3yr AP + fellowship or 4yr AP/CP ? ? ?

[med2B]

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NEED SOME serious advice (yaah, others...) about my situation.

4th year US medstudent, confirmed i want to do path, no research, good step 1, good LOR, good clinical grades.
Have done elective in dermpath, like it, considering doing it as a fellowship.
Prefer to ending up doing private practice (i.e. no academics).

Decision: 3yr AP + fellowship (1 yr dermpath) or 4yr AP/CP ? ? ?

I mean know people say having AP/CP certification makes you more attractive candidate for jobs etc, b/c you can officially handle calls from both fields. Also, the sheer # of AP/CP slots avail for residency as opposed to just the AP makes doing AP/CP a better gamble in terms of matching.
But at the same time, already having a fellowship right after your 3 yrs of AP means you'd be DONE in 4 years, ready to practice, while the other typical app's just finishing their 4yr AP/CP are looking for their fellowships...

BASICALLY,
** Say your a PD, reviewing applications for the DERMpath fellowship slot you've got. 2 applicants are left among your pool that you've narrowed:
same step scores, same research, same medschool, same residency prgm (you get the idea...the candidates are identical except for AP/CP vs AP),
only difference is that 1 person did 3 yrs AP, while the other did AP/CP in 4 years. Is the PD REALLY more likely to take the AP/CP person over the AP??? Does the CP really make the candidate better for a fellowship in DERMpath, an AP-driven field? 😕

Should I then just shoot for AP programs only then with the plan of doing my dermpath fellowship during my 4th year? 😕

 

[yaah]

Well, this question is best answered by your advisor or someone in path at your school.

At a lot of programs though, AP and AP/CP are equivalent when it comes to the match. Thus, programs will slot out 5 spots, for example, for candidates who are either AP/CP or straight AP. The meat of the residency in terms of what programs need out of residents occurs in the AP fields. CP can function very well without significant resident input, although there are some requirements, like blood banking and heme. If you look at Frieda or scutwork.com, you will see that UCSF, for example, matched 6 people to "pathology" and 2 to "clinical pathology only." And Brigham matched 7 to "AP only and combined AP/CP" because they don't really distinguish between the two. I don't really know of any that have a separate match for AP only.

Programs do ask you if you want to do AP only or AP/CP though. You can always switch from the combined program to a straight AP track. Lots of people do that after a couple of months.

Thus, there are more programs out there that have AP only candidates than it appears. You don't have to go to a huge program. I am not sure how much this is encouraged or discouraged though...In my impression people who declared themselves AP only seemed to actually have a bit of a leg up, although you should ask your advisor about this because I'm not sure.

Dermpath is a tough fellowship to get, and I would say it isn't guaranteed - so I would have a fallback plan. If that fallback plan includes general private practice and does not include research, you might be best advised to do a combined residency. Some say that in the future having the combined degree isn't really going to matter a ton in terms of landing a private practice job in this era of increasing specialization, but that might be wishful thinking. I'll let you know when I start looking for jobs! 😉

 

[SLUsagar]

yaah, thanks for the reply...quick question: you said:
In my impression people who declared themselves AP only seemed to actually have a bit of a leg up

why do you believe so? i assume you are AP/CP....if indeed AP is a leg up, any reason you didn't?

thanks

 

[yaah]

yaah, thanks for the reply...quick question: you said:
In my impression people who declared themselves AP only seemed to actually have a bit of a leg up

why do you believe so? i assume you are AP/CP....if indeed AP is a leg up, any reason you didn't?

To be honest, I didn't think I needed that tiny bit of leg up. I really don't think it makes a ton of difference, it's just that often, some of the more high powered programs often tend to encourage residents to pursue straight AP or CP. Thus, if you come into the interview with that declared, you may seem more confident and definitive in your career plans. Like I said though, I don't think it makes a ton of difference. If you are going to match somewhere it probably doesn't matter whether you are AP or AP/CP.

This was only true with certain interviewers - the proponents of AP only education that I interviewed with often asked me why I was doing combined. Then they would ask my career plans and ask why I would want to do CP. Then I would clarify my career plans and the fact that I don't have my entire future life mapped out, etc.

Don't do AP only just because you think your chances at matching will improve, because that is probably a fallacy. Perhaps all of those who interviewed for AP only were asked similar questions to mine, only "why not do combined? It's only an extra year and it will increase your marketability and you will learn a lot..." A lot of times, programs ask you whether you are applying for AP only vs AP/CP because they will structure your interview to meet with some from both. If you are only doing AP, it's clearly a waste of time to interview with a coagulation pathologist, e.g.. Frankly I kind of thought it was tough to have to decide before even starting residency whether I wanted to do combined or solo. And I was honest in that in my interviews - I hadn't had any CP and wanted to see what it was like. Some people get the false impressions that you have to have this immense knowledge of the field and all of its possibilities before you even start residency. First year residents know squat. Everyone knows this. They just want to know that you know what you are getting into, that you have thought about future career plans, and that you have goals. You can have specific goals if you like, but bear in mind that these are often flexible. There are occasional candidates who have strong biases towards one field or another due to past research or experience, which is fine.

 

[b&ierstiefel]

Well from what I heard on previous posts (they were about a year or more old though), if you wanna guarantee matching, CP is the way to go. Apparently in previous years CP spots didn't fill in some of the more prestigious name institutions.

Also, I heard that the responsibilites on CP don't come close to those on AP. So maybe if you want less responsibility and want to go to a top institution, one can always do CP.

Tangent: Hey PGY-1's and above, by when should I make a firm decision as to do AP vs. AP/CP?

 

[yaah]

Tangent: Hey PGY-1's and above, by when should I make a firm decision as to do AP vs. AP/CP?

The problem with doing CP only is that you are buttonholed. Into an academic career, generally, although there may be possibilities in some blood bank private practice. Most CP only folks are researchers or possibly pharmaceutical company types.

It depends where you go as to when you need to decide. If you go to Brigham, the first two years are identical for AP and AP/CP. All AP. CP doesn't start until year 3. Many other programs have the first year as all AP. So at those programs you really don't have to decide until you are partway through your residency. They may ask you to commit earlier, but you can always change your mind. I would have a pretty good idea though when you start interviewing because, as I said, if you are AP only they won't give you any CP interviews. And almost everyone will ask you whether you are doing the combined and why or why not.

 

[desmangt]

I think that if someone doesn't want academics with research they should definitely pursue AP/CP. If they are interested in a diagnostic academic career, then do AP only + fellowship. If you are interested in a diagnostic/research career, then AP/CP can have its advantages. CP rotations are usually lighter, thus providing more time for research activities while in the program. This is a good strategy if you are still unsure of which type of career you eventually want. Don't blow off CP, cuz you still need to pass the boards, but other academic projects can make major progress during these CP months. If you know for sure you want a diagnostic/research career, I would pursue AP plus work a year in someone's lab. Dermpath doesn't really need CP, but like Yaah said, dermpath is never guaranteed. Employment is the ulimate goal of all this training.

 

[b&ierstiefel]

I think that if someone doesn't want academics with research they should definitely pursue AP/CP. If they are interested in a diagnostic academic career, then do AP only + fellowship. If you are interested in a diagnostic/research career, then AP/CP can have its advantages. CP rotations are usually lighter, thus providing more time for research activities while in the program. This is a good strategy if you are still unsure of which type of career you eventually want. Don't blow off CP, cuz you still need to pass the boards, but other academic projects can make major progress during these CP months. If you know for sure you want a diagnostic/research career, I would pursue AP plus work a year in someone's lab. Dermpath doesn't really need CP, but like Yaah said, dermpath is never guaranteed. Employment is the ulimate goal of all this training.

yeah, me and a couple of friends who are all doing a pathology month were discussing this tonight. i'd say that i have to agree with ya. i'm still debating between ap vs. ap/cp but i'm now leaning more toward ap.

 

[Brian Pavlovitz]

yeah, me and a couple of friends who are all doing a pathology month were discussing this tonight. i'd say that i have to agree with ya. i'm still debating between ap vs. ap/cp but i'm now leaning more toward ap.

I asked this question (AP+fellowship or AP/CP) of the Pathology director in the hospital I'm at, and he said that he would encourage AP/CP and then fellowship. He said that groups will typically want you to also "cover" an area of the clinical laboratories (heme, blood bank) in addition to AP.

I told him that I envisioned myself working in a hospital doing surgical pathology + a subspecialty such as cytology or hematopathology. He still suggested AP/CP.

 

[b&ierstiefel]

I asked this question (AP+fellowship or AP/CP) of the Pathology director in the hospital I'm at, and he said that he would encourage AP/CP and then fellowship. He said that groups will typically want you to also "cover" an area of the clinical laboratories (heme, blood bank) in addition to AP.

I told him that I envisioned myself working in a hospital doing surgical pathology + a subspecialty such as cytology or hematopathology. He still suggested AP/CP.

yeah...AP/CP being only one more year than AP or CP alone...perhaps the benefits outweigh the extra year. One extra year means little to me...I mean it took me 7 years to do medical school.

 

[MS05']

yeah...AP/CP being only one more year than AP or CP alone...perhaps the benefits outweigh the extra year. One extra year means little to me...I mean it took me 7 years to do medical school.

Can you tell me what you can (or rather, what you can not do) if you do only a CP residency? How exactly does this button whole you into an only academic career?

Thanks!

 

[yaah]

Can you tell me what you can (or rather, what you can not do) if you do only a CP residency? How exactly does this button whole you into an only academic career?

Thanks!

It doesn't necessarily limit you to an academic career only. But most private practice positions require multitasking - such as, having board certification in anatomic and clinical path is desirable so that you can provide coverage and support to different areas.

Are you destined to an academic career if you do CP only? Not necessarily. Many people get jobs in pharmaceutical or technology.

The problem is, a lot of CP is automated, and the function of the lab director is often to oversee and troubleshoot. You don't do a lot, at many places. Private practice places are not going to be salivating to hire someone for a good salary who doesn't actually do much with their day, they're going to hire someone who can do other things as well.

Thus, most people interested in CP only have specific research interests and plan that as their career, getting certified in CP so that they can have some function at an academic center.

I guess my point is, if you are planning on CP only, you probably should make sure you know what you are getting into by talking with advisors.

 

[LADoc00]

Im not going to read all the responses. I will just add my 2 cents. IF big IF you are guaranteed a dermpath slot somehow (as in you have it in writing, pure and simple) then CP is not needed. The nature of DP is that you are such a high volume money maker, other scrapers can cover the CP (usually non revenue generating) for you. Think of a giant strip club, at strip clubs they dont have their best dancers working the door or at the bar, they strip constantly and are good at making money doing it!

 

[Doctor B.]

I asked this question (AP+fellowship or AP/CP) of the Pathology director in the hospital I'm at, and he said that he would encourage AP/CP and then fellowship. He said that groups will typically want you to also "cover" an area of the clinical laboratories (heme, blood bank) in addition to AP.

I told him that I envisioned myself working in a hospital doing surgical pathology + a subspecialty such as cytology or hematopathology. He still suggested AP/CP.

Good advice, Brian P. That is the best route to go if you want to do private practice.

 

[b&ierstiefel]

As I've rotated through surg path this month, I've talked to several attendings regarding the AP/CP issue.

Since I'm committed to an academic career involving heavy research, I asked them if people like me needed to do AP/CP. All of them told me that AP/CP is unnecessary if you're going this route and encouraged me to do AP only.

On the flip side, I told them that my understanding of AP/CP was that it was definitely necessary if one wanted to go into private practice. They totally agreed...and it makes sense cuz if you're a path lab director at a community hospital for example, you're gonna need expertise in both.

 

[yaah]

It also depends somewhat on what your research interests are and things like that. I know some residents who are decided on academic careers who do combined residency because they want to learn those parts of CP that they would not otherwise explore. Of course, you could always do electives in things that you wanted to experience (like molecular diagnostics, cytogenetics, whatever). I think people sometimes get a little too caught up in minimizing their residency training - don't forget, if you do AP only that is less $$$ they have to pay you for training. There's nothing wrong with MORE education, in my book. I wanted to do CP to learn things about chemistry, micro, whatever. Call me crazy, call me naive, you can call me whatever you want. But I find it all interesting and I want to explore it. What if something in CP strikes my fancy? What if I can use things I learned in AP and in CP?

The point is, everyone has to decide for themselves. Don't let people talk you into AP (or CP) only if you don't feel comfortable with it. It is, after all, only one more year. And if you're a researcher, this extra year can be used to hone your skills there. And don't let people talk you into combined if that isn't what you need or want. Unfortunately, when you are just applying to residencies it's hard to know - because it feels like you are deciding on your entire future.

 

[GreatPumpkin]

AP/CP is the way to go.

Even in academics it is best to have both. It will make it easier to advance to leadership roles, i.e. Chairman. It would not be easy to be a chairman of a pathology department with no CP experience.

Not to mention it is definately the way to go for if you want to do private practice. Sure you can find jobs in private practice with AP only and Derm, but why limit your opportunites.

 

[b&ierstiefel]

Thing is yaah, when I was considering AP/CP, I kinda felt obligated to feel that way considering everything I heard from talking to some residents and especially reading posts from the more experienced veterans on SDN. However, I never really had a concrete interest in CP related matters. Hence, it was very easy to talk me outta AP/CP.

Given my background and ultimate career interests/motives, almost all of the attendings, mentors, and advisors (granted they're all in academia) I talk to recommend doing the shortest residency training possible. Hence, the medicine attendings, for example, would really push me to do "short track" residency training.

Well, I'm full thrust into application season now. I've told all of the programs I'll be interviewing at that I'm interested in AP only training. Now it's time to do it and pay the consequences 🙂

GreatPumpkin, welcome back! I can certainly appreciate your comments regarding doing AP/CP. I guess this is what it's come to in this age of credential inflation.

Cheers.