Posted November 4, 2011
Dear Pathology Fellowship Program Director:
As previously noted, the National Resident Matching Program (NRMP) has reported that, in its experience, fellowship areas in which 50 to 60 percent of programs favor a match have tended to ultimately successfully employ a match, but often require another year or two of deliberation. To initiate a match, 75 percent of accredited positions need to be enrolled, though the NRMP allows some initial leeway (while not a firm number, 70 percent enrollment is apparently acceptable).
Based on the initial enrollment survey, five areas were near or exceeded the 50 percent mark by program, so a simple vote was held by program in these areas. Those results are as follows (percentage of programs, not total positions, favoring a match):
Transfusion Medicine: 40%
Molecular Genetic Pathology: 74%
Pediatric Pathology: 81%
The other fellowship areas had already expressed a level of interest below a threshold to warrant participation in this vote. One area of low interest was Surgical Pathology, which includes, of course, many non-accredited programs. The Association of Directors of Anatomic and Surgical Pathology (ADASP) is undertaking an initiative of implementing voluntary guidelines and timelines. The Association of Pathology Chairs (APC) was unsuccessful in a similar effort a few years ago, but the APC Council offers its strong support for this ADASP initiative, and hopes that residents will benefit from it.
From the most recent vote of only the five areas that were near or exceeded the 50 percent mark on the previous vote, APC Council draws the following conclusions:
Molecular Genetic Pathology and Pediatric Pathology support a match at a level that allows us to initiate one for those two areas. In follow up to the vote above, APC staff contacted each of these program directors by phone to determine if they would favor a match in 2013 or 2014. Based primarily on slots already being committed for 2013, sufficient remaining openings do not exist for a 2013 match. While a few of these programs still were not reached by phone (did not respond to calls and messages), the data support a 2014 match in these two areas. The APC Council offers deep gratitude to these program directors for their bold willingness to play a leadership role and, after four years of discussion, take the ultimate step in considering a match - to try it!
Of the other three programs, Transfusion Medicine seems to have rejected a match for the immediate future; for Cytopathology, the vote was evenly split; and for Hematopathology, a majority favored a match. Based on the NRMP experience, then, a match may well be in the future, particularly for Hematopathology, but the current level of support is not high enough to initiate one now.
Undoubtedly, the pathology community is weary of the discussions and votes. But we need to keep in mind the real problem that many of our residents face, which has been the driver of this effort. Some have felt that, for instance, given the positive response in Hematopathology, an immediate additional effort should be made to pursue a Hematopathology match. APC Council firmly maintains the vision that the best interest of the field would be served by a pan-pathology match, but obviously, most areas are not prepared to move ahead at this time. Council has decided to wait until its next face-to-face meeting in January 2012 to consider future recommendations.
For now, we know that no fellowships in pathology will utilize a match in 2013, and we have the exciting prospect of matches in Molecular Genetic Pathology and Pediatric Pathology in 2014. In that regard, we realize a minority of those programs do not favor a match, but we hope that, since a decision has been made, those few programs will reconsider. Obviously, programs must honor any commitments already made for 2014, but the APC Council hopes EVERY Molecular Genetic Pathology and Pediatric Pathology program will otherwise fully participate to quickly give a fair and full utilization of this approach. We ask those few fellowship directors in these areas opposed to a match to participate for the sake of the greater good, which we realize is asking a lot. And we hope all residency program directors and chairs will work with their residents and with these fellowships to make this as smooth a transition as possible, as any such change has challenges.
At last, we will stop talking about it and use it! Many thanks to all of you for all of your important and considered input.
J. Allan Tucker, M.D.
Chair, APC Graduate Medical Education Committee
Association of Pathology Chairs
9650 Rockville Pike
Bethesda, MD 20814