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? 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 ( ) Changes in body fluid led to the development of clinical chemistry and hematology Rudolph Virchow ( ) 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 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 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 2,500 Avg. # per Program 14.3 Avg % Female 49.7% Avg % IMGs 57.1% AMA FRIEDA, Training Program Survey, 2007 Total # of Residents 2,500 Avg. # per Program 14.3 Avg % 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 Career Options 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 Group67% Multispecialty Group 7% Medical School10% Hospital10% Independent Laboratory 9% Locum Tenens 1% College of American Pathologists Survey, N=940 Type of Practice Solo 7% Pathology Group67% Multispecialty Group 7% Medical School10% Hospital10% Independent Laboratory 9% Locum Tenens 1% College of American Pathologists Survey, N=940

Pathology Workload Mean hours per week48 hrs Surgical Pathology25.0 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 Specialties55 hrs College of American Pathologists Survey, N=940 Mean hours per week48 hrs Surgical Pathology25.0 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 Specialties55 hrs College of American Pathologists Survey, N=940

Pathology Salaries Median Income by Age All Ages$220,000 < 40$180, – 49$230, – 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, – 49$230, – 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 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 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 : Introduction by chair and program director : 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 99 th percentile: 40 Step I and II 99 th percentile: 26 Number interviewed: 68 (14 IMGs) Number ranked: 61

Criteria for Selection Demonstrated interest in Pathology Completion of USMLE Step I with score >85 th 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: To learn more about pathology:

Where to go & What to do next? For information about pathology training and fellowships: assn.org/ama/pub/category/2997. html (FREIDA On Line) For information about pathology training and fellowships: 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: To find out about individual training or fellowship programs:

“To know Pathology is to know Medicine” Sir William Osler