congratulations residency graduate-what every new...
TRANSCRIPT
Congratulations Residency
Graduate- What Every "New"
Pathologist Should Know About
Employment Decisions!
Elizabeth A. Wagar, M.D.
Chair, Department of Laboratory Medicine
Univ. Texas MD Anderson Cancer Center
Expectations
• Do you have any medical school or undergraduate research experience?
• Have you presented any abstracts?
• Have you published any manuscripts?
• Are you tracking through a specialty area of expertise?
• Have you completed any specialty fellowships?• Have you completed any specialty fellowships?
• Have you identified an academic “mentor”?
• If considering basic research, do you have a PI?
• Do you like to teach? Have you given lectures?
• Will teaching interfere with your sign-out style?
• How much does income vs. achievement contribute to your sense of satisfaction?
The Dichotomy of Academic
Medicine
University School of
Medicine: DeanAcademic Medical
Center Administration:
CEO
University
President
or Provost
Dept. of Pathology
and Laboratory
Medicine
Chairman: Reports to the
Dean for academic affairs
Chairman: Serves as Clinical
Chief for the Department,
reporting to the medical staff
organization for clinical affairs
The Pathology Faculty Member
• Will have an academic appointment
(typically professorial)
• Will be a member of the medical center
Medical Staff organization (if performing Medical Staff organization (if performing
clinical service)
• May have an additional administrative
appointment (medical director)
Appointments
• Clinical Instructor (typically not a full
professorial appointment, can be a
“stepping stone”)
• Assistant Professor (4-7 years)• Assistant Professor (4-7 years)
• Associate Professor (4-7 years)
• Professor
• Voluntary professorial titles (institutions
outside of the university)
Tenure vs. Non-Tenure
Appointments
• Tenure typically indicates a basic research commitment, teaching but will have some privileges in addition to tenure (academic senate membership)membership)
• Non-Tenure (Clinical) indicates a commitment to scholarly activities, translational research, educational activities related to clinical appointment
• Either category will have an academic review process
A Typical Academic Offer…
We are pleased to offer you a position in the
Department of Pathology and Laboratory
Medicine:
• Academic Appointment: Asst. Professor, • Academic Appointment: Asst. Professor,
Clinical Track
• Administrative Appointment: Asst. Medical
Director, Transfusion Medicine
Both appointments will report to the Chair.
Academic Promotion: Clinical
Series
• Promotion from Asst. to Assoc. Clinical Professor: Scholarly work, (5-10 publications), translational research, teaching activities (residents), service (medical director, sign-out sections), local/regional presencesections), local/regional presence
• Promotion from Assoc. Clinical Professor to Professor: Scholarly work (20-30 publications), translational research, teaching activities, leadership in clinical activities, national presence (lectures, research presentations)
These expectations may vary considerably.
Getting Paid in Academic Medicine
• Pay based on appointment + clinical
service
• AP faculty pay (at least partially) based on
productivity (RVUs)productivity (RVUs)
• CP faculty pay based on medical director
status and appointment, some RVUs
(hemepath), other service (committees)
Getting Paid in Academic Medicine:
The First Paycheck
• What are all of these numbers?!
• The X, Y, Z method (X = professorial rate, Y = clinical revenue, Z = bonus)
• May be paid from multiple accounts • May be paid from multiple accounts because of different funding sources (university funds, clinical funds, research funds)
• Feel free to discuss your paycheck with the departmental administrator
Academic Practice Plans
• Most frequent type is department-based
• Larger institutional formats: Mayo, MD Anderson
• Plans manage the clinical revenue, billing, collections, usually with a billing service
• Chair and Practice Plan use clinical revenue to • Chair and Practice Plan use clinical revenue to pay faculty salary
• Chair may have other sources of revenue (e.g. educational funding from the university, philanthropy, Dean’s account, outside consultations, outreach revenue)
What About Research?
• Most clinical appointees perform
translational/clinical research
• May be independently funded or a co-
investigator with another groupinvestigator with another group
• Funding can be philanthropy, NIH, state
• A track record of research is important to
future funding
Research
• Identify a specialty area
• If basic research, work with a recognized
PI
• If clinical research, publish as a resident in • If clinical research, publish as a resident in
an area of interest or specialty
• Be prepared to write or contribute to
research proposals (NIH format)
• Write an NIH biosketch
Teaching
• Volunteer to teach! medical students, residents, laboratory professionals, others
• Use your teaching opportunities to continue to learn as an assistant professor (e.g. pick teaching topics that are less familiar to you so you can review them)
• Determine how to best interface with residents and at sign-out if in anatomic pathologyanatomic pathology
• Understand your IT system so it does not interfere with teaching at sign-out
• Prepare to “take longer” with some clinical service activities
• Ask friendly senior faculty members for examples of didactic presentations so you can develop a lecture style
• Use “rounds” in CP rotations to review microbiology cases, chemistry problems, transfusion medicine review
• Attend Grand Rounds and national meetings
Presentations
• Research presentations should be based
on the research writing outline
(introduction, materials and methods,
results, discussion, references)results, discussion, references)
• Didactic presentations should be
developed for the specific audience
• Always practice your presentation!
Publishing
• First manuscripts should be published with a mentor/PI
• Identify a journal, read the instructions for submission for that journal!
• Write in scientific format, as required by the specific journaljournal
• Review repeatedly with your mentor
• Be prepared for reviewer comments and addressing them in a formal response (if preliminarily accepted)
• Accept rejection, identify what work would strengthen the current manuscript
Publishing
• Notes
• Letters to the editor
• Case studies
• Clinical research (retrospective/prospective)
• Pathology (retrospective/prospective)• Pathology (retrospective/prospective)
• Basic research
• Review articles
• Requested editorials
• Book chapters
• Books
Additional Service
• Every academic environment also encourages service to the community
• Receive some promotional credit for such activitiesactivities
• Should not detract from primary appointments
• Volunteering for charities, participating in local teaching activities outside of the university, serving as science fair judges
Questions?
Elizabeth A. Wagar, MD
Professor and ChairProfessor and Chair
Department of Laboratory Medicine
Univ. Texas MD Anderson Cancer Center
713-792-2934
WHAT EVERY NEW
PATHOLOGIST
SHOULD KNOW
RICHARD E. HOROWITZ, MDRICHARD E. HOROWITZ, MD
CLINICAL PROFESSOR OF PATHOLOGY
USC SCHOOL OF MEDICINE
ASCP ANNUAL MEETING
LAS VEGAS
OCTOBER 21, 2011
DISCLOSURES
NONE
ARE YOU READY?
CAN YOU DO A FROZEN IN LESS THAN 5 MINUTES?
CAN YOU CUT IN A WHIPPLE WITH LESS THAN 40
BLOCKS?
CAN YOU SIGN OUT 100 CASES A DAY? 200?
CAN YOU HANDLE AN IRATE SURGEON?
CAN YOU RECOMMEND A TEST(S) FOR
CYSTIC FIBROSIS CARRIER SCREENING?
CAN YOU SPEAK AND WRITE CLEARLY?
HOW’S YOUR SPELLING?
CAN YOU CONDUCT A TUMOR BOARD OR AN
INFECTION CONTROL COMMITTEE?
CAN YOU PLACATE A WEEPING MED TECH?
WHAT’S a 401k or a 529 PLAN OR A 501(c)(3)?
THE SOURCES
ADASP CRITERIA FOR HIRING A COMMUNITY
PATHOLOGIST. 2002
APC EXPECTATIONS OF THE WORKPLACE.
2005
KASS ADEQUACY OF RESIDENCY TRAINING.
2007
BRIMHALL CRITICAL SKILLS FOR PATHOLOGY PRACTICE.
2007
TALBERT RESIDENT PREPARATION FOR PRACTICE.
2009
EXPECTED COMPETENCIES - AP
ACCURATE SURGICAL PATHOLOGY DIAGNOSIS
GROSS DISSECTION, DESCRIPTION, SAMPLING
RAPID & ACCURATE INTRA-OPERATIVE CONSULTATION
JUDGEMENT IN ORDERING SPECIAL STAINS & STUDIES
INTERFACE WITH SURGEONS & ONCOLOGISTS
PRACTICE INDEPENDENTLY YET KNOW LIMITATIONS
ADEQUATE WORKLOAD AND TAT
CYTOLOGY INCLUDING FNA
IMMUNOCHEMISTRY
GASTRO-INTESTINAL PATHOLOGY
AUTOPSY PATHOLOGY
AP QUALITY MANAGEMENT
CONSISTENT AP DEFICIENCIES
GROSS DISSECTION, DESCRIPTION, SAMPLING
JUDGEMENT IN ORDERING SPECIAL STAINS & STUDIES
INTERFACE WITH SURGEONS & ONCOLOGISTSINTERFACE WITH SURGEONS & ONCOLOGISTS
PRACTICE INDEPENDENTLY, YET KNOW WHEN TO ASK
INADEQUATE WORKLOAD AND PROLONGED TAT
EXPECTED COMPETENCIES - CP
KNOWLEDGE OF CLINICAL MEDICINE
CLINICAL EXPERIENCE & PERSPECTIVE
INTEGRATION OF LAB DATA WITH CLINICAL INFORMATION
HANDLING CLINICAL LABORATORY CONSULTATIONHANDLING CLINICAL LABORATORY CONSULTATION
TEST INTERPRETATION AND TEST STRATEGIES
BENCH SKILLS IN TRANSFUSION MEDICINE AND COAGULATION
LABORATORY MANAGEMENT
QUALITY MANAGEMENT
INSPECTION & ACCREDITATION STRATEGIES
REGULATORY COMPLIANCE
CONSISTENT CP DEFICIENCIES
LACK OF KNOWLEDGE OF CLINICAL MEDICINE
LACK OF CLINICAL EXPERIENCE & PERSPECTIVE
INABILITY TO TRANSFORM LABORATORY DATA INTO
MEANINGFUL AND CLINICALLY USEFUL INFORMATION
FOR PATIENT CARE
EXPECTED COMPETENCIES – OTHER
MOLECULAR APPLICATIONS IN PATHOLOGY
(IHC, FLOW, PCR, FISH, CYTOGENETICS, PHARMACOGENOMICS, MICROARRAYS, LASER DISSECTION, ETC, ETC)
PRINCIPLES AND METHODOLOGY
INDICATIONS
INTERPRETATION OF TEST RESULTS
SUB-SPECIALIZATION
SURGICAL PATHOLOGY FELLOWSHIP
DERMATOPATHOLOGY
CYTOPATHOLOGY
GI FELLOWSHIP
HEMATOPATHOLOGY
TRANSFUSION MEDICINE
EXPECTED COMPETENCIES – NON PATHOLOGY
COMMUNICATION SKILLS
WRITTEN AND VERBAL
INTERPERSONAL SKILLS
AVAILABILITY, AFFABILITY, EMOTIONAL INTELLIGENCE
PRACTICE MANAGEMENT
CODING, BILLING, BUSINESS
PROFESSIONAL SKILLSPROFESSIONAL SKILLS
COLLEGIALITY, COMPETITION, COMPLAINT MANAGEMENT
LEADERSHIP AND TEACHING SKILLS
COMMITTEE MEETING METHODS
LABORATORY DIRECTION
PERSONNEL MANAGEMNENT, BUDGETING, MOTIVATION
PRACTICE BASED LEARNING
LIFELONG LEARNING & SELF-ASSESSMENT
BEYOND THE LABORATORY AND HOSPITAL
MEDICAL SOCIETIES, COMMUNITY, POLITICS
CONSISTENT DEFICIENCIES – NON PATHOLOGY
COMMUNICATION SKILLS
WRITTEN AND VERBAL
INTERPERSONAL SKILLS
AVAILABILITY, AFFABILITY, EMOTIONAL INTELLIGENCE
PRACTICE MANAGEMENT
CODING, BILLING, BUSINESS
PROFESSIONAL SKILLSPROFESSIONAL SKILLS
COLLEGIALITY, COMPETITION, COMPLAINT MANAGEMENT
LEADERSHIP AND TEACHING SKILLS
COMMITTEE MEETING METHODS
LABORATORY DIRECTION
PERSONNEL MANAGEMNENT, BUDGETING, MOTIVATION
PRACTICE BASED LEARNING
LIFELONG LEARNING & SELF-ASSESSMENT
BEYOND THE LABORATORY AND HOSPITAL
MEDICAL SOCIETIES, COMMUNITY, POLITICS
THE INVOLVED PATHOLOGIST*
IS A PRACTICING PHYSICIAN INVOLVED WITH:
THE MEDICAL STAFF
THE LABORATORY STAFF
HOSPITAL ADMINISTRATION
AND THE COMMUNITY
*PIERRE KEITGES MD AND RE HOROWITZ MD
PATHOLOGIST & MEDICAL STAFF
PREREQUISITES:
COMMUNICATION SKILLS
KNOWLEDGE OF MEDICAL STAFF ORGANIZATION & BY-LAWSKNOWLEDGE OF MEDICAL STAFF ORGANIZATION & BY-LAWS
PARTICIPATES ENTHUSIASTICALLY
KNOWS HOW TO CONDUCT AND CHAIR A MEETING
VOLUNTEERS – ALWAYS SAYS: “YES, WITH PLEASURE!”
ASPIRES TO LEAD THE MEDICAL STAFF
LEARNS GOLF AND DANCING
PATHOLOGIST & MEDICAL STAFF
AGREES TO ACCEPT ANY COMMITTEE ASSIGNMENT
REQUESTS ASSIGNMENT TO SPECIFIC COMMITTEES, e.g. INFECTION
CONTROL, TRANSFUSION, TISSUE
VOLUNTEERS TO CHAIR COMMITTEES
VOLUNTEERS FOR MEDICAL STAFF EDUCATIONAL FUNCTIONS, e.g., VOLUNTEERS FOR MEDICAL STAFF EDUCATIONAL FUNCTIONS, e.g.,
CPCs, ORGAN RECITALS
PARTICIPATES IN STAFF OVERSIGHT FUNCTIONS, e.g., UTILIZATION
REVIEW, PEER REVIEW, JCAHO INSPECTIONS
VOLUNTEERS TO EDIT MEDICAL STAFF NEWSLETTER
PARTICIPATES IN MEDICAL STAFF SOCIAL EVENTS, e.g., DANCES,
GOLF TOURNAMENTS
PATHOLOGIST IN THE LABORATORY
PREREQUISITES:
ABILITY TO PLAN, LEAD, MOTIVATE , ORGANIZE & CONTROL
EMPHASIZE WORKER ACHIEVEMENT
DEMONSTRATE YOUR OWN TECHNICAL EXPERTISE
DEMONSTRATE THE LAB’S INVOLVEMENT IN PATIENT CARE
KNOW YOUR EMPLOYEES BY NAME – THEIR KIDS TOOKNOW YOUR EMPLOYEES BY NAME – THEIR KIDS TOO
THINGS TO DO:
CONSTRUCT AND DISPLAY AN ORGANIZATIONAL CHART
MAKE DAILY ROUNDS IN THE LAB; INCL PM AND WEEKENDS
ARTICULATE THE LAB’S MISSION TO THE EMPLOYEES
MAKE WORK MEANINGFUL AND RELEVANT
PARTICIPATE IN STAFF ACTIVITIES (BASEBALL, DANCES)
PATHOLOGIST AND ADMINISTRATION
PREREQUISITES:
BE THE DIRECTOR, NOT THE MEDICAL DIRECTOR
KNOWLEDGE OF HEALTH CARE ECONOMICS
KNOWLEDGE OF HOSPITAL ORGANIZATION
GOLF & DANCING
THINGS TO DO:
MONTHLY FORMAL MEETINGS WITH ADMINISTRATION
ESTABLISH RAPPORT WITH HOSPITAL CEO, CFO AND COO
PREPARE ANNUAL REPORT
CONDUCT NURSING ROUNDS WITH CHIEF TECH
VOLUNTEER FOR HOSPITAL COMMITTEES & ACTIVITIES
PARTICIPATE IN HOSPITAL FUND RAISING ACTIVITIES
PARTICIPATE IN HOSPITAL SOCIAL AND SPORTING EVENTS
PATHOLOGIST BEYOND THE HOSPITAL
PREREQUISITES:
HAVE A CIVIC, POLITICAL & INTELLECTUAL AGENDA
HAVE A PHILANTHROPIC INCLINATION
THINGS TO DO:
JOIN & BE ACTIVE IN LOCAL AND NATIONAL MEDICAL AND
PATHOLOGY ORGANIZATIONS
OBTAIN CLINICAL APPOINTMENT IN LOCAL MEDICAL SCHOOL
TAKE AMA OR CAP COURSE ON POLITICAL ACTIVISM
VOLUNTEER IN YOUR COMMUNITY SCHOOLS
VOLUNTEER FOR HOSPITAL’S SPEAKERS BUREAU
VOLUNTEER TO RAISE FUNDS FOR THE HOSPITAL
ACGME COMPETENCIES
PATIENT CARE - DIAGNOSTIC COMPETENCE
MEDICAL KNOWLEDGE - APPLICATION OF SCIENCE
PRACTICE BASED LEARNING - EBP, PIP, CME, QA
COMMUNICATION SKILLS – EFFECTIVE X-CHANGE
PROFESSIONALISM – SENSITIVITY, INTEGRITY & RESPECT
SYSTEMS-BASED PRACTICE – LOCAL & NATIONAL
REFERENCES
1. Horowitz, RE. The Successful Community Hospital Pathologist - What it takes. Human Pathol. 29:211-214, March 1998
2. Horowitz, RE. Expectations and Essentials for the Community Practice of Pathology. Hum Pathol. 37:969-973, August 2006
3. Kass, ME, Crawford, JM, Grimes, MM, Bennett, B, et al. Adequacy of Pathology Resident Training for Employment: A Survey Report From the Future of Pathology Resident Training for Employment: A Survey Report From the Future of Pathology Task Group. Arch Pathol Lab Med. 131: 545–555, April 2007
4. Brimhall, BB, Wright, LD, McGregor, KL, Hernandez, JS. Critical Leadership and Management Skills for Pathology Practice. Arch Pathol Lab Med. 131:1547-1554, October 2007
5. Talbert, M.L. et al Resident Preparation for Practice. A White Paper from the College
of American Pathologists and Association of Pathology Chairs. Arch Pathol Lab Med.
133(7):1139-1147, July 2009.