Brian Datnow, M.D
Clinical Professor of Pathology
Residency Program Director
UCSD
Pathology Interest Group 2012
What % of medical treatment is based on results
produced by the Department of Pathology?
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A 10%
B 30%
C 50%
D 70%
E 90%
Answer
D. 70%
What is Pathology?
• Diagnostic Medicine
• Teaching
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Medical Students
Residents & Fellows
Graduate Students
Fellow Physicians
• Basic & Clinical
Research into
Mechanisms of Disease
AIMS OF PATHOLOGY AS A DISCIPLINE
• 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
Rudolph Virchow (1821-1902)
Originator of modern pathology
theory
Paul Ehrlich (1854-1915)
Changes in body fluid led to the
development of clinical chemistry
and hematology
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MODERN SUBSPECIALTIES
IN PATHOLOGY
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)
Diagnoses in Anatomic Pathology
A Continuing Goal & Major Focus of
Translational Research
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Morphology
Flow Cytometry
Electron microscopy
Immunohistochemistry
In-situ hybridization
Nucleic acid blotting technologies
Genomics
Techniques in Pathology
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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
What and How Long are the
Training Programs?
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Anatomic & Clinical Pathology (4y)
Anatomic Pathology (3y)
Clinical Pathology (3y)
Research Pathology (lifetime)
85%*
10%
3%
1%
* Percentage of pathways pursued by trainees
Pathology Training
Programs
Resident Workload
Avg. Weekly Workload
48.3 hours
Avg. Annual Compensation
$32,000-$56,000
(UCSD $45,000-$56,000)
Avg. Vacation
3.1 weeks
(UCSD 4 weeks)
AMA FRIEDA, Training Program Survey, 2007
Pathology Training
Programs
Total # of Residents
Avg. # per Program
Avg % Female
Avg % IMGs
AMA FRIEDA, Training Program Survey, 2007
2,500
14.3
49.7%
57.1%
Pathology Specialties
(Fellowship Training)
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
Pathology Specialties
(Fellowship Training)
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Forensic Pathology
Hematopathology
Molecular Diagnostics
Informatics
What are the Career
Options for Pathologists?
• 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
• Pathology Group
• Multispecialty Group
• Medical School
• Hospital
• Independent Laboratory
• Locum Tenens
7%
67%
7%
10%
10%
9%
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 Medical
Specialties
College of American Pathologists Survey, N=940
55 hrs
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
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
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
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
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
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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 Pathology
Autopsy Pathology
Cytopathology
Forensic Pathology
Neuropathology
Surgical Pathology
Pathology Disciplines
Clinical Pathology
Clinical Chemistry
Coagulation
Cytogenetics
Flow Cytometry
Hematology
Immunization and Transplantation
Microbiology
Molecular Pathology
Toxicology
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
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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:
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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:
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www.abppath.org
www.pathologytraining.org
www.acgme.org
www.amaassn.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:
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www.pathologytraining.org
www.apcprods.org
www.university.edu
www.medical_school.edu/pathology
“To know
Pathology is to
know Medicine”
Sir William Osler