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Brian Datnow, M.DClinical Professor of PathologyResidency Program Director
UCSD
Pathology Interest Group 2012
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What % of medical treatment is based on results produced by the Department of Pathology?
• A 10%• B 30%• C 50%• D 70%• E 90%
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Answer
D. 70%
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What is Pathology?• Diagnostic Medicine• Teaching
Medical Students Residents & Fellows Graduate Students Fellow Physicians
• Basic & Clinical Research into Mechanisms of Disease
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• To further our understanding of the mechanisms of disease, and, in so doing, allow for a more effective treatment strategies
• To consult with clinical colleagues in the care of patients so that laboratory information is effectively and properly integrated into diagnosis & treatment planning; in this context, pathologists must be knowledgeable about clinical findings and data from virtually all other specialty areas
AIMS OF PATHOLOGY AS A DISCIPLINE
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Paul Ehrlich (1854-1915)Changes in body fluid led to the
development of clinical chemistry and hematology
Rudolph Virchow (1821-1902) Originator of modern pathology
theory
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• Surgical pathology• Autopsy & forensic pathology• Cytopathology• Neuropathology• Pediatric pathology• Dermatopathology• Hematopathology• Clinical chemistry• Microbiology & infectious disease• Transfusion medicine• Diagnostic immunopathology• Cytogenetics• Molecular diagnostics• Genomics (personalized medicine)
MODERN SUBSPECIALTIES IN PATHOLOGY
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• Morphology• Flow Cytometry• Electron microscopy• Immunohistochemistry• In-situ hybridization• Nucleic acid blotting technologies• Genomics
Diagnoses in Anatomic Pathology A Continuing Goal & Major Focus of
Translational Research
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Patient-Related• Fine needle aspiration biopsy• Apheresis• Bone marrow aspiration & biopsy
Procedural• Frozen section• Autopsy• Prosection of gross specimens• Light, polarization, & phase-contrast microscopy• Electron microscopy• Immunohistology• In-situ hybridization & comparative genomic hybridization• Flow cytometry• Cytogenetics• Chromatography• Polymerase chain reaction & nucleic acid blotting
technologies• Mass spectroscopy• Spectrophotometry• Bacterial, mycological, & viral cultures• Differential microbial biochemistry
Techniques in Pathology
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What and How Long are the Training Programs?
• Anatomic & Clinical Pathology (4y) 85%*• Anatomic Pathology (3y) 10% • Clinical Pathology (3y) 3% • Research Pathology (lifetime) 1%
* Percentage of pathways pursued by trainees
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Pathology Training Programs
Resident WorkloadAvg. Weekly Workload
48.3 hours
Avg. Annual Compensation $32,000-$56,000
(UCSD $45,000-$56,000)
Avg. Vacation3.1 weeks
(UCSD 4 weeks)
AMA FRIEDA, Training Program Survey, 2007
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Pathology Training Programs
Total # of Residents 2,500Avg. # per Program 14.3Avg % Female 49.7%Avg % IMGs 57.1%
AMA FRIEDA, Training Program Survey, 2007
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Pathology Specialties(Fellowship Training)
Anatomic Pathology: • Cytopathology • Dermatopathology• Gynecologic Pathology• Breast Pathology • Neuropathology • Pediatric Pathology • Gastrointestinal • Bone & Soft Tissue • Head & Neck • Lung • Urologic Pathology
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Pathology Specialties(Fellowship Training)
Clinical Pathology: • Hematopathology • Microbiology• Transfusion Medicine• Cytogenetics• Clinical Chemistry• Nuclear Medicine• Molecular Medicine
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Pathology Specialties(Fellowship Training)
• Forensic Pathology• Hematopathology• Molecular Diagnostics• Informatics
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What are the CareerOptions for Pathologists?
• Community Practice (80%)• Academic Practice & Medical School
Administration (15%)• Industry (3%)• Government, Public Health &
Regulatory Positions, e.g., FDA (1%)
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Pathology Practice Demographics
Type of Practice• Solo 7%• Pathology Group 67%• Multispecialty Group 7%• Medical School 10%• Hospital 10%• Independent Laboratory 9%• Locum Tenens 1%
College of American Pathologists Survey, N=940
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Pathology WorkloadMean hours per week 48 hrs
• Surgical Pathology 25.0• Cytopathology 5.9• Billable Clinical Pathology 2.6• Clinical Pathology
Management 7.4• Teaching/Research 1.9• Autopsy 2.1• Other 3.1
Mean Total, Other MedicalSpecialties 55 hrs
College of American Pathologists Survey, N=940
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Pathology Salaries
Median Income by Age• All Ages $220,000• < 40 $180,000• 40 – 49 $230,000• 50 – 59 $250,000• >59 $200,000
Latest data (2011) for all ages$325,000
College of American Pathologists Survey, N=940
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What is the Lifestyle of Pathologists?
• 48 hour work week vs. 55 hour average work week all specialties
• Above average professional satisfaction (70%)
• Above average family satisfaction
• Average professional respect• Below average stress
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Current & Future Career Opportunities
• Starting salary offers over $125,000 – above primary care specialties, slightly below surgical specialties
• Two offers for each graduating candidate; higher for U.S. graduates
• 20,000 Board-Certified Pathologists U.S.; 2,500 in training (800,000 physicians in U.S.)
• Anticipated increased job opportunities in five years
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Current & Future Career Opportunities
• Every academic department in U.S. has a vacancy (130 medical schools; 155 training programs)
• Pathology Departments have $400 million in NIH research grants – more than many NIH institutes (Special Opportunities for Physician Scientists)
• Diagnostic Medicine: $35 billion market, growth 5-7% annually
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Residency Positions and Funding
• Nineteen (19) residency positions (ACGME certified)• Six (6) openings for 2011-2012 Thirteen (13) funded by the hospital Six (6) funded by the VAMC• One (1) *Neuropathlogy Fellowship (2 year)• One (1) Research Fellowship (1 year)• Four (4) Surgical Pathology Fellowships ( I year)• One (1) *Hematopathology Fellowship ( I year)• One *Cytopathology Fellowship (2013) ( I year)* Designates ACGME/ABP recognized.
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Other Fellowships in San Diego
• Hematopathology at Scripps-Green
• Forensic Pathology (ME)
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UCSD Pathology Residency Training Experience
• UCSD Hillcrest• UCSD Thornton• UCSD Moore’s Cancer Center• UCSD CALM• VAMC• Also at affiliated UCSD laboratories and
other affiliated institutions
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Affiliated Medical Centers
• Veterans Affairs Medical Center (structured rotations in AP and CP)• Rady Children’s Hospital Medical Center (structured rotations in
Pediatric Pathology)• Medical Examiner of San Diego County (structured rotations in
Forensic Pathology)• Kaiser Permanente Medical Center (elective rotations in Surgical
Pathology and Cytopathology)• United States Naval Hospital (elective rotations in Hematopathology,
Surgical Pathology and Cytopathology)• Green Hospital at Scripps Clinic (elective rotations in
Hematopathology)
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Pathology Disciplines
Anatomic PathologyAutopsy PathologyCytopathologyForensic PathologyNeuropathologySurgical Pathology
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Pathology Disciplines
Clinical PathologyClinical ChemistryCoagulation CytogeneticsFlow CytometryHematologyImmunization and Transplantation MicrobiologyMolecular PathologyToxicology Transfusion Medicine
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Accreditation Council for Graduate Medical Education
(ACGME)• Accreditation of all residency and most
fellowship programs• Divided into RRCs (Residency Review
Committees) which are specific for each specialty
• The Pathology RRC is comprised of Pathologists and non-Pathologist ACGME personnel
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ACGME and ABP Training Requirements
APCP-4 programs must include 18 months of formal education in anatomic pathology and 18 months of formal education in clinical pathology.
• The AP-3 and CP-3 programs must include 24 months of anatomic pathology (AP-3) or clinical pathology (CP-3) education.
• The remaining 12 months of training for APCP-4, AP-3, and CP-3 programs may be a continuation of structured anatomic pathology or clinical pathology education, or may be devoted to a specialized facet of pathology.
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Residency Options
Combined Anatomic Pathology (AP) and Clinical Pathology (CP)
Four (4) year program includes 24 months
of AP and 24 months of CP. At the completion of training, the resident
will be board eligible in AP and CP.
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Residency Options AP only
Three (3) year program. At the completion of training, the resident
will be board eligible in AP.
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Residency Options CP only
Three (3) year program. At the completion of training, the resident
will be board eligible in CP.
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Interview Process• Morning interviews with 4-6 faculty members (AP
and CP, UCSD and VAMC) for 4-6 applicants 0800-0900: Introduction by chair and program
director 0900-1100: Interviews • Tour of UCSD Hillcrest Hospital with chief or senior
resident• Transportation to campus• Lunch with the residents• Tour of Moore’s Cancer Center, Thornton Hospital
and VAMC with chief or senior resident• Visit ends• Feedback from applicants has been positive
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2010 Match Applicants• Number of applicants: 234• Number with MD., PhD: 20• UCSD Graduates: 3• US Graduates: 138• International graduates: 96 • USMLE scores: Step I 99th percentile: 40 Step I and II 99th percentile: 26• Number interviewed: 68 (14 IMGs)• Number ranked: 61
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Criteria for Selection• Demonstrated interest in Pathology• Completion of USMLE Step I with score
>85th percentile• Solid letters of recommendation preferably
from Pathologists• Solid grades in Medical School especially
subjects related to Pathology• Satisfactory Dean’s letter• Ability to work with others• Good communication skills
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Anatomic Pathology Activities in Which Medical Students Can Participate
• Gross examination & prosection of surgical pathology specimens
• Frozen sections• Autopsies• Microscopy & case signout
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Where to go &what to do next?
To learn more about pathology:• www.apcprods.org• www.asip.org• www.uscap.org• www.ascp.org/member/rps/• www.aclps.org• www.cap.org/html/member/residents_forum.html• www.aamc.org/students/considering/start.htm
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Where to go &What to do next?
For information about pathology training and fellowships:
• www.abppath.org• www.pathologytraining.org• www.acgme.org• www.ama-assn.org/ama/pub/
category/2997.html (FREIDA On Line)
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Where to go &What to do next?
To find out about individual training or fellowship programs:
• www.pathologytraining.org• www.apcprods.org• www.university.edu• www.medical_school.edu/pathology
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“To know Pathology is to know Medicine”
Sir William Osler