Transitioning from pathology resident to community pathologist

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

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

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 2007:545-5. Horowitz R.E Expectations and essentials for the community practice of pathology. Human pathology 2006. 37:969-973.

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”

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.

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

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

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.

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 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.