Transitioning from pathology
resident to community pathologist
Kimberly W. Sanford, M.D.
Assistant Professor
Virginia Commonwealth University
Objectives
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Discuss recent surveys of graduates and employers
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Discuss changes in community practice over last decade
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Discuss common struggles of new graduates in community
practice
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Pathology residency training
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Key question : Are graduates ready to take full
responsibility of practicing pathology immediately after
graduation?
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Competency and accuracy is not the question
Do new graduates possess full range of skills to function
independently ?
80 % of graduates take positions in community practice
Are the academic centers an appropriate venue to train
residents for community practice?
Kass ME et al. Archives of Pathology Laboratory Medicine 2007:545-5.
Horowitz R.E Expectations and essentials for the community practice of pathology.
Human pathology 2006. 37:969-973.
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Perceived graduate deficiencies by employers
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Grossing of specimens
Managing workload
Maintaining expected TAT
Providing pertinent correlation for surgeon/clinician
Clinical consultation skills
Lab management/administration
Inability to “hit the ground running”
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Changes in community practice over the last
decade
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Increased regulatory guidelines
Increasing workload
Decreasing reimbursement
Radiology guided FNA/biopsy replacing surgical biopsy
Expanding knowledge of medicine
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Immunohistochemical stains
Molecular techniques: PCR, FISH, cytogenetics
Increased request for laboratory testing consultations from
clinicians.
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Struggles of transitioning to community practice
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Acclimating to a new culture
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Meeting patient and clinician demands
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Transitioning to a generalist
Balancing AP workload with lab director responsibilities
Trained in protective academic center
Worries of litigation
Minimal support staffing
May not have collaborative environment
Decreased turnaround time
Maintaining and expanding knowledge base
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Struggles of transitioning to community practice
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Acquiring non diagnostic skills
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Acting as liaison
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Lab staff, clinicians, hospital administration
Lab management/administration duties
Purchasing decisions
Billing and coding for services rendered
Knowledge of health insurance contracts and reimbursement
Local and state politics
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Conclusions
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Academic vs. community practice employers satisfaction
Training takes place in academic centers that function
differently than community settings
Due to reduced residency training a surgical pathology
fellowship is highly recommended for community practice.
Community practice groups are encouraged to develop
training programs and have realistic expectations of new
hires.
Application of training begins at the end of residency or
fellowship program.
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References
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Kass ME, Crawford JM, Bennett B, et al. Adequacy of pathology
resident training for employment. A survey report from the future of
pathology task group. Archives of pathology and laboratory medicine
2007. 131:545-55.
Horowitz RE. Expectations and essentials for the community practice
of pathology. Human pathology 2006. 37:969-973.
Nochomovitz LE. Surgical pathology training. Infantilization, loss of
the authentic experience, and a few suggestions. American Journal of
Surgical Pathology 2005. 29:1665-1671.
Alexander CB. Pathology graduate medical education (overview from
1926 to 2005). Human pathology 2006. 37:923-8.
Horowitz RE. The successful community hospital pathologist – What
it takes. Human pathology 1998. 29:211-4.
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