Transitioning from pathology resident to community pathologist Kimberly W. Sanford, M.D. Assistant Professor Virginia Commonwealth University

Page 2 Objectives Discuss recent surveys of graduates and employers Discuss changes in community practice over last decade Discuss common struggles of new graduates in community practice

Page 3 Pathology residency training Key question : Are graduates ready to take full responsibility of practicing pathology immediately after graduation? 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: Horowitz R.E Expectations and essentials for the community practice of pathology. Human pathology :

Page 4 Perceived graduate deficiencies by employers 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”

Page 5 Changes in community practice over the last decade Increased regulatory guidelines Increasing workload Decreasing reimbursement Radiology guided FNA/biopsy replacing surgical biopsy Expanding knowledge of medicine  Immunohistochemical stains  Molecular techniques: PCR, FISH, cytogenetics  Increased request for laboratory testing consultations from clinicians.

Page 6 Struggles of transitioning to community practice Acclimating to a new culture  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 Meeting patient and clinician demands  Decreased turnaround time Maintaining and expanding knowledge base

Page 7 Struggles of transitioning to community practice Acquiring non diagnostic skills  Acting as liaison 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

Page 8 Conclusions 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.

Page 9 References 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 : Horowitz RE. Expectations and essentials for the community practice of pathology. Human pathology : Nochomovitz LE. Surgical pathology training. Infantilization, loss of the authentic experience, and a few suggestions. American Journal of Surgical Pathology : Alexander CB. Pathology graduate medical education (overview from 1926 to 2005). Human pathology : Horowitz RE. The successful community hospital pathologist – What it takes. Human pathology :211-4.