you are an executive or HR person with one of the big corporate labs or hospital systems (labcorp/quest/HCA etc) and you were wondering if your pipeline of peons available for exploitation was going to continue into the year 2027 or 2028, then it is indeed a good thing.
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Exploitation I agree with but it’s capitalism. If someone can make money off your work then they will.
If they can pay you less, they will to keep their company financially profitable.
The amount of money these Quest employees make for them over a 20+ year career is mind boggling. Don’t work for Quest unless you don’t have any other options. Have respect for yourself and all the hard work you put into your training/craft.
It happens in every field. There are healthcare entities that have their own internal medicine residency programs to funnel trainees back into their system after they graduate.
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An American medical student with significant loans is unlikely to settle or tolerate an abusive low-paid position as much as an IMG without loans or options might. We need people who actually like pathology to advocate for the specialty in ways other than being a CAP yes man and sometimes that means giving the finger to a crap employer.
As for these reference lab employed positions, yes they make money off you but that’s how capitalism works. For the right person, it’s a great fit and I know pathologists who like the 8-5 corporate atmosphere and 300k salary without resections, autopsies, frozen sections, tumor boards, CP or call.
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Amazing. Notice that Rad Onc only had TEN POSITIONS.
Looks like those folks know to deal with a glut of docs in their field. Path would never do it because there is too much scut attending would have to do.
Looks like those folks know to deal with a glut of docs in their field. Path would never do it because there is too much scut attending would have to do.
That seems...not right. Other specialties also seem way too low for how many actual positions are out there, like Derm. There's no way only 38 people are going into Derm each year. There's more than that many residency spots in my state alone each year. Are a large number of some of these specialties falling into that nebulous Transitional PGY-1 year category at the bottom?
Radonc pgy-1 only has 10 slots. You need to look at pgy-2. Same with derm/rads/optho. And all signs point to radonc going down in flames. Do not use them as an example of what to do.
An American Medical student with debt will absolutely settle/tolerate it (at least temporarily) if they are forced to because they have no other options. It has been happening for years. Work for labcorp/quest/HCA/etc or go live in a cardboard box.
The presence of student loan debt actually hurts, rather than helps, US grads’ leverage in the market. It is harder to say no to a bad deal if you have bills piling up.
It is a myth that corporate lab jobs involve a reasonable workload and hours, from what I have seen. My first job out of training was with labcorp and it was also, by far, the longest hours and heaviest workload of any place I have been. It wasn’t even close to being an 8-5. Of course I was out of there as soon as I found a private hospital based job but that didn’t change the fact that I had to work there until then. I have now “given the finger” to several crap employers, but it is too easy for them to just move on to the next person desperate for any job they can find.
These places exploit you partly by paying you less but also by dumping a massive volume of work on people. They want you to not only cost them as little as possible from an HR standpoint but also to generate as much revenue/work as they can squeeze out of you. Less time off, less pay, less benefits, and much more work. You get exploited on both sides of the equation. 300k actually sounds a little high to me for most of these types of jobs.
And this isn’t true free market capitalism. It is corporate crony capitalism. There is a big difference. Big corporate players can collude with each other, with government, academia, professional organizations etc to rig the system in their favor. Perpetuating a bad job market with oversupply is certainly part of that. A true free market involves an equilibrium between supply and demand. How is it a true free market when the supply is maintained at an artificially high level for years (the primary purpose being to potentiate this exploitation)?
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The 2022 NRMP data for pathology looks pretty much the same as it has for the last few years. It is unfortunate to see a small increase in the total number of path residency spots. Supply and demand really matters for this field. I suspect these new residency spots are at HCA or small community hospitals. Look like a small increase in raw number of US MD seniors matched into about 1/3 of available pathology residency slots. Pathology has the highest percentage of non-US IMGs of any specialty.
No doubt most fields of medicine are being commoditized. Clinical specialties with fewer trainees are most protected from this trend (think Derm). IMO, Pathology is the most vulnerable field and was first to the party. This trend will continue. I can't imagine a private pathology group and/or independent pathology laboratory thriving in this future given the current workforce shortage, increases in small business health insurance rates by 20% year after year, growth in wages (histotechs now earn >$50 per hour where I am), increase in the cost of consumables, general inflation, and inevitable decreases in reimbursement for AP and CP. LADoc and others called out this trend a few years ago.
No doubt most fields of medicine are being commoditized. Clinical specialties with fewer trainees are most protected from this trend (think Derm). IMO, Pathology is the most vulnerable field and was first to the party. This trend will continue. I can't imagine a private pathology group and/or independent pathology laboratory thriving in this future given the current workforce shortage, increases in small business health insurance rates by 20% year after year, growth in wages (histotechs now earn >$50 per hour where I am), increase in the cost of consumables, general inflation, and inevitable decreases in reimbursement for AP and CP. LADoc and others called out this trend a few years ago.
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50 bucks an hour for a histotech? On the train some biology degree people. Save some money. Same for path assistants.
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The pathology academics are calling this job market “HOT” on Twitter. Where were these people BEFORE the pandemic? No one was calling the job market hot back then or 5-10 years prior.
It took a worldwide pandemic to improve the Pathology job market lol.
It took a worldwide pandemic to improve the Pathology job market lol.
Just more disappointed doctors who threw away their careers on pathology. Once everyone is employed path will still be at the bottom. The other docs will just exploit/leverage their specimens (aka the pathologist) to corporate. Everyone knows who the commodity is. Spots will increase, just going to get worse for our field.
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And yet if you read this month's issue of CAP Today, you'll get the impression that these academics or large practice leaders aren't at all pleased with the job market (page 30). One of the pathologists interviewed, who I'm guessing is a physician owner of a regional mega-lab, laments that residents currently have a choice of jobs to pick from.
The other two academic physicians are complaining about something without knowing that they are actually the cause of the problem. Both are bemoaning the fact that, in their experience, they have to spend up to 5 years getting a fresh fellowship trained pathologist up to par only for them to leave for a better, higher paying job.
Only in pathology is it acceptable to put a resident through 4 years of "training", then another year of "specialization", and yet still be considered not fully ready for practice by your peers. If you read what those two faculty pathologists say and how they say it (and you should because I don't want to put words in their mouths), it is the most direct admission ever published that I've seen of the overall state of pathology training. And somehow all of our practice leaders sit around dumbfounded that they can't seem to attract anyone with more than 10 working neurons into the field.
Available online for anyone curious (relevant questions on page 3):
Dark days are over, but new and old challenges pile up - CAP TODAY
March 2022—The omicron surge was waning on Feb. 1 when Compass Group members met by Zoom with CAP TODAY publisher Bob McGonnagle. Inpatient numbers, test demand, and positivity rates were declining. “We’re on the downslope,” Northwell Health’s Dwayne Breining, MD, reported. But other pressures...
www.captodayonline.com
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Ironically a lot of new grads are crap. The more fellowships, usually the worse they are. Is it possible to make it through a urology or dermatology residency and fellowship and still be completely incompetent? Some of these clowns can’t even handle a pap smear after a cytology fellowship.
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Honestly, pretty much ALL new fellowship grads are not ready for the real world. This is true of mostly any specialty and not limited to just pathology. In our world, we're supposed to be the gate keepers of medicine and our contributions weigh heavily on how a patient is treated (or not treated). I think it is this reason where most newly minted grads have a difficult time making the transition. The kid gloves are off and now you have to be the person whose name goes at the bottom of the report. In my experience, working with "fresh grads" can be quite difficult because they: 1) read cases with less efficiency (i.e. slower); 2) consume more time with lots of curb-side consults; 3) do not have the time or experience to deal with administrative duties since they are barely keeping up with their own caseload. It takes time to hone your craft. The fresh grad may be more comfortable in certain areas of sign-out but will undoubtably be bogged down with the other 80-90%. Even some of these grads have issues with their main subspecialty, as echoed by SunBakedTrash.
Overall, pathology needs more Chads. Unfortunately, our field doesn't attract Chads.
Overall, pathology needs more Chads. Unfortunately, our field doesn't attract Chads.
I dunno about this. In radiology, there is a ramp up in efficiency for 3-6 months when entering private practice, but if you go from fellowship to academics, it's pretty seamless. At the end of my fellowship, my attendings told me to just start finalizing unless I had questions. I know a lot of surgical specialists go straight from fellowship to attending pretty easily. I think it's pretty weird that pathologists would require 2-5 post-fellowship years to become "real" attendings.
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You're still comparing apples and oranges. I will make a bet with you and say that since radiology has more Alpha-Chads than pathology, they are more likely to exude the confidence that they know what they are doing. I've come across a lot of interventional guys and they do not understand (even after YEARS of practice) the simple concept regarding "how much tissue is enough" to help the pathologist render a diagnosis. I've met a couple that are top notch and can routinely perform this expert service. So yeah, maybe the radiologist feels they did their job because their instrument told them their needle was in the correct location, etc etc, but in reality, it's quite the opposite.
I can be snarky and say that a radiologist will often give the super helpful broad differential diagnosis of "malignancy, infection, etc". Every field has their limitations, so we understand why these blanket statements are made. I just think more pressure is put on pathology because you're given an actual piece of tissue and everyone expects you to make a very specific and correct diagnosis (even if the sampling was suboptimal or downright out in left field).
To put things in different light, take a look at the technology we have readily available today based on cost and time efficiency. Is it cheaper and faster to read a digital film in radiology versus a digital virtual slide in pathology? I am not sure why you find it "pretty weird" that additional time is required for a pathologist to become a real attending. Again, we're the gatekeepers and often have the final word when it comes to diagnostic medicine. The crown is pretty heavy.
You're the one that said "pretty much ALL new fellowship grads are not ready for the real world. This is true of mostly any specialty and not limited to just pathology." YOU made the comparison first, I was just countering a flawed argument. If you think radiology and pathology are "apples" and "oranges", I'm not sure why you made that blanket statement about "ALL fellowship grads...in mostly any specialty" in the first place.
Now you're saying essentially, "Pathology is EXCEEDINGLY different from other specialties and years of post-fellowship training is normal and expected". Right. Ok. I'm not a pathologist so I can't say much about that, but it's quite different from your initial statement and not typical of other specialties.
Also, I'm not sure "alpha-chads" is a common personality type within radiology. Perhaps you have us confused with ortho or cardiology.
Now you're saying essentially, "Pathology is EXCEEDINGLY different from other specialties and years of post-fellowship training is normal and expected". Right. Ok. I'm not a pathologist so I can't say much about that, but it's quite different from your initial statement and not typical of other specialties.
Also, I'm not sure "alpha-chads" is a common personality type within radiology. Perhaps you have us confused with ortho or cardiology.
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ALL new pathology fellowship grads is what I should have stated...
Alpha-Bros are more common in Ortho.
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CMZ, you and I both know that a valuable thing a ( well trained, confident) pathologist learns is to NOT try to eek out a dx on suboptimal material. If one has a problem telling a rad that they need more, they missed it, etc. they are in the wrong field. You tell them what you need, they don’t tell you what is adequate.
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It was not a problem at all to come out of 4 years of path and go right into practice a number of years ago. It is no secret. It was called “ independent sign out experience”. It has to come sometime. Might as well be while your in the ivory tower. Lots more eyeballs on the resident. By the time they are 4th years, if they cannot s/o a standard “ run” or know what is needed to w/u a non-standard case or consult appropriately, they are gone.
Surgeons and everyone else does it. Time to drop the charade path plays with residents. 4 years of “kabuki” pathology in a “potemkin” hospital.
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This is on point. The majority of older pathologists are great people, but weirdly a vocal minority thinks each graduating resident is a major threat to patients unless they do 2 fellowships and have 5 years experience.
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In pathology, sadly it’s Quantity>>>Quality, which actually should be the other way around.
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My question is why is this acceptable? My personal opinion is that it is not OK to successfully matriculate a resident from a program that is incapable of independent practice in any field. Yes, pathology is radically different from every other specialty. But so is anesthesia, surgery, ophthalmology, radiation oncology, and all the other niche fields of medicine that aren't your traditional clinical specialties. Yes there is some chart review and looking over their shoulders initially, but we don't ever really worry about the new graduates of these programs being incompetent and having to be handheld for up to 5 years just to be effective at their jobs.
I can't remember if it was at a CAP resident's forum or it was published somewhere, but a survey showed a ridiculous amount of recent graduates needed higher amounts of direct supervision for 1-2 years as an attending to safely practice. About 1/3 if I remember correctly. Pathology is certainly unique in that we appear to routinely and at a national level graduate partially trained pathologists who then can't seem to find a job because so few practices want to take a chance on an incompetent graduate or invest years - at their expense - getting that pathologist up to par.
So to ultimately circle back to the original point of this thread, despite applications being up we will still have recruiting problems. Its becoming harder and harder to hide the garbage training, the increasing effort to cover up the deficiencies of recent graduates, and the distorted job market as a result. I would be dubious of any increases in applicants because I would bet you good money that any increased "interest" in pathology represents back up applications from MDs and DOs who can't get into their other specialty of choice.
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I get into these types of discussions on a daily basis with my experienced clinician colleagues. Sometimes I think I am fighting a losing battle, but I have to take the time to temper their expectations with what the true reality is...
Are recent new grads really any different than in previous years? Or is it just the same old "kids these days..." kind of thing?
It took me about six months to feel fairly comfortable and maybe a year to feel like I could deal with almost any situation that might pop up. We've hired some new people and they seem to be on a similar track. Honestly, I'd be a little nervous for someone who came out of fellowship guns blazing no matter the specialty.
It took me about six months to feel fairly comfortable and maybe a year to feel like I could deal with almost any situation that might pop up. We've hired some new people and they seem to be on a similar track. Honestly, I'd be a little nervous for someone who came out of fellowship guns blazing no matter the specialty.
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I’m within 10 years of finishing training so I’m still an infant compared to some of the dudes in my group.
I think the hyper sub-specialization crap breeds a mentality that only a GI pathologist can sign out a TA or it takes a dermatopathologist to handle a basal cell carcinoma. The compounding fellowship hyper focus and time away from general pathology further isolates trainees from the confidence that they can handle basic things and most importantly “knowing what you don’t know.”
I’m no boomer but I think pathology training is getting worse. i think Mike was right on the money with “kabuki” pathology in a “potemkin” hospital.
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That's how things are marketed. You talk to any derm and they want a dermatopathologist to read their stuff. Dermpaths and Derms speak the same lingo, so they feel more comfortable knowing that someone with a similar background is reading their difficult BCC. For bone marrows and other heme-related items, most oncologists are going to want a hemepath to read their stuff. It's all about personalized medicine now and who best to read this stuff than a hyperspecialized pathologist
Speaking about newbie pathologists, we had a recent hire in my group (and I don't care if this person reads this here or not)... this individual had done two popular fellowships and seemed to carry themselves well. I trusted their training and knew they would work hard. Stage fright is a real thing, unfortunately. This individual typically inundated several of our senior folks with absurd daily curb side consults. It was so bad that it was interfering with their daily caseloads because these consults came every day non-stop. Some of the consults came as surprise 20 slide packages with a broad question. Some consults would read, "Is this necrosis?" "Does this bone marrow look normal?" Obviously, this individual had no idea about the finer qualities of sending a consult. If you're going to send a consult, send me the pertinent slides with areas marked that you have a question on. Don't send me the whole ****ing case and expect me to decipher the mystery for you. The first couple of times it's cute, but not after a year.
Granted, I'm not giving you all a lot of context, but the types of questions being asked were often very elementary that I am pretty sure a medical student would feel ashamed to ask. On the flip side, whenever we would show around a difficult case, this pathologist would argue with you if they had a difference of opinion. They would argue until they were blue in the face because they suddenly became an expert consultant in whatever organ system we were discussing. One time I said, "Well since we cannot come to a consensus, then I guess we need to send this out for expert opinion." One case in question was sent out and the consultant agreed with the group's main consensus (except the junior pathologist). Still not satisfied, this person decided to send the case to yet another consultant and this time they got the answer they were looking for and felt validated by that particular expert's opinion. I tried to have a conversation with this pathologist about the finer points in asking for an expert consultants help. I explained that pathology (like any field in medicine) is very much an art as it is a science and there will always be someone who disagrees with your assessment. I've seen this countless times in the hemepath world. You're likely going to get a huge difference of opinion if you show a case to Jeffrey Medeiros than you would with Elaine Jaffe. It doesn't mean entirely that one pathologist is wrong and the other is correct.
At any rate, this crap continued on for well over a year. I did not renew that person's contract and they are now going to be someone else's problem. I hope they find peace.
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In the same vein, we had a partner, a fairly senior partner who happened to be one of the lazier guys in the group. Every afternoon he checked out of his ~100 bed solo joint he had been at for years at about 3 and went across town to another of our hospitals to shoot the s***with the 2 guys there. EVERY DAY he showed them ALL his cx bx’s and ecc’s!
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That's how things are marketed. You talk to any derm and they want a dermatopathologist to read their stuff. Dermpaths and Derms speak the same lingo, so they feel more comfortable knowing that someone with a similar background is reading their difficult BCC. For bone marrows and other heme-related items, most oncologists are going to want a hemepath to read their stuff. It's all about personalized medicine now and who best to read this stuff than a hyperspecialized pathologist
Speaking about newbie pathologists, we had a recent hire in my group (and I don't care if this person reads this here or not)... this individual had done two popular fellowships and seemed to carry themselves well. I trusted their training and knew they would work hard. Stage fright is a real thing, unfortunately. This individual typically inundated several of our senior folks with absurd daily curb side consults. It was so bad that it was interfering with their daily caseloads because these consults came every day non-stop. Some of the consults came as surprise 20 slide packages with a broad question. Some consults would read, "Is this necrosis?" "Does this bone marrow look normal?" Obviously, this individual had no idea about the finer qualities of sending a consult. If you're going to send a consult, send me the pertinent slides with areas marked that you have a question on. Don't send me the whole ****ing case and expect me to decipher the mystery for you. The first couple of times it's cute, but not after a year.
Granted, I'm not giving you all a lot of context, but the types of questions being asked were often very elementary that I am pretty sure a medical student would feel ashamed to ask. On the flip side, whenever we would show around a difficult case, this pathologist would argue with you if they had a difference of opinion. They would argue until they were blue in the face because they suddenly became an expert consultant in whatever organ system we were discussing. One time I said, "Well since we cannot come to a consensus, then I guess we need to send this out for expert opinion." One case in question was sent out and the consultant agreed with the group's main consensus (except the junior pathologist). Still not satisfied, this person decided to send the case to yet another consultant and this time they got the answer they were looking for and felt validated by that particular expert's opinion. I tried to have a conversation with this pathologist about the finer points in asking for an expert consultants help. I explained that pathology (like any field in medicine) is very much an art as it is a science and there will always be someone who disagrees with your assessment. I've seen this countless times in the hemepath world. You're likely going to get a huge difference of opinion if you show a case to Jeffrey Medeiros than you would with Elaine Jaffe. It doesn't mean entirely that one pathologist is wrong and the other is correct.
At any rate, this crap continued on for well over a year. I did not renew that person's contract and they are now going to be someone else's problem. I hope they find peace.
There’s no quality control when it comes to assessing a persons ability to practice independently. Crap programs (low volume, poor teaching, etc) that shouldn’t exist should be closed down. Crap in crap out.
Perhaps it's time the ABPath changes the exam to better assess resident's readiness for independent practice. I propose that instead of a multiple choice exam, the resident have to type the answer into a box.
I think this mimics real world more, and could allow partial marks for answers (Eg. a metaplastic breast carcinoma is shown, the person who writes metaplastic breast carcinoma gets 10 points, the person who writes only breast carcinoma gets partial 5 points, the person who writes breast sarcoma gets 1 point, and other wrong answers like DCIS gets 0 points, if a person writes any benign diagnoses, they get -5 points).
I think the computer algorithms are powerful enough these days that setting up these type of questions and scoring them using an algorithm shouldn't be a problem.
I think this mimics real world more, and could allow partial marks for answers (Eg. a metaplastic breast carcinoma is shown, the person who writes metaplastic breast carcinoma gets 10 points, the person who writes only breast carcinoma gets partial 5 points, the person who writes breast sarcoma gets 1 point, and other wrong answers like DCIS gets 0 points, if a person writes any benign diagnoses, they get -5 points).
I think the computer algorithms are powerful enough these days that setting up these type of questions and scoring them using an algorithm shouldn't be a problem.
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I would prefer the equivalent of an oral board personally instead of the slide exam. Just have the examinee sit at a two headed microscope drive the glass with the examiner at the side looking in. The examiner knows what the diagnoses are and they should be fairly routine things (breast cancer, basic GI biopsies, etc.).
The examinee should have about 10 minutes/slide and the examiner should ask questions like:
- What is the differential diagnosis?
- What IHC stain/ancillary studies would help in sorting out the ddx?
- What is the final dx?
- If applicable, what molecular alterations, etc. are associated with said entity?
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I have always thought that it takes 6 months to one year to get the real skinny on a pathologist. By that time, prior mistakes sitting in the file cabinet of path reports will surface like steatorrhea in the bowl.
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When I was involved in hiring, unless we were looking for specific subspecialization such as heme or dp, I far preferred a generalist with solid judgement/maturity and one year of independent s/o experience. In many cases the multiple fellowship person was not a good fit in a busy PP situation. They tend to be happier in academics.
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The solution to this problem is 100% on the PD’s and faculty. OK. I know the “rules” about who can sign out and bill for xyz. BUT, the faculty and PD are going to have to allow the more senior residents real independent s/o. For goodness sake, bend the rules. If the resident cannot then “ bottom line/sign” the report, that indicates a level of distrust such that the trainee will not be “trustable” in a few month more time when they graduate. Would you hire them then?
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Recent new grads are far different than they were in the 1980’s. All of us were able to pass boards in our 4th year and enter jobs out of residency. All senior residents were allowed independent s/o in their last surg path rotation.
You were expected to 1. correctly sign it out. 2. know what needs to be done so it can be correctly signed out in problem cases. 3. consult appropriately. If you cannot do that with the trust of the faculty/PD you are gone.
This was the military. Perhaps this is not or never was possible in civ land.
This is not the old chestnut “ kids these days”.
That's how things are marketed. You talk to any derm and they want a dermatopathologist to read their stuff. Dermpaths and Derms speak the same lingo, so they feel more comfortable knowing that someone with a similar background is reading their difficult BCC. For bone marrows and other heme-related items, most oncologists are going to want a hemepath to read their stuff. It's all about personalized medicine now and who best to read this stuff than a hyperspecialized pathologist
Speaking about newbie pathologists, we had a recent hire in my group (and I don't care if this person reads this here or not)... this individual had done two popular fellowships and seemed to carry themselves well. I trusted their training and knew they would work hard. Stage fright is a real thing, unfortunately. This individual typically inundated several of our senior folks with absurd daily curb side consults. It was so bad that it was interfering with their daily caseloads because these consults came every day non-stop. Some of the consults came as surprise 20 slide packages with a broad question. Some consults would read, "Is this necrosis?" "Does this bone marrow look normal?" Obviously, this individual had no idea about the finer qualities of sending a consult. If you're going to send a consult, send me the pertinent slides with areas marked that you have a question on. Don't send me the whole ****ing case and expect me to decipher the mystery for you. The first couple of times it's cute, but not after a year.
Granted, I'm not giving you all a lot of context, but the types of questions being asked were often very elementary that I am pretty sure a medical student would feel ashamed to ask. On the flip side, whenever we would show around a difficult case, this pathologist would argue with you if they had a difference of opinion. They would argue until they were blue in the face because they suddenly became an expert consultant in whatever organ system we were discussing. One time I said, "Well since we cannot come to a consensus, then I guess we need to send this out for expert opinion." One case in question was sent out and the consultant agreed with the group's main consensus (except the junior pathologist). Still not satisfied, this person decided to send the case to yet another consultant and this time they got the answer they were looking for and felt validated by that particular expert's opinion. I tried to have a conversation with this pathologist about the finer points in asking for an expert consultants help. I explained that pathology (like any field in medicine) is very much an art as it is a science and there will always be someone who disagrees with your assessment. I've seen this countless times in the hemepath world. You're likely going to get a huge difference of opinion if you show a case to Jeffrey Medeiros than you would with Elaine Jaffe. It doesn't mean entirely that one pathologist is wrong and the other is correct.
At any rate, this crap continued on for well over a year. I did not renew that person's contract and they are now going to be someone else's problem. I hope they find peace.
Sounds like this person lacked confidence with their name on the line and then overcompensated to (in their mind) look stronger when the pressure was off.
I'm sure having real sign-out experience in residency was a big deal. I don't know when that was changed, but I'd be curious to know if, say, a 2000 or 2010 new attending operating under similar residency conditions as now was really more qualified than a 2022 new attending.
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That's how things are marketed. You talk to any derm and they want a dermatopathologist to read their stuff. Dermpaths and Derms speak the same lingo, so they feel more comfortable knowing that someone with a similar background is reading their difficult BCC. For bone marrows and other heme-related items, most oncologists are going to want a hemepath to read their stuff. It's all about personalized medicine now and who best to read this stuff than a hyperspecialized pathologist
Speaking about newbie pathologists, we had a recent hire in my group (and I don't care if this person reads this here or not)... this individual had done two popular fellowships and seemed to carry themselves well. I trusted their training and knew they would work hard. Stage fright is a real thing, unfortunately. This individual typically inundated several of our senior folks with absurd daily curb side consults. It was so bad that it was interfering with their daily caseloads because these consults came every day non-stop. Some of the consults came as surprise 20 slide packages with a broad question. Some consults would read, "Is this necrosis?" "Does this bone marrow look normal?" Obviously, this individual had no idea about the finer qualities of sending a consult. If you're going to send a consult, send me the pertinent slides with areas marked that you have a question on. Don't send me the whole ****ing case and expect me to decipher the mystery for you. The first couple of times it's cute, but not after a year.
Granted, I'm not giving you all a lot of context, but the types of questions being asked were often very elementary that I am pretty sure a medical student would feel ashamed to ask. On the flip side, whenever we would show around a difficult case, this pathologist would argue with you if they had a difference of opinion. They would argue until they were blue in the face because they suddenly became an expert consultant in whatever organ system we were discussing. One time I said, "Well since we cannot come to a consensus, then I guess we need to send this out for expert opinion." One case in question was sent out and the consultant agreed with the group's main consensus (except the junior pathologist). Still not satisfied, this person decided to send the case to yet another consultant and this time they got the answer they were looking for and felt validated by that particular expert's opinion. I tried to have a conversation with this pathologist about the finer points in asking for an expert consultants help. I explained that pathology (like any field in medicine) is very much an art as it is a science and there will always be someone who disagrees with your assessment. I've seen this countless times in the hemepath world. You're likely going to get a huge difference of opinion if you show a case to Jeffrey Medeiros than you would with Elaine Jaffe. It doesn't mean entirely that one pathologist is wrong and the other is correct.
At any rate, this crap continued on for well over a year. I did not renew that person's contract and they are now going to be someone else's problem. I hope they find peace.
It’s on the program director to make sure every graduate is competent to sign out surgical pathology/hemepath and cytopath independently. Not every program director is strict with this. This is why we get garbage coming out of training.
Subpar graduates go on forward to fellowship then it becomes the fellowship directors problem. Then it becomes the employers problem once they get out into the workforce…then the second employers problem and the cycle continues.
This is why we have to have higher standards who we match in to pathology and which programs should be offered a residency program.
