General Pathology

Being a general pathologist often means being your own best advocate when it comes to employment, as contract negotiation is variable and navigating a partnership tract can be frustrating. Plus, it comes with distinct challenges such as not always having the answer to one-off questions and spending valuable time finding the answers.

General pathologists must wear many hats and juggle a widely varied caseload consisting of many different specialties. You will be called on to consult on cases from many different clinical specialties, which can be quite challenging at times because there is no room to be weak in a subject. In addition, academic practices may have a subspecialty model of practice, and community practices may look for a subspecialty to contribute an expertise to a group, so as a general surgical pathology fellow it is important to do an “emphasis” subspecialty through electives so you can market yourself as enriched in an area.

There is no fellowship program requirement for general pathology. However, a general surgical pathology fellowship is typically one year and focuses on a wide breadth of anatomic pathology cases. Rotations typically include exposure to many organ systems through tertiary care consult cases, general sign-out or “hotseat,” and electives. It is important to note that a general surgical pathology fellowship is an anatomic pathology fellowship, and therefore it is important to maintain your clinical pathology training from residency when looking for employment opportunities as a general pathologist.

Yes, there is on-call time for general pathologists in medical practices. The frequency and nature of the on-call duties vary widely depending on the practice. For example, some generalists may only have limited on-call duties, such as occasionally dealing with late frozen section cases. Others may have more frequent responsibilities, like being on the frozen section once a week during the day and night, and/or taking weekend call once every 5–6 weeks. A general pathologist requires a broad knowledge base to manage the wide range of medical cases that can come through the door at any time.

The case volume and use of ancillary tests vary among different practices. One practice may see over 2,000 cases a year involving all organs and the use of IHC and special stains, with molecular testing sent out. Another practice might have a case volume of 20,000, with ancillary tests run. Still a different practice could carry a case volume of 10,000 a year, with reliance on specialized testing for complex cases.

Likewise, one pathologist might sign out about 30–35 cases a day, with immunohistochemistry and FISH/cytogenetics available within the organization, and molecular testing usually sent out. Another pathologist might see approximately 45 cases, including cytology, with ancillary tests only sometimes run. Despite this massive variety in case distribution among practices, most modern groups have systems in place to ensure equal distribution.

A general pathologist interacts with every member of the healthcare team—perhaps a conversation with a pulmonologist in the morning, an oncologist in the afternoon, and a neurosurgeon in the evening—and is expected to have a valued opinion for each specialty, in every one of their cases. As a rule, pathologists interact with a variety of specialties, including surgeons, medical oncologists, mid-level practitioners, neurosurgeons, radiation oncologists, radiologists, hospitalists, pulmonologists, and podiatrists. But one pathologist may interact with all hospital administrators, while another may be a pathology point person for spine centers. Specialty interactions may also include breast, genitourinary, head and neck, thoracic, and obstetrics and gynecology.

Yes. The College of American Pathologists (CAP) and the United States and Canadian Academy of Pathology (USCAP).

General pathologists may pair with any of the subspecialties in both anatomic and clinical pathology.

Most general pathologists typically do not have direct patient interaction, and some will tell you the answer to this question is a straight-up “No.” However, others will tell you that they are sometimes present/in the room when radiology or pulmonology do thyroid/lymph node/EBUS FNAs, during procedures to check specimen adequacy, or other specific situations. Again, this all depends on where you are in practice. For instance, while many generalists do not engage in patient interaction, they may still occasionally interact with hospital laboratory staff for a variety of reasons, such as regular bench top clinical testing, among others. Changes to CPT codes for pathology patient counseling may offer more opportunities for direct patient contact in the future.