Tuesday, February 28, 2006

Rank order list 2006 Pathology

Papaya
Congrats to all and best wishes on the match in a few weeks. I'm finishing up a month of hellish inpatient medicine and going on to Emed next month (another torture?). I guess I'll be the first one to post the rankings since I gotta put my little one to bed shortly.
1. JHU
2. Brigham
3. UCLA
4. MGH
5. Emory
6. Upenn
7. BIDMC
8. Duke
9. UCSF
10. UTSW
11. Stanford
12. UVa
Beary
I can't wait, here it is:
1) UVA
2) Michigan
3) Indiana
4) Utah
5) UTSW
6) Nebraska
7) Iowa
unranked - Wash U
Kibosh
1. UVA
2. UVM
3. Iowa
4. Indiana
5. Wisconsin
6. Michigan
7. Ohio State
8. Northwestern-Evanston Hospital
9. Nebraska
10. Penrose
11. UMinn
12. Colorado
papillomatous
1. Cornell
2. Columbia
3. Penn
4. U Chicago
5. Stanford
6. UCSF
7. BWH
8. MGH
9. UCLA
10. UCSD
(unranked - Mt. Sinai)
Gene
1. Texas A&M
2. UTSW
3. UNM
4. UTHSCSA
5. Methodist Houston
6. Baylor Houston
7. Wash U
unranked- UT Houston
Prairie
1. Iowa
2. UVa
3. U of Washington
4. Yale
5. Stanford
6. Emory
7. UCLA
8. Mayo - not bad, just not a good fit for me at all
I was so torn between Iowa and Virginia - if I get either one I'll be SO happy. UW would also rock. At least it's now out of my hands
Aubrey
1. UVA
2. JHU
3. UNC
4. Duke
5. B&W
6. MGH
7. VCU
miko2005
#1 Stanford
#2 UCSF
#3 UC Davis
Emaline
1. UVM
2. UNM
3. UVa
4. Iowa
5. U of Wisc
6. Utah
7. MUSC
8. Colorado
(did not rank Emory or OSU)
Bio-psy
1. Wake Forest
2. MUSC
3. UVA/MCV
4. East Carolina
5. UT Knoxville
6. MCG
7. ETSU
8. Emory (great program but don't like Atlanta)
9. UFL
10. EVMS (program sucks but still probably better than scramble)
NikRiveria
1.MGH
2.BIDMC
3.Yale
4.NYU
5.cornell
6.einstein/montifore
7.Mt.Sinai
Janedough
1- mayo
2- UVA
3- Cleveland Clinic
4- Vanderbilt
5- Dartmouth
6- U of MI
7- Yale
8- Iowa
9- Wash U
10- Beaumont (safety)
11- Wayne (safety)
Ohio- unranked
BamaAlum
1. Vanderbilt- overworked resident myth grossly misreported
2. Emory- loved it. Awesome program if you can deal with Atlanta
3. UAB- some of the nicest facilities I saw, tons of surgicals and very strong on the CP side
4. MUSC- The people there are just so darn nice I couldn't rank them lower than this
5. MCV- Again, the people were nice. Seemed like a solid program.
6. Florida-Gainesville- Medium sized program in college town.
7. UTSW- Didn't care for Dallas much.
8. Cleveland Clinic- Tons of surgicals, which may be good or bad depending on your take. Cleveland is colder than a mother..
9. Iowa- Great program, nice residents and faculty. Only downside for me was that it was in Iowa
ChipLeader
1. U Washington
2. Duke
3. UCSF
4. Hopkins
5. Stanford
6. UCLA
7. BWH
8. U Utah
9. U Colorado
10. UTSW
11. UNC
Dr Plum
1. Duke
2. UVa
3. Hopkins
4. Brigham
5. Mayo
6. UNC
7. Emory
8. UAB
Star123
1. Univ of Florida - Shands
2. UNM
3. Med Coll of Wisconsin
4. Iowa
5. Evanston
6. Northwestern
7.Nebraska
8. Emory
Interviewed but didn't rank: St Joes in Phoenix, Vanderbilt, Creighton, OHSU - Portland
Invited for Interview but Declined to interview: Penrose, Hershey, UVA, UCLA, UW, Rush, MUSC
CameronFrye
1a. UVA
1b. Michigan
1c. Hopkins
1d. BWH
Tidal
1. Mt. Sinai- GIGANTIC volume, big name, residents literally walk into any fellowship they want (including derm!!!)
2. Columbia- Great for research, laid back environment, nice facilities
3. MGH- Big volume, big name, similar to #1 but not in NYC
4. Cleveland Clinic- Big volume, great job placement, terrible winters
5. Hopkins- Nice volume, good reputation, Baltimore sucks (sorry!!)
6. Yale- OK volume, OK residents, I'd be OK if I matched there
Kaw
1. UVA--they are taking 5
2. Emory
3. UNC
4. Duke
5. Vermont -- was really impressed by this program
6. MUSC
7. MCV
8. Maryland
9. Brown
Declined offer by NIH -- though very enticing
Tappa
1. BIDMC
2. MGH
3. BWH
4. BU
5. Tufts
6. UMass
jsheokhan
1. U maryland
2. UTSW
3. Baylor Houston
4. Methodist Houston
5. UPMC
6. UTMB
7. NYU
8. Northwestern
9. OSU
10. Drexel
Torurismo
1. Cleveland Clinic
2. Wash U
3. U Chicago
4. Mt. Sinai (not in the midwest)
5. BWH (not in the midwest)
6. Michigan
7. Columbia (not in the midwest)
8. Case Western
9. OSU
10. Pitt
Not ranked: Cincinnati and Northwestern
AznDragon
1. UTSW
2. Baylor-Dallas
3. Baylor-Houston
4. UT-Houston
5. Emory
6. Iowa
7. Wash U.
8. SLU
9. Oklahoma
10. KU
11. U of Missouri-Columbia
12. Methodist-Houston
Rustio
1. Penn
2. Hopkins
3. Emory
4. UCSF
5. UCLA
6. UAB
7. U of Utah
8. Stanford
Mr Plow
1. OHSU
2. UNM
3. U of Utah
Mudbug
1 Iowa
2 Northwestern Evanston
3 UVM
4 Michigan
5 Dartmouth
6 Med Coll Wisconsin
7 Minnesota
8 U Mass
9 Baystate
10 U Chicago
11 Mayo
12 U of Illinois
unranked: Loyola

HappyPanda
1.U Chicago
2.UTSW
3.NYU
4.Methodist Houston
5.UT Houston
6.Case Western Reserve
7.UMass
8.U Colorado
9.U South Florida
10.UMDNJ
11.Hartford
12.Med Col Georgia
SLK
sorry for the late post.
1, Mt Sinai, NY
2, Baystate, MA
3, Metro, OH
4, KUMC, KS
5, NYU, NY
6, UWisc, WI

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Wednesday, February 22, 2006

Englishpod 57

Vocabulary
to make good impression/impress someone
to dress appropriately
to be decisive
in what context
that could be a disaster
to keep something in mind
an half hour conversation
creative
to come up with an idea
I'd like to be given a choice
nuts
generally speaking
Seriously
Tend to
I am not so sure about that
I quite like that idea:
You agree with: Wow~
When you are confused, then ask: Regarding what?

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Tuesday, February 21, 2006

Rank Order List

Tomorrow is the last day of submitting rank order list. Many program directors and also applicants became panic. PDs tried to sell their reserved prematch slots, while applicants are struggling to make the best bid. Some applicants are even expecting good prematch!!

List programs with "Rank you" letter/call from PD.
New York University pathology residency program
Methodist pathology residency program
University of South Floria pathology residency program
University of Kansas Medical Center/KUMC pathology residency program
Medical Collage of Georgia pathology residency program
Dartmouth Medical School pathology
University of Wisconsin pathology
Cornell University pathology

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Monday, February 20, 2006

The 1000th visit.


Finally the visit reached 1000.

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Sunday, February 19, 2006

USCAP 2006 pathology Job

by Yaah at SDN

I just got back from USCAP 2006 in Atlanta (not that I would really have noticed if it was in Atlanta other than that is what the airport and the local tv stations said it was since we barely left the two block area around the hotel). It was interesting and I am glad I went (was there sunday-this AM).

Thoughts:

1) Went to the house staff seminar on sunday night. It was a panel of private and academic pathologists and a recently graduating resident. The consensus: Employers are looking for people who have some extra training (like a cyto or hemepath fellowship) but not TOO MUCH extra training. More than two fellowships is actually frowned upon and employers start to wonder what your problem is. As usual, doing a dermpath fellowship is the most desirable currently but almost any fellowship will give you a leg up (except for microbio, chem). Private jobs are starting out in many places well over $200k, academics $120-140k. But the real numbers are not actually available and a lot of it depends on variables like whether they pay your malpractice, benefits, etc. In short: There are enough jobs out there and opportunities are apparently increasing.

The importance of the surgical pathology fellowship was emphasized, as the impression is growing among employers that residents are not as well trained in basic competencies as they were in the past and now require more hand holding at the start.

You can see the handouts for free online at www.uscap.org - look at the "evening specialty conference handouts" under house staff.
1.What Employers Are Looking For - Fred G. Silva - Executive Director, USCAP, Augusta, GA
2.What Employees Are Looking For - Carol Farver - Cleveland Clinic, Cleveland, OH

They also specifically addressed the "path mill" type jobs and said the current prevelance of these jobs is still under 5% of the total jobs around the country, and the CAP and other organizations are actually actively lobbying to decrease these jobs and encourage people not to take them. Dr Silva and others said that it is unlikely these jobs will become commonplace.

The main factors important to employers which are often overlooked are "Interpersonal skills" and "Communication skills" as well as the ability to work with others. If you do well in residency and get good references from your attendings, this will have a large impact on your job search success.

2) Lots of good specialty conferences. I attended the long course yesterday on liver/pancreas and thought it was pretty good. Also attended a lot of poster presentations, platforms, and specialty conferences at night. The highlights I think were seeing Rosai present a case presentation (he looks old but moves fast- he blew by me at the poster presentations and obviously can still move quickly ) and the GI conference on tuesday night. It included 5 case presentations, two of which will be long remembered - John Hart from U of Chicago presenting a case of Behcet's disease and being very liberal with his use of the term "scrotal ulcer" and Appelman presenting a case of solitary rectal ulcer syndrome in a weightlifter which was the highest of high comedy.

3) I got to present a poster and it was a great experience - got to talk to lots of great GU pathologists and others from around the country. They also had a session every morning from 7-8am where they had food for housestaff and the opportunity to meet well known pathologists and chat, which people did not take advantage of. Another local resident and I went M-W and were nearly the only ones there. We also got taken out for dinner last night by three attendings from our instutitions which was neat. Then they bought us drinks at the bar.

USCAP is busy - there are events from 8am-9:30pm every day and multiple events at each time. Never a shortage of things to do.

4) There were about 10,000 posters about EGFR and P16.
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One interesting thing at USCAP was also to notice which programs have lots of posters and platforms (especially with residents presenting). We had quite a few and I think we in top ten, according to attendings, but there was no actual list. But in going through the posters every day it was pretty clear that there were a couple of programs that were just swimming in abstracts. Cleveland Clinic, for one (Goldblum's name was on about half of them!). JHU was well represented. The most surprising was Wayne State. It was insane. Seemed like in some sections every other poster was cleveland clinic or wayne state.
======================
I just got back from the USCAP conference last night. It was a great week and I hope I get to go next year! It was amazing to see all of the posters residents presented and to listen to the platform presentations. Some programs really crank out the research. My program was also suppose to be in the "top 10" of abstracts accepted, but I have no idea where we really ranked.


Yaah was right when he said that there were a lot of good specialty conferences. I went to the long course on Wednesday and to some short courses on Thursday and Friday. The one on the non-neoplastic bowel was great!

It was a very busy conference with something going on all the time. I was lucky that my program will pay for the whole week if you present a poster. Now I just have to wait to be reimbursed. It was expensive conference to go to on a resident's salary.

Maybe next year some of the SDNers can get together!

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Friday, February 17, 2006

Advertise my site for 2nd time

Basicly, I followed the suggestions of Biz Stone's classis article.

I registered or submitted my Dr. SLK and ZhangLab to several blog promoting sites,

The following sites have been registered with my blogs, so you will find the links on the bottom of the left side navigation bar.
Again, writing good posts is the only best way of your blog's adivertisement. Best luck with your blogs' traffic.

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The 888th visit.


The 888th visit was made today.


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Sunday, February 05, 2006

cons of path

- Being pestered by clinicians:

Point #1: A pathologist is the doctor's doctor.
Point #2: Doctors are the worst patients.

- As for call, regardless of the call, call is call. Call blows. Home call is nicer than in house call but what sucks about home call is that some calls will require you to get your ass back into the hospital. That sucks. That being said, clinicians have it worse than the pathologists, generally speaking. Clinicians take call more often. And it's in house call. Clinicians also get more calls when they are on call and I feel for them. But that's their problem...and why I went into pathology. I don't like my pager. I am tempted to destroy it.

- Medicolegal issues - pathologists too have to carefully word things and document the stupidest of things just so that it doesn't come back to bite them in the ass later.

UCSFBound
Inappropriate usually consists of an intraoperative consultation that will have absolutely NO IMPACT on what they will do during that surgery.

For example, I received a frozen on a lymph node for a renal cell carcinoma. Reason for said frozen: hem-onc wants to plan course of post-op treatment (said they get more of drug x if the node is positive). Didn't change a damn thing surgically, in fact they were closing when I reported it back 10 minutes later (I at least figured they would take some more nodes, but they already had those out when they called). I have run into many surgeons who do not use the frozen results to manage their patients intraoperatively, rather, they like to have a diagnosis for their patient when they see them that afternoon in recovery.

I think the worst is when your attending will read these non-sensical frozens. I remember talking with a surgeon when I first started in July for like 5 minutes about why he was getting this thing, only for my attending to cave and allow it (and telling me that there is no reason for this). It makes it hard to tell the surgeon "inappropriate" when your attending wont back you up.

Angrytesicle
Word up man. Regarding your renal cell carcinoma story, I experienced an identical event this past Friday. Surgeon wanted a diagnosis on a metastatic RCC to a lymph node in the chest wall. The diagnosis we gave him was "consistent with metastatic RCC." What difference did this make in surgical management? None. I suppose that if the lymph node was negative for tumor, he might have dug around a little more. However, based on reading pre-op notes there were no other suspicious lesions except for this enlarged node. Doing the frozen was easy. But having to stay in the hospital just for this one case was the difference between me going home at 6 pm versus 8 pm. Wasn't very thrilled about this

Yaah

And in addition, diagnoses are more appropriately made with fixation and the time taken for good histologic sections. The frozen is basically a throwaway that is only glanced at during the real signout, and only to make sure nothing weird showed up on the slide that wasn't on frozen. The unfortunate thing is that if it is a small lesion (like thyroid or something) the bulk of the lesion is on frozen, and the final diagnosis becomes that much more difficult.

This is why breast frozen section has mercifully become much less common over the last few years. Surgeons have been taught now that doing a frozen on breast lesion destroys a lot of margins and diagnostic tissue.



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Academia Pathjob

PathDawg
The bottom line is this kids: Academia is not about learning and pursuing a higher level of understanding. Academia is about money and politics. If you are a "bread and butter" good diagnostician, you can get a job in an academic center; its just that you'll never progress within the department.
My first job in pathology was at an academic center. It was more than obvious that unless you brought in serious NIH money, you were ignored. The powers that be see diagnosticians as "necessary evils". If you want to pursue a career as a diagnostic surgical pathologist (and want to progress as you get better and more experienced), then private practice is the place for you.

LADoc
Academia is about becoming one with an evil leftist empire that threatens all of Western civilization. Until we all make the same crap salary they do and drive eco friendly cars while eating vegan sprout wraps and drinking organic farmer friendly coffee, they will never rest. They seek to destroy all that is good in the world in the name of cloning furry animals (err or lying about cloning furry animals ) and one day creating the holy grail of molecular biology research: the glowing penis. I read somewhere there is a secret feminist research cult that is using taxpayer money to replace all men on the earth and the rise of utopian muffnazi empire. Seriously, they are working on it as I type this.

There are several faculty members at my institution who publish translational/clinical projects with much less than 50% time off service for research.

The problem is a lot of the basic science people they bring on board work two months of the year on service (usually autopsy). It is utterly painful signing out with these people for a myriad of reasons, including the lack of teaching that goes on and their lack of experience due to the fact that they look at cases so infrequently.

UCSFbound
Another issue I have, which has been previously alluded to, is the fact that it is the rare position in academia where you can work strictly in diagnostics and teach. I enjoying teaching, and would like to pursue it in the future, but with the way things are I now have to devote more time to research than I would like to. So, for a person like me, who wants to be a part of medical education, private practice isn't a great option.

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Fellowship

LADoc00
No, for a number of reasons. For one, there are a TON of cyto fellowship positions, probably 2x as many that are needed. And this is nowhere near as marketable as it used to be given that breast FNAs are being replaced by cores from radiology. Pap smears too hopefully will go away with universal HPV screening. So move that down the list.

Now GYN in my opinion is near worthless, gynpath is bread and butter stuff you can get in any solid surg path year. Competition for these fellowships is limited to academic geek types who fantasize about large ovarian masses and endometrial polyps...move that down.

GI is HUGE and up-n-coming. How many solid GI fellowships are there? Maybe MAYBE 6 in the whole US: Odze at Brigham being no1, MGH, BID, UCLA (but their big guy left), Cleveland, Hopkins...the list is slim. And dont bring up UCSF please, that fellowship is 80% liver. Move that one WAY up.

GU is interesting b/c out of the blue this is hugely marketable. Okay realize Im saying "marketable" NOT useful. I can dx anything that someone who spent a year with Epstein can but in terms of marketing myself to urologists I dont have the same leverage, move this way up, there are less GU fellowship slots than GI!!

Overall my list:
1.) Derm, still king
2.) GI
3.) GU
4.) Heme
5.) Cyto
6.) Forensics (can be very competitive at the best places: NM and MiamiDade)
7.) Blood bankTM
8.) BoneSoftTissues
9.) Gyn
10.) general surg path
11.) Lung
12.) Liver (near worthless)
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Angrytesticle
Thanks for sharing your insights...very much appreciate it.

I remember talking to you about derm last year. I really enjoyed my derm weeks and derm is definitely on my radar now. However, I'm certainly more than aware of the competitiveness of getting a derm fellowship and honestly, this is quite unsettling.

And I second your opinion on the GI fellowship. We have a very strong GI fellowship here with Odze at the helm.
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No. But I don't wanna spend the clinical part of my career (as limited and minimalized as it may be) just doing autopsies. Those kind of jobs are not very abundant. I want to be able to sign out cases in some specialty. That way I can have a more stable job and increase my salary. If this doesn't happen, I've wasted my time by going through medical school and I've wasted my time doing a residency. It's all about sound backup plans.

I will say this though...it's gonna be "my way or the highway". If I don't get the fellowship I want for whatever reason, that's it! I'm going straight to postdoc. I'm not gonna waste a year doing some fellowship I have absolutely no interest in (like cyto) just to wait in line for the fellowship I want. For example, this is the case for Heme and Neuro at my program. Spots are booked not just for next year but for future years as well.

There's the musings of a future scientist. How you like dem apples?
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Pathdawg
Ouch, babe. The cyto slam kinda hurts. I agree to a point that there are indeed lots of cyto fellowships. However, cytology is still an integral part of pathology practice, and fellowship-trained people do it better than generalists (and thats not just my defensive cyto-trained self talking). GI path seems to be somewhat in favor, but isn't this bread and butter surgpath too? I also think heme should be higher. My list:
1) Derm
2) Heme
3) Cyto
4) GI (I'll include liver with this)
5) GU
6) TM
7) Bone/ST
8) Forensics
9) GYN
10) Gen. surgpath
11) Pulmonary
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LAdoc
Sorry for the cyto slam, cyto is absolutely a key skill, my issue is there are just way too many cyto trained pathologists nowadays and overall the field is trending away from cyto. Differentiate a fellowship that is "useful" (which cyto would be far and away no1, you see prob. 5x more cyto than derm) from those that are "marketable."

Heme was good, circa around 1 year ago. The reimbursements for flow were so crazy at one point that even small hospitals were buying million dollar equipment packages. It had been that flow was actually reimbursed similar to immunostains, on a per antibody basis. So if you had a rule out panel with 18-20 antibodies (not totally uncommon) at $95 per, you were pulling down $1800 just for the professional component (a negative takes me aroun 20 min to read and write up, do the math on a per hour billing for that)! Then you billed another $65 for the spin adequacy. That was insane money, especially if you could get your hemeoncs to order flow on every marrow and node. People flooded into heme fellowships, got phat offers and then it all changed. Now flow is a gobal fee, so where before you got $1850, now it is $500 or even less. Huge hit. People were saying flow was now even a money LOSER to do as the fees were all capped. Crazy. Anyway, lots of places that were bringing flow on line and hiring hemepath people reversed course realizing it was far more cost effective to send to USLABS/Clarient etc.

I am a hemepath person so Im being frank, I definitely would not have done a whole year of it (I still like hemepath) if I saw the writing on the wall years ago. I think heme will undergo further mass consolidation in the near future to commercial labs like Quest due to fixed asset costs required in building a cutting edge diagnostic hemelab.

*Oh and Neuropath isnt on there, it would be dead last. In fact I highly advise people to not do neuro unless 1.) you are at a very very high volume place 2.) you also do a surg path year/cyto/heme or derm to tighten your skill set 3.) you also do CP as you can see that would be a 4yearAPCP+2NP+1fellowship=7 year plan, which is freakin absurd, hence why it is dead last.
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pathdawg
I'd put neuropath second to last, just before opthomologic path (I actually knew an opthomologic path fellowship trained guy. Is there a less useful fellowship out there? I think not. The only thing they're good for is orienting the one globectomy specimen you get once every ten years).

I am thinking of going back and doing a GI path fellowship, but focused to the 2nd part of the jejunum. This way, I would be sub-subspecialized. If it isn't from the 2nd part of the jejunum, I don't want to even see it. I would know nothing about the duodenum, ileum, rest of the jejunum, liver, or remainder of the GI tract. But if you have a lesion from the middle of the jejunum, I'm your guy. I bet some affected university would hire me, just so they can brag that they have the (2nd part of the) jejunum expert. It would be a sweet gig, too. I wouldn't get paid crap, but I would look at about seven slides a year in consultation. Sweet.
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LADoc
Its ALL about marketing, why do think our large consumer corps spend billions a year on this crap? Why are there multimillion $$$ ads for flipping Viagra during the super bowl? You can argue what is more useful all day long, but at the end of the day the group with the fellowship trained GI and GU people will walk away with the contracts and you will be holding your nuts in your hand and crying for momma. This is the sad and f'd up thing about the path market today. This isnt superficial bro, this is what puts the spam n eggs on your kids plate, makes your Benz payments and pays your employees. i.e. this is the nuts n bolts of real life in pathlandia.

Until the ABP wises up and closes down 50% of the residency programs, the surplus in path will continue to increase already cut throat competition.
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Truth be told, the souless moronic bean counters who make the decisions on granting contracts aren't even sure what "GI" stands for. They don't give contracts based on credentials. They give them based on cost. To them, cheaper=better. Plain and simple. If you can underbid your competitor, you win. This is how the sweatshops like Quest and Labcorp of the world get by. They are mills and they can thus get by with low contracts by producing huge volume.

btw, I agree with your point on cutting the residency spots 1000%. This would greatly increase our earning potential.

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Cyto

Cytology is the "Emperor's New Clothes" of Path.

Everyone around me pretends to see the illusionary enlarged hyperchromatic nuclei. Join me in prayer for the end of pap smears, breast and soft tissue FNAs. They are a scourge upon us.
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You crack me up, man. First of all, I was working up a damn B-cell NHL, not a T-cell angioimmunoblastic whatever. Secondly, heme is waaaaay too unnecessarily complicated. Cyto is straightforward. You follow certain criteria and make a dx without having to cut somebody open. If you think about it, thats pretty cool. With heme, you have to get about 12 IHC stains, then get flow, then get cytogenetics, then get B- and T-cell rearrangment PC-frickin' R studies. WTF! Make a damn call already without spending tens of thousands of dollars. Jeeech.
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From my limited exposure, cytologists tend to be quite fanatical (and also very good) at what they do.

"I trust the cells better."
__________________
Take me out to pasture and shoot me.
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I think it may even vary from institution to institution. Different practices abound. Like here, the pulmonologists and surgeons INSIST on doing bronchoscopies with biopsy for attempted diagnosis of interstitial lung disease, which has a sensitivity of about 5%. The path attendings here say it is ingrained in the culture and they are somehow not swayed by the comments on about 95% of their transbronch biopsies "Tissue insufficient for diagnosis of interstitial lung disease."

At Wake Forest, they diagnose and treat many sarcomas based on FNA only, because one of the attendings there will make diagnoses on them. Breast FNAs are not done commonly here at all. And we almost never see sarcoma FNAs. I think perhaps the future will depend on availability of molecular tests for diagnosis, from tissue obtained by FNA. But who knows.
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Jobs of Path 1

LADoc00 at SDN
The pathology job situation in LA is beyond the pale. Aside from a IED killing most of the LA path society off, you might as well put your head between your legs and kiss your butt off. Realize the absurd number of:
people who want to live in LA, everyone, everyone and their DAMN MOMS TOO.
Massive managed care penetration of Kaiser, you will be a Kaiser biotch in LA, end of story.
The horrendous number of residents churned out down there is crazy, just crazy. UCLA, UCI, USC AND Loma Linda!!! Then the other crew from UCSF/Stanford and Davis trying to break in b/c their own markets are totally impacted. Madness I say.
I would do IM if you HAVE to stay in LA, you will be used/abused in that path scene, it is pure sharks.

When I went to LA path society meeting downtown, I used to have watch my back! There are resident/fellows who would shank me for just half of what I was making. They even have a yearly resident conference where they present cases and then are paraded around on a stage as the PD hope to auction em off to groups who might hire em. Im serious, it was cRaZy, I couldnt stop laughing at these poo' bastards. They might as well just had a big wet t-shirt contest and be honest about it

Goodluck. Play the lottery.
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Yep. The supply is far outstripping demand. The problem you face in any big city is there is massive subset of the medical world who HAVE to live there and thus will take any job/contract/terms put in front of their face, they are:
1.) IMGs that want to stay in near big cities b/c they only can make friends with other people from their own country or they live with freakin grandparents who dont speak english. How they can enjoy marriage/life with grandma listening to you bang your wife has always baffled me.
2.) Women married to men who have jobs in big cities and cant relocate. They often dont have much ambition in terms of salary and for managed care are a wet dream come true, there are Kaiser groups of 8-10 pathologists composed of pure women!
3.) Gays who want to stay near gay friendly areas. Dunno, if I was a gay guy and my choice was 250K more a year or living in West Hollywood next to Trunks, my choice would be easy.
4.) Single women on the manhunt. Often terrified of moving to rural/suburb areas and marrying...God forbid!...someone who isnt rich/high status.
5.) Some URMs, although URMs in pathology are SUPER RARE, not sure why. (This is a very minor component, if at all)

Those factors along with a general oversupply create a Perfect Storm of caca that makes it impossible to find reasonable employment, I would say these are the worst path markets in the US:
1.) Boston - far and away the worst
2.) NYC - also a complete waste of time to even send a resume anywhere within commute range of Manhattan
3.) SF - people dont realize this city is small! And is the fastest shrinking city in the US.
4.) LA
5.) San Diego
6.) San Jose/Silicon Valley
7.) Baltimore
8.) Chicago
9.) Miami
+ Probably lots of New England places Im not familiar with, overall the Northeast US is a complete waste of time.
-----------------------------------------

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Friday, February 03, 2006

PhD to MD

标 题: Re: 恳请大家的建议
发信站: BBS 未名空间站 (Wed Feb 1 20:59:53 2006)

绝对应该去申请转到MD!!!!!我父母朋友的儿子就是先上了一个Ivy League的graduate school,后来因为比较出色就被医学院收进去了(内部申请),现在已经fellowship快毕业了。这对你是天赐良机,如果能把握好,Ivy League的医学院出来前途无量,FMG或一般学校的AMG进不去的residency你就有可能去。和这种良机相比MCAT是绝对值得你花时间的。

发信人: usa521 (nini), 信区: MedicalCareer?
标 题: Re: 恳请大家的建议
发信站: BBS 未名空间站 (Wed Feb 1 20:54:12 2006), 转信
我因为已经在医学校phd了,我现在的学校是常青藤,竞争比较激烈。但是据说第一年或者第二年的phd可以申请md,这个申请是内部申请,可能会比外部的申请好一些,但是还是需要mcat。
我现在phd第一年,应该有充分的时间准备这些,但是投入产出比,不知道是哪个好

发信人: againstwind (逆风而行), 信区: MedicalCareer
标 题: Re: 恳请大家的建议
发信站: BBS 未名空间站 (Wed Feb 1 20:49:27 2006)
1。phd-md竞争非常激烈的,因为可以豁免学费,一般是给顶尖的美国学生的,你事先可以去问一下。学制7-8年,上两年医学基础,然后做研究,然后最后两年临床实习。非常stress的,但是出来非常光明。需要考mcat,因为是医学院的program。医学院一般要求是美国公民,至少也要有绿卡。

2。药剂师10万我觉得不错呀,相对医学生要经过残酷的考试,住院医生培训,生活质量不可同日而语。

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Thursday, February 02, 2006

我也谈谈美国教育zt

送交者: 唐宗宋祖 2006年1月30日15:55:04 于 [教育与学术]http://www.bbsland.com

前面看到几篇谈美国大学教育的文章。我自己也在美国大学教书,学校在100-150之间。有些自己的体会,感觉不吐不快。

我个人认为,其实所谓的美国的“差”学生并不差,也不笨,只是数理和逻辑能力很薄弱而已。(的确很薄弱,跟中国学生比起来,差的太多了。美国教育的传统就是数学差劲)但是如果你根据一个人的数理知识和数理能力来判断他的水平,其实有点舍本逐末了。或者说,一叶障目,不见泰山。

我们自己想想,一个人在社会上的成功和幸福,和他的数理水平到底有多大关系?其实就像卡内基指出的,一个人的成功,不到30%和专业技术有关,70%和这个人的沟通能力,交际能力,个性品质有关系。可能对于纯理工学生来说,专业技术的比重会高些,但也不会超过50%。

如果从这个角度看,美国的所谓“差”学生,其实一点都不差。他们的沟通能力,交际能力,个性品质,其实相当的不错,甚至超过大多数同一档次的中国学生。他们只是数学知识,逻辑推理能力要远远落后于中国学生。

另一点,美国学生相对比较思想单纯,不象中国学生思想会转弯。其实这和智商无关,也不是“笨”。只是美国环境比较单纯,学生不需要那么复杂。况且,大家思想都那么复杂,很多精力都消耗在内斗和互相替防上了,很无必要。

还有一点,就是身体。说老实话,拚tenure,拚科研,拚到后来,就是拼勤奋,也就很大程度上是拼身体,拚意志了。我自己是相当羡慕几个老美教授的身体素质。他奶奶的,我年轻的时候还能几个通宵不睡觉,过了35以后,一个通宵就撑不住了。还好tenure才6年,咬咬牙就拼过去了。

我个人认为,中国教育比较欠缺,比较失败的几点:
1)非常偏重和强调理工,其实最终很容易演化为知识的灌输而已。
2)非常忽视人的个性品质,交际沟通能力的培养。
3)相当忽视体育。
4)学术道德低下。其实这也不单是教育界自己的问题。

美国的高等教育,总体而言,不论是体制,资金和人员素质,远远超过其他国家。美国整体教育的最大问题,我个人认为,是初中等教育太过于自由化,放纵化。以后有机会在聊吧。
---------------------------------
中国教育差最重要的原因是教师不是学生 - paladin 1/31/06 (1)
再挖根子--首要的是制度问题。 - yuan2 1/31/06 (0)
美国逃潦尤颍瑆ithout a doubt! /无内容 - chouette 1/31/06 (1)
对!美国教育的成功在于它的制度--虽然也有问题。 /无内容 - yuan2 1/31/06 (0)
是那么回事!同意本文的观点。 - yuan2 1/31/06 (0)
Well, american students are better in math. - usedpen 1/30/06 (1)
the problem lies in teachers, not students - paladin 1/31/06 (0)
No wonder you are in 100-150 tier school - kayakar 1/30/06 (1)
what's the use of good math if you 一个通宵就撑不住了? - kayakar 1/30/06 (0)
老美学生的数理差,是有历史传统的 - 老陶 1/30/06 (3)
本来一个国家的强大本来根本就不需要那么多懂数理的人 - paladin 1/31/06 (2)
Graduate Entrance Exam fails how many in China? /无内容 - yaubei 1/31/06 (0)
您这是短视行为,连老美现在都不会这么看 /无内容 - 老陶 1/31/06 (0)
“中国人数学好”不过是一种stereotype,是填鸭填出来的。 - prn 1/30/06 (4)
你是填鸭填出来的,别以为别人象你 /无内容 - yinyue 1/31/06 (1)
难怪这么阴郁呢。是不是太把自己当回事儿,而学生又太不 - prn 2/01/06 (0)
kind of agree - dothis 1/30/06 (0)
锟斤拷锟斤拷同锟斤拷 - dothis 1/30/06 (0)
俺认为美国学生数学根本不差 /无内容 - 职业 1/30/06 (4)
你教过他们数学吗?没有的话别乱说了。 /无内容 - 分析几何 1/30/06 (1)
俺指导俺孩子的数学,现在,发现他们很深的 - 职业 1/30/06 (0)
美国大学生在各方面也就象中国高中生水平 /无内容 - yinyue 1/30/06 (1)
那是因为够了,到研究生时再钻研就可以累。。 /无内容 - 职业 1/30/06 (0)
大多美国学生连英语作文都不行,唯一行的就是口语 /无内容 - yinyue 1/30/06 (4)
大多数中国学生的中文作文也不怎么样。 - prn 1/30/06 (2)
我在这碰到的很多中国留学生连中文口语都不行。 - prn 1/30/06 (1)
那是因为他们从来没说过真话,写过真文章 /无内容 - 职业 1/30/06 (0)
那是因为他们的写作在大学才教,但足够累 /无内容 - 职业 1/30/06 (0)



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Scramble 3

"Phone Interview with the Program Director"


Usually, 24 hours after the match results are posted, a list of the programs that did not fill all their positions become available to registered candidates only. You will be notified on "Unmatch Day," the day before Match Day.

Are you sure the specialty you chose is still what you want? You have about 24 hours to reconsider and convince the program director on your phone interview. Another important consideration is your geographical flexibility. If you are flexible, you can be confident you will have a reasonable chance at the Post Match Scramble.

If you are one of those unfortunate few, listen to the advice from your Dean of Students and remain calm and attack the Post Match Scramble in an orderly manner until you secure a position. If you do not have a Dean or somebody familiar with the complex process then plan ahead and retain professional guidance early.

Beginning at 12 noon (EST) on Unmatch Day, unmatched applicants and unfilled programs begin the laborious process of contracting for positions.

In order to be prepared you need the following:

1. Fax Machine and Email Account ... critical ... your future will depend on a these tools (fax your CV, PS, LORs, Dean's Letter, ECFMG Certificate, transcript, picture)

2. Professionally prepared Curriculum Vitae ... they don't use ERAS after the Match!

3. Letters of Recommendation ... should be written in an Americanized format

4. Medical School Transcript

5. ECFMG Certificate

6. A flawless, and well written Personal Statement

7. Dean's Letter ... this is usually at least a 3 page comprehensive letter

8. Universal Application for Residency if the program asks for it

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scamble 2

USMLE post match scramble is an important and free process for International Medical Graduates (IMGS) in which all those who have been unsuccessful in obtaining a match for their residency can apply for the unfulfilled positions. The list of these unfulfilled positions is usually posted on NRMP website (http://www.nmrp.org/) two days prior to the posting of the final match results. In 2005 this will be 12:00 noon, Eastern Time in the United States, on Tuesday, March 15, 2005 and will last from noon on March 15 to noon on March 17, 2005. In these 48 hours the online USMLE Post Match scramble process usually transmits thousands of documents.
The USMLE Post Match scramble involves three different organizations: 1. MyERAS, operated by the Association of American Medical Colleges ERAS; 2. The National Resident Matching Program (NRMP, or "the Match") NRMP; 3. Your ERAS Crew at ECFMG, your designated Dean's Office ECFMG. Any applicant who has not matched can apply for USMLE Post Match scramble. IMGs must have their passing results for all required exams reported to the NRMP in time to participate in the Match, but they do not have to be certified prior to the Match in order to participate. To participate in USMLE Post Match scramble and to increase your chances of getting a match in the USMLE Post Match scramble, one should apply as soon as the list of unfilled positions has been posted at http://www.nrmp.org/ at 12:00 noon, Eastern Time in the United States, on Tuesday, March 15, 2005. This is also the site where the final Match results will be posted 2 days later. You may apply to any program that has an unfilled position. If you have applied to a program earlier then let them know that they already have your application, and ask them to take another look at it. You cannot re-transmit your application.
In case you did not register with the Match, you need an NRMP / AAMC ID and a password to gain access to the list of unfilled positions. Ideally, you will have contacted a few programs in advance to find out whether you should apply, and how each program wants to receive your application. Since it will be difficult to reach the program directors and receive the answers you need during the USMLE Post Match scramble, the following method is considered to be the most appropriate:
1. Add up to 30 programs to the list of programs to which you have applied 2. Try to follow up with these programs by phone 3. If a program prefers to receive your application by fax, you can still fax your application to them.
You may apply to a maximum of 30 programs during the two-day USMLE Post Match scramble.
There is no charge for applying to programs during the USMLE Post Match scramble. However, to release your application, you must complete the payment process, even if the amount due is zero. Any programs to which you apply after 12:00 noon, Eastern Time in the United States, on Thursday, March 17, 2005 will be charged at the regular rate. For more information, see ERAS 2005 Application Fees on the AAMC ERAS website.
On Thursday, March 17, 2005, at 1:00 PM, the results of the Match will be announced.
One should always consider USMLE Post Match scramble as there are some programs that participate in ERAS, but not in the Match and vice versa. Although the list of such programs is not readily avaiable, it is better to increase your chances of getting a residency by exploring all the options including this USMLE Post Match scramble. You might have to appear for interviews in some programs even in USMLE Post Match scramble process but that depends from program to program and the program directors will be in best position to tell you.
You can make changes or update your application before the USMLE Post Match scramble only till the extent the software will allow you to change. You may change the information in MyProfile and you may reassign personal statements and Letters of Recommendation.
Throughout the season ERAS crew checks your files, on a daily basis, for any new information that would require an updated ECFMG Status Report to be transmitted to the programs. That new information could be a USMLE score or issuance of an ECFMG Certificate. Once a new Status Report has been created, based on any of these conditions, it will be transmitted automatically at the end of the day. There is nothing you need to do. During the two USMLE Post Match scramble days, ERAS crew will login to the ERAS PostOffice several times each day to retrieve your document assignments and program lists. They will process those lists and transmit your documents shortly thereafter.
----------------------------------------------------------------------- List of things to do to prepare yourself appropriately for the USMLE Post Match scramble ----------------------------------------------------------------------- During the 48 hours of the USMLE Post Match scramble, there is no time for manual processing. Your file must be ready for automatic processing by our system before the USMLE Post Match scramble begins.
That means:
1. At least one week before the USMLE Post Match scramble, you must apply to at least one program.
2. If you are planning to apply during the USMLE Post Match scramble only, you must still apply to at least one program about one week before the USMLE Post Match scramble.
3. You must also make sure that all of your documents have been received and assigned, so that ERAS can attach and transmit them before the USMLE Post Match scramble.
4. If you are sending ERAS new or replacement LoRs, they must have them one week prior to the USMLE Post Match scramble, so that they have time to attach them. If you have a new, additional LoR, assign it to one of your original programs. This gives them time to attach it before the USMLE Post Match scramble. During the USMLE Post Match scramble ERAS will not have time to do it.
5. If you are sending ERAS a replacement LoR from the same writer, attach a note to it that reads, "This replaces the previous LoR." Otherwise, ERAS might mistake it for another copy of the one they have already scanned and discard it without scanning. After that, your file is ready for the USMLE Post Match scramble.

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Scamble -1

Official Timeline
February 22, 2006
Late Registration Deadline
Rank order list certification deadline
Applicants and programs must certify their rank order lists by 9:00 PM eastern time. Staff will be available to answer your questions during the final deadline hours. CERTIFIED applicant and program rank order lists and any other information pertinent to the Match must be entered in the R3 System by this date and time.

Monday, March 13, 2006
Applicant matched and unmatched information posted to the Web site at 12:00 noon eastern time.

Tuesday, March 14, 2006
Filled and unfilled results for individual programs posted to the Web site at 11:30 am eastern time.

Locations of all unfilled positions are released at 12:00 noon eastern time. Unmatched applicants may begin contacting unfilled programs at 12:00 noon eastern time.

March 16, 2006
Match Day! Match results for applicants are posted to Web site at 1:00 pm eastern time.
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Plan of The Game

1. Have the following equipment available: two or even better, three phone lines, cell phones will do fax machine; computer with high speed internet connection a couple of friends who will help you to call the programs frozen lunches or a friend ready to bring some from the nearest McDonald's
2. Get the unmatched programs list
3. Call, e-mail and Fax your application as fast as you can, so you are ahead of others

What you should expect on that day
1. Monday from about 9 AM CST every future resident in the country is trying to log on to the NRMP. Needless to add - most of them are unsuccessful. The closer it gets to 11 AM, the less chances one has to get there. The web site just cannot handle the load. That's where having a fast internet connection, more than one computer and a couple of friends trying to log on, pays off big time.
2. After logging on, you still are three clicks away from downloading a list of unfilled programs. Each click you will have to repeat from 10 to 100 times because everybody else is doing that. What you will see is a "Site is unavailable" page after some time out. My advice - do not give up and start over, use browser "Refresh" to get thru.
3. After getting the list, you have to filter out the information you need: specialty and geographic location. Now you need to compile a list of phone numbers, e-mails and faxes of the programs you want to apply to.
4. You log on to ERAS and apply for 20-25 programs you are interested the most. Save 5 applications for the leads you are going to get from faxing and e-mailing.
5. One of your helpers faxes your application to ALL programs in ALL specialties you consider. I recommend using some fax service like http://jblast.jfax.com/ . You can pre-load your documents in advance. The most important thing - they have lots of phone lines and fax machines trying to deliver your faxes simultaneously. Their service is $.06 per page and it's worth it!
6. Another helper of yours e-mails your application to the programs.
7. You and all other helpers available call the programs.
8. You get a spot if everything went OK!

Everything listed above should be of some help for you just by itself. If you need professional help getting your information before or after the match to as many programs as possible, please see the "IMG Residency Match" and "Post Match Scramble" pages.

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Wednesday, February 01, 2006

Residency-Chinese



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