Brian Datnow, M.DClinical Professor of PathologyResidency Program Director

UCSD

Pathology Interest Group 2012

What % of medical treatment is based on results produced by the Department of Pathology?

• A 10%• B 30%• C 50%• D 70%• E 90%

Answer

D. 70%

What is Pathology?

• Diagnostic Medicine• Teaching

Medical Students Residents & Fellows Graduate Students Fellow Physicians

• Basic & Clinical Research into Mechanisms of Disease

• Diagnostic Medicine• Teaching

Medical Students Residents & Fellows Graduate Students Fellow Physicians

• Basic & Clinical Research into Mechanisms of Disease

• 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

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

• 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

• 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

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

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

• Anatomic & Clinical Pathology (4y) 85%*• Anatomic Pathology (3y) 10% • Clinical Pathology (3y) 3% • Research Pathology (lifetime) 1%

* Percentage of pathways pursued by trainees

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

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

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

Total # of Residents 2,500Avg. # per Program 14.3Avg % Female 49.7%Avg % IMGs 57.1%

AMA FRIEDA, Training Program Survey, 2007

Pathology Specialties(Fellowship Training)

Anatomic Pathology: • Cytopathology • Dermatopathology• Gynecologic Pathology• Breast Pathology • Neuropathology • Pediatric Pathology • Gastrointestinal • Bone & Soft Tissue • Head & Neck • Lung • Urologic Pathology

Anatomic Pathology: • Cytopathology • Dermatopathology• Gynecologic Pathology• Breast Pathology • Neuropathology • Pediatric Pathology • Gastrointestinal • Bone & Soft Tissue • Head & Neck • Lung • Urologic Pathology

Pathology Specialties(Fellowship Training)

Clinical Pathology: • Hematopathology • Microbiology• Transfusion Medicine• Cytogenetics• Clinical Chemistry• Nuclear Medicine• Molecular Medicine

Clinical Pathology: • Hematopathology • Microbiology• Transfusion Medicine• Cytogenetics• Clinical Chemistry• Nuclear Medicine• Molecular Medicine

Pathology Specialties(Fellowship Training)

• Forensic Pathology• Hematopathology• Molecular Diagnostics• Informatics

• Forensic Pathology• Hematopathology• Molecular Diagnostics• Informatics

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%)

• Community Practice (80%)• Academic Practice & Medical School

Administration (15%)• Industry (3%)• Government, Public Health &

Regulatory Positions, e.g., FDA (1%)

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

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

Pathology Workload

Mean 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

Mean 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

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

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

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

• 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

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

• 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

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

• 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

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.

Other Fellowships in San Diego

• Hematopathology at Scripps-Green

• Forensic Pathology (ME)

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

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)

Pathology Disciplines

Anatomic PathologyAutopsy Pathology

Cytopathology

Forensic Pathology

Neuropathology

Surgical Pathology

Pathology Disciplines

Clinical PathologyClinical ChemistryCoagulation CytogeneticsFlow CytometryHematologyImmunization and Transplantation MicrobiologyMolecular PathologyToxicology Transfusion Medicine

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

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.

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.

Residency Options

AP only

Three (3) year program.

At the completion of training, the resident will be board eligible in AP.

Residency Options

CP only

Three (3) year program.

At the completion of training, the resident will be board eligible in CP.

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

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

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

Anatomic Pathology Activities in Which Medical Students Can Participate

• Gross examination & prosection of surgical pathology specimens

• Frozen sections• Autopsies• Microscopy & case signout

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

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

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)

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)

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

To find out about individual training or fellowship programs:

• www.pathologytraining.org• www.apcprods.org• www.university.edu• www.medical_school.edu/pathology

“To know Pathology is to know Medicine”

Sir William Osler