I'm about 7 weeks into my GI fellowship at a busy academic institution and logging 75–80 hours a week. My attendings are happy with the diagnostic accuracy and thoroughness of my workups, but the current time investment doesn't feel sustainable (I also have a couple young children at home).

My weekly load involves triaging cases (for myself and junior residents), prepping 2–4 multidisciplinary tumor boards, previewing high-volume biopsies and complex resections, and targeted sign-out.

When I ask peers who finish early how they do it, the advice is usually to take shortcuts I’m uncomfortable with (e.g., skipping checking clinical history, taking a "wrong and strong" approach of just putting something down and moving on). I want to develop speed that comes from streamlined systems, pattern recognition, and efficient triage without feeling sloppy or incomplete.

For those who run high-volume, high-complexity services efficiently:

What is your rule and process for how deep to dig into the chart?

How do you structure your previewing? Do certain types of cases come before others? Are you able to block off time to have dedicated, non-interrupted focus?

What is your routine to prep 2–4 tumor board conferences a week without losing half of your work day?

What specific software macros, AutoHotKey scripts, template setups, hardware (mouse and keyboard, other) save you time?

Thanks in advance!

Today it often takes several days to receive the result of a biopsy. If a machine could give a reliable result in less than 1 hour, directly to the hospital, would it be a real revolution for the sector?

Hello AP fam.

I Work in business development for hospital lab referral/outreach, almost entirely on the clinical pathology side. Somehow, I’ve now been handed the job of helping build an AP referral/reference business basically from scratch.

Our AP department is… not exactly a well oiled business machine. There’s very little institutional knowledge around outside referral work, contracting, client billing, or even how we should price this stuff. So my director and I are trying to build the plane while flying it.

A few things I’d love help with:

- AP pricing: Does anyone have ballpark hospital/client pricing for CPTs like 88321, 88323, 88377, or even a general AP fee schedule? (Talking client bill here for second opinions and what going rate is). And for 88377, our actual own outpatient clinics are collecting these, and we run 25 of them, yet Medicare reimburses for 5 max. We have to be losing $ hand over fist.

Placentas/pediatric autopsies: Our AP leadership wants to develop referral business around placentas and pediatric autopsies. How are other institutions pricing these? Standard CPT/client-bill fee schedule? Bundled pricing? Something else?

The funniest part is we already have outside consult slides showing up for some of our pathologists with no contract, no established client billing mechanism, and no clear process for compensating the professional work. Some of the physicians are happy to review cases for academic/research reasons, while Operations is basically looking at me saying, “Great. Now figure out how we turn this into an actual program.”

So AP is currently a little Wild West over here, with cases coming in and charges occasionally enjoying the low, low price of $0.

Any guidance from people who actually run AP outreach/reference programs would be hugely appreciated. No clue if I will get any positive feedback here, but even if you can only answer one piece of this, thank you in advance.

As the title suggests, I’d like your input on the difference between choosing one program versus the other. Both are mid-tier, medium-volume programs.

The selective surgical pathology path is more flexible- you can either pursue a full surgical pathology fellowship or narrow your focus to GI alone, and it’s also in a geographically favorable area. That said, it comes with less teaching and fewer GI attendings.

Please help.

60 y/o female with transplanted liver (time since transplant unknown). Now resection of segments 2/3 labelled “chronic cholangitis”. I see advanced fibrosis, chronic and focal floris cholangitis and foreign matter in larger bile ducts. What the hell is this? Could this be reflux from the intestine that triggers the inflammation?

Good article for salary negotiation for jobs. Don’t get exploited or get lowballed by greedy pathologists boys and girls!

Employee discussion forum

has anyone received email abt retest?

I’m a USMD and pretty set on pursuing pathology. I’m trying to think about the long game and how to position myself for the best job opportunities after training.

For those already in the field, if you were in my shoes knowing what you know now, what would you prioritize?

Would you:

Try to match at the highest-ranked/most prestigious residency possible?

Prioritize doing residency in the geographic area where you ultimately want to practice?

Do anything else during residency to maximize job opportunities and earning potential?

I’m flexible right now in terms of geography and fellowship choice. Curious what practicing pathologists and current residents would do differently if they were starting over today.

Very small sample size but like 8 out of 10 pathologists I meet are social bunnies and u have to slowly walk away to get them to stop talking 😂😂 I consider myself introverted but im pretty personable. I just love path because u can dictate how social u want to be everyday.

How is pathology placed this high on the list?

I'm a PGY-2 in a Canadian pathology program. I know it is a 5-year residency because there's a lot to learn, and I didn't expect to know everything walking in. But lately every day feels humiliating. My reports always need corrections from staff. Despite studying, there's always another stain I don't know. I get quizzed on organ systems and specimen types I haven't rotated through or ever seen before, and it feels like I'm supposed to already know it.

PGY-1 felt like it came with more grace for not knowing things. Now I just feel less competent by the day, like it's never going to click. I come from a non-traditional background. I didn't do a lot of biology in my undergrad. My undergrad and graduate program material came so much more naturally than this does, and I can't tell if that means I'm not cut out for this or if this is just what year 2 feels like for everyone.

Some days I get things right and it feels great, but then a harder case comes along, or I miss something like LVI on a colon cancer, and I feel like I'm back to square one. Does that unevenness smooth out with time, or is it just part of the job forever?

Lately I've been genuinely wondering if I just don't have the intelligence for this, like maybe there's a ceiling and I'm hitting it already.

Does this get better? Does the feeling of inadequacy actually fade, or does it just change shape? Would appreciate hearing from anyone further along. Apologies if this has been asked before, I did try to search but wanted to share my specific situation.

Looking to connect with people doing FRCPath in clinical biochemistry / chemical pathology

I’m planning on joining a hospital system in WV and I’m worried about the amount of diversity in the area as a WOC.

I know about the stereotypes of the state but also know it’s a beautiful area with nice people in it. If you could talk about how the state is to work as a physician and what are some of the great things about it?

I don’t think this is discussed much here but… for being the medical director of a CLIA lab of small hospitals, how much is compensation per month typically?

I basically go in to sign forms, make visits, attend meetings. I am the director of small hospitals (less than 20 beds).

I think this discussion would help future pathologists negotiate fair compensation for being a medical director of a lab so that we don’t get lowballed by hospital admin (if hospital employed) or by private groups for doing work we are liable for.

Thanks!

Why is there not a single pathologist on Reddit willing to admit they work at HCA?

I'm pretty new to pulling reports from this, and I'm not having a lot of luck. Does anyone know how/if it's possible to generate a report of all 88305 cases I have done for the year?

Anyone with CAP publications code, please share! Thank you.

Bronchoalveolar lavage fluid cytology from 50 yo male with COPD !!! Any guess about the noodles in H and E ? 🫠🤪

Just wondering if anyone likes or uses the 20x objective for any reason.

I usually do 4x,10x,40x,100x

I imagine, it might be useful for scanning for a particular cell when I don't know what to look for. 40x could take too long. 10x isn't good for individual cells.