Congratulations Residency

Graduate- What Every "New"

Pathologist Should Know About

Employment Decisions!

Elizabeth A. Wagar, M.D.

Chair, Department of Laboratory Medicine

Univ. Texas MD Anderson Cancer Center

Expectations

• Do you have any medical school or undergraduate research experience?

• Have you presented any abstracts?

• Have you published any manuscripts?

• Are you tracking through a specialty area of expertise?

• Have you completed any specialty fellowships?• Have you completed any specialty fellowships?

• Have you identified an academic “mentor”?

• If considering basic research, do you have a PI?

• Do you like to teach? Have you given lectures?

• Will teaching interfere with your sign-out style?

• How much does income vs. achievement contribute to your sense of satisfaction?

The Dichotomy of Academic

Medicine

University School of

Medicine: DeanAcademic Medical

Center Administration:

CEO

University

President

or Provost

Dept. of Pathology

and Laboratory

Medicine

Chairman: Reports to the

Dean for academic affairs

Chairman: Serves as Clinical

Chief for the Department,

reporting to the medical staff

organization for clinical affairs

The Pathology Faculty Member

• Will have an academic appointment

(typically professorial)

• Will be a member of the medical center

Medical Staff organization (if performing Medical Staff organization (if performing

clinical service)

• May have an additional administrative

appointment (medical director)

Appointments

• Clinical Instructor (typically not a full

professorial appointment, can be a

“stepping stone”)

• Assistant Professor (4-7 years)• Assistant Professor (4-7 years)

• Associate Professor (4-7 years)

• Professor

• Voluntary professorial titles (institutions

outside of the university)

Tenure vs. Non-Tenure

Appointments

• Tenure typically indicates a basic research commitment, teaching but will have some privileges in addition to tenure (academic senate membership)membership)

• Non-Tenure (Clinical) indicates a commitment to scholarly activities, translational research, educational activities related to clinical appointment

• Either category will have an academic review process

A Typical Academic Offer…

We are pleased to offer you a position in the

Department of Pathology and Laboratory

Medicine:

• Academic Appointment: Asst. Professor, • Academic Appointment: Asst. Professor,

Clinical Track

• Administrative Appointment: Asst. Medical

Director, Transfusion Medicine

Both appointments will report to the Chair.

Academic Promotion: Clinical

Series

• Promotion from Asst. to Assoc. Clinical Professor: Scholarly work, (5-10 publications), translational research, teaching activities (residents), service (medical director, sign-out sections), local/regional presencesections), local/regional presence

• Promotion from Assoc. Clinical Professor to Professor: Scholarly work (20-30 publications), translational research, teaching activities, leadership in clinical activities, national presence (lectures, research presentations)

These expectations may vary considerably.

Getting Paid in Academic Medicine

• Pay based on appointment + clinical

service

• AP faculty pay (at least partially) based on

productivity (RVUs)productivity (RVUs)

• CP faculty pay based on medical director

status and appointment, some RVUs

(hemepath), other service (committees)

Getting Paid in Academic Medicine:

The First Paycheck

• What are all of these numbers?!

• The X, Y, Z method (X = professorial rate, Y = clinical revenue, Z = bonus)

• May be paid from multiple accounts • May be paid from multiple accounts because of different funding sources (university funds, clinical funds, research funds)

• Feel free to discuss your paycheck with the departmental administrator

Academic Practice Plans

• Most frequent type is department-based

• Larger institutional formats: Mayo, MD Anderson

• Plans manage the clinical revenue, billing, collections, usually with a billing service

• Chair and Practice Plan use clinical revenue to • Chair and Practice Plan use clinical revenue to pay faculty salary

• Chair may have other sources of revenue (e.g. educational funding from the university, philanthropy, Dean’s account, outside consultations, outreach revenue)

What About Research?

• Most clinical appointees perform

translational/clinical research

• May be independently funded or a co-

investigator with another groupinvestigator with another group

• Funding can be philanthropy, NIH, state

• A track record of research is important to

future funding

Research

• Identify a specialty area

• If basic research, work with a recognized

PI

• If clinical research, publish as a resident in • If clinical research, publish as a resident in

an area of interest or specialty

• Be prepared to write or contribute to

research proposals (NIH format)

• Write an NIH biosketch

Teaching

• Volunteer to teach! medical students, residents, laboratory professionals, others

• Use your teaching opportunities to continue to learn as an assistant professor (e.g. pick teaching topics that are less familiar to you so you can review them)

• Determine how to best interface with residents and at sign-out if in anatomic pathologyanatomic pathology

• Understand your IT system so it does not interfere with teaching at sign-out

• Prepare to “take longer” with some clinical service activities

• Ask friendly senior faculty members for examples of didactic presentations so you can develop a lecture style

• Use “rounds” in CP rotations to review microbiology cases, chemistry problems, transfusion medicine review

• Attend Grand Rounds and national meetings

Presentations

• Research presentations should be based

on the research writing outline

(introduction, materials and methods,

results, discussion, references)results, discussion, references)

• Didactic presentations should be

developed for the specific audience

• Always practice your presentation!

Publishing

• First manuscripts should be published with a mentor/PI

• Identify a journal, read the instructions for submission for that journal!

• Write in scientific format, as required by the specific journaljournal

• Review repeatedly with your mentor

• Be prepared for reviewer comments and addressing them in a formal response (if preliminarily accepted)

• Accept rejection, identify what work would strengthen the current manuscript

Publishing

• Notes

• Letters to the editor

• Case studies

• Clinical research (retrospective/prospective)

• Pathology (retrospective/prospective)• Pathology (retrospective/prospective)

• Basic research

• Review articles

• Requested editorials

• Book chapters

• Books

Additional Service

• Every academic environment also encourages service to the community

• Receive some promotional credit for such activitiesactivities

• Should not detract from primary appointments

• Volunteering for charities, participating in local teaching activities outside of the university, serving as science fair judges

Questions?

Elizabeth A. Wagar, MD

Professor and ChairProfessor and Chair

Department of Laboratory Medicine

Univ. Texas MD Anderson Cancer Center

713-792-2934

eawagar@mdanderson.org

WHAT EVERY NEW

PATHOLOGIST

SHOULD KNOW

RICHARD E. HOROWITZ, MDRICHARD E. HOROWITZ, MD

CLINICAL PROFESSOR OF PATHOLOGY

USC SCHOOL OF MEDICINE

ASCP ANNUAL MEETING

LAS VEGAS

OCTOBER 21, 2011

DISCLOSURES

NONE

ARE YOU READY?

CAN YOU DO A FROZEN IN LESS THAN 5 MINUTES?

CAN YOU CUT IN A WHIPPLE WITH LESS THAN 40

BLOCKS?

CAN YOU SIGN OUT 100 CASES A DAY? 200?

CAN YOU HANDLE AN IRATE SURGEON?

CAN YOU RECOMMEND A TEST(S) FOR

CYSTIC FIBROSIS CARRIER SCREENING?

CAN YOU SPEAK AND WRITE CLEARLY?

HOW’S YOUR SPELLING?

CAN YOU CONDUCT A TUMOR BOARD OR AN

INFECTION CONTROL COMMITTEE?

CAN YOU PLACATE A WEEPING MED TECH?

WHAT’S a 401k or a 529 PLAN OR A 501(c)(3)?

THE SOURCES

ADASP CRITERIA FOR HIRING A COMMUNITY

PATHOLOGIST. 2002

APC EXPECTATIONS OF THE WORKPLACE.

2005

KASS ADEQUACY OF RESIDENCY TRAINING.

2007

BRIMHALL CRITICAL SKILLS FOR PATHOLOGY PRACTICE.

2007

TALBERT RESIDENT PREPARATION FOR PRACTICE.

2009

EXPECTED COMPETENCIES - AP

ACCURATE SURGICAL PATHOLOGY DIAGNOSIS

GROSS DISSECTION, DESCRIPTION, SAMPLING

RAPID & ACCURATE INTRA-OPERATIVE CONSULTATION

JUDGEMENT IN ORDERING SPECIAL STAINS & STUDIES

INTERFACE WITH SURGEONS & ONCOLOGISTS

PRACTICE INDEPENDENTLY YET KNOW LIMITATIONS

ADEQUATE WORKLOAD AND TAT

CYTOLOGY INCLUDING FNA

IMMUNOCHEMISTRY

GASTRO-INTESTINAL PATHOLOGY

AUTOPSY PATHOLOGY

AP QUALITY MANAGEMENT

CONSISTENT AP DEFICIENCIES

GROSS DISSECTION, DESCRIPTION, SAMPLING

JUDGEMENT IN ORDERING SPECIAL STAINS & STUDIES

INTERFACE WITH SURGEONS & ONCOLOGISTSINTERFACE WITH SURGEONS & ONCOLOGISTS

PRACTICE INDEPENDENTLY, YET KNOW WHEN TO ASK

INADEQUATE WORKLOAD AND PROLONGED TAT

EXPECTED COMPETENCIES - CP

KNOWLEDGE OF CLINICAL MEDICINE

CLINICAL EXPERIENCE & PERSPECTIVE

INTEGRATION OF LAB DATA WITH CLINICAL INFORMATION

HANDLING CLINICAL LABORATORY CONSULTATIONHANDLING CLINICAL LABORATORY CONSULTATION

TEST INTERPRETATION AND TEST STRATEGIES

BENCH SKILLS IN TRANSFUSION MEDICINE AND COAGULATION

LABORATORY MANAGEMENT

QUALITY MANAGEMENT

INSPECTION & ACCREDITATION STRATEGIES

REGULATORY COMPLIANCE

CONSISTENT CP DEFICIENCIES

LACK OF KNOWLEDGE OF CLINICAL MEDICINE

LACK OF CLINICAL EXPERIENCE & PERSPECTIVE

INABILITY TO TRANSFORM LABORATORY DATA INTO

MEANINGFUL AND CLINICALLY USEFUL INFORMATION

FOR PATIENT CARE

EXPECTED COMPETENCIES – OTHER

MOLECULAR APPLICATIONS IN PATHOLOGY

(IHC, FLOW, PCR, FISH, CYTOGENETICS, PHARMACOGENOMICS, MICROARRAYS, LASER DISSECTION, ETC, ETC)

PRINCIPLES AND METHODOLOGY

INDICATIONS

INTERPRETATION OF TEST RESULTS

SUB-SPECIALIZATION

SURGICAL PATHOLOGY FELLOWSHIP

DERMATOPATHOLOGY

CYTOPATHOLOGY

GI FELLOWSHIP

HEMATOPATHOLOGY

TRANSFUSION MEDICINE

EXPECTED COMPETENCIES – NON PATHOLOGY

COMMUNICATION SKILLS

WRITTEN AND VERBAL

INTERPERSONAL SKILLS

AVAILABILITY, AFFABILITY, EMOTIONAL INTELLIGENCE

PRACTICE MANAGEMENT

CODING, BILLING, BUSINESS

PROFESSIONAL SKILLSPROFESSIONAL SKILLS

COLLEGIALITY, COMPETITION, COMPLAINT MANAGEMENT

LEADERSHIP AND TEACHING SKILLS

COMMITTEE MEETING METHODS

LABORATORY DIRECTION

PERSONNEL MANAGEMNENT, BUDGETING, MOTIVATION

PRACTICE BASED LEARNING

LIFELONG LEARNING & SELF-ASSESSMENT

BEYOND THE LABORATORY AND HOSPITAL

MEDICAL SOCIETIES, COMMUNITY, POLITICS

CONSISTENT DEFICIENCIES – NON PATHOLOGY

COMMUNICATION SKILLS

WRITTEN AND VERBAL

INTERPERSONAL SKILLS

AVAILABILITY, AFFABILITY, EMOTIONAL INTELLIGENCE

PRACTICE MANAGEMENT

CODING, BILLING, BUSINESS

PROFESSIONAL SKILLSPROFESSIONAL SKILLS

COLLEGIALITY, COMPETITION, COMPLAINT MANAGEMENT

LEADERSHIP AND TEACHING SKILLS

COMMITTEE MEETING METHODS

LABORATORY DIRECTION

PERSONNEL MANAGEMNENT, BUDGETING, MOTIVATION

PRACTICE BASED LEARNING

LIFELONG LEARNING & SELF-ASSESSMENT

BEYOND THE LABORATORY AND HOSPITAL

MEDICAL SOCIETIES, COMMUNITY, POLITICS

THE INVOLVED PATHOLOGIST*

IS A PRACTICING PHYSICIAN INVOLVED WITH:

THE MEDICAL STAFF

THE LABORATORY STAFF

HOSPITAL ADMINISTRATION

AND THE COMMUNITY

*PIERRE KEITGES MD AND RE HOROWITZ MD

PATHOLOGIST & MEDICAL STAFF

PREREQUISITES:

COMMUNICATION SKILLS

KNOWLEDGE OF MEDICAL STAFF ORGANIZATION & BY-LAWSKNOWLEDGE OF MEDICAL STAFF ORGANIZATION & BY-LAWS

PARTICIPATES ENTHUSIASTICALLY

KNOWS HOW TO CONDUCT AND CHAIR A MEETING

VOLUNTEERS – ALWAYS SAYS: “YES, WITH PLEASURE!”

ASPIRES TO LEAD THE MEDICAL STAFF

LEARNS GOLF AND DANCING

PATHOLOGIST & MEDICAL STAFF

AGREES TO ACCEPT ANY COMMITTEE ASSIGNMENT

REQUESTS ASSIGNMENT TO SPECIFIC COMMITTEES, e.g. INFECTION

CONTROL, TRANSFUSION, TISSUE

VOLUNTEERS TO CHAIR COMMITTEES

VOLUNTEERS FOR MEDICAL STAFF EDUCATIONAL FUNCTIONS, e.g., VOLUNTEERS FOR MEDICAL STAFF EDUCATIONAL FUNCTIONS, e.g.,

CPCs, ORGAN RECITALS

PARTICIPATES IN STAFF OVERSIGHT FUNCTIONS, e.g., UTILIZATION

REVIEW, PEER REVIEW, JCAHO INSPECTIONS

VOLUNTEERS TO EDIT MEDICAL STAFF NEWSLETTER

PARTICIPATES IN MEDICAL STAFF SOCIAL EVENTS, e.g., DANCES,

GOLF TOURNAMENTS

PATHOLOGIST IN THE LABORATORY

PREREQUISITES:

ABILITY TO PLAN, LEAD, MOTIVATE , ORGANIZE & CONTROL

EMPHASIZE WORKER ACHIEVEMENT

DEMONSTRATE YOUR OWN TECHNICAL EXPERTISE

DEMONSTRATE THE LAB’S INVOLVEMENT IN PATIENT CARE

KNOW YOUR EMPLOYEES BY NAME – THEIR KIDS TOOKNOW YOUR EMPLOYEES BY NAME – THEIR KIDS TOO

THINGS TO DO:

CONSTRUCT AND DISPLAY AN ORGANIZATIONAL CHART

MAKE DAILY ROUNDS IN THE LAB; INCL PM AND WEEKENDS

ARTICULATE THE LAB’S MISSION TO THE EMPLOYEES

MAKE WORK MEANINGFUL AND RELEVANT

PARTICIPATE IN STAFF ACTIVITIES (BASEBALL, DANCES)

PATHOLOGIST AND ADMINISTRATION

PREREQUISITES:

BE THE DIRECTOR, NOT THE MEDICAL DIRECTOR

KNOWLEDGE OF HEALTH CARE ECONOMICS

KNOWLEDGE OF HOSPITAL ORGANIZATION

GOLF & DANCING

THINGS TO DO:

MONTHLY FORMAL MEETINGS WITH ADMINISTRATION

ESTABLISH RAPPORT WITH HOSPITAL CEO, CFO AND COO

PREPARE ANNUAL REPORT

CONDUCT NURSING ROUNDS WITH CHIEF TECH

VOLUNTEER FOR HOSPITAL COMMITTEES & ACTIVITIES

PARTICIPATE IN HOSPITAL FUND RAISING ACTIVITIES

PARTICIPATE IN HOSPITAL SOCIAL AND SPORTING EVENTS

PATHOLOGIST BEYOND THE HOSPITAL

PREREQUISITES:

HAVE A CIVIC, POLITICAL & INTELLECTUAL AGENDA

HAVE A PHILANTHROPIC INCLINATION

THINGS TO DO:

JOIN & BE ACTIVE IN LOCAL AND NATIONAL MEDICAL AND

PATHOLOGY ORGANIZATIONS

OBTAIN CLINICAL APPOINTMENT IN LOCAL MEDICAL SCHOOL

TAKE AMA OR CAP COURSE ON POLITICAL ACTIVISM

VOLUNTEER IN YOUR COMMUNITY SCHOOLS

VOLUNTEER FOR HOSPITAL’S SPEAKERS BUREAU

VOLUNTEER TO RAISE FUNDS FOR THE HOSPITAL

ACGME COMPETENCIES

PATIENT CARE - DIAGNOSTIC COMPETENCE

MEDICAL KNOWLEDGE - APPLICATION OF SCIENCE

PRACTICE BASED LEARNING - EBP, PIP, CME, QA

COMMUNICATION SKILLS – EFFECTIVE X-CHANGE

PROFESSIONALISM – SENSITIVITY, INTEGRITY & RESPECT

SYSTEMS-BASED PRACTICE – LOCAL & NATIONAL

REFERENCES

1. Horowitz, RE. The Successful Community Hospital Pathologist - What it takes. Human Pathol. 29:211-214, March 1998

2. Horowitz, RE. Expectations and Essentials for the Community Practice of Pathology. Hum Pathol. 37:969-973, August 2006

3. Kass, ME, Crawford, JM, Grimes, MM, Bennett, B, et al. Adequacy of Pathology Resident Training for Employment: A Survey Report From the Future of Pathology Resident Training for Employment: A Survey Report From the Future of Pathology Task Group. Arch Pathol Lab Med. 131: 545–555, April 2007

4. Brimhall, BB, Wright, LD, McGregor, KL, Hernandez, JS. Critical Leadership and Management Skills for Pathology Practice. Arch Pathol Lab Med. 131:1547-1554, October 2007

5. Talbert, M.L. et al Resident Preparation for Practice. A White Paper from the College

of American Pathologists and Association of Pathology Chairs. Arch Pathol Lab Med.

133(7):1139-1147, July 2009.

R.E.Horowitz@ucla.edu