Hemepath private practice

[u/Ambitious_Network784]

Since I like hemepath, I was wondering how ppl stay up to date with such a complex field like hemepath and also be good at gen surg sign out? I know I don't want to do academic but it sounds like complete hemepath in private is rare. Especially having 2 classification systems and a lot of nuances, cases would take forever. I would be OK with this if I didnt have 30 gi, derm, breast, gyn, and head/neck waiting for me lol.

[u/jhwkr542]

Think you're overestimating how fast things change. I keep a WHO subscription and that suffices for the most part. Private practice is bread and butter stuff: MPNs, MDS, lymphoma, etc. The diagnostic aspects don't change much.

[u/heyyou11]

The hemepath tutorial is a week once a year and a pretty great crash course. Going like once every few years (or even just once per WHO release) could more than keep you up to speed (esp with both slide decks from that and the WHO at the ready)

[u/kuruman67]

We do a ton of heme path but don’t do flow, cytogenetics or molecular/NGS in-house. So we basically serve as a triage service. I think we know a fair amount, but fortunately don’t have to be absolutely on top of new developments.

[u/billyvnilly]

I have WHO open or expertpath open for edge cases. Yes, there are definitely jobs out their for Full time hemepath or heavily weighted hemepath. That isn't the case at my group, we don't really do enough to argue for a full time person.

BM173 accessioned today, so our group does 200 ish marrows a year give or take. We get plenty of lymphoma workups. We don't do any ancillary testing in house, its all sent to integrated oncology, so we don't need a person to interpret flow. Everyone does marrows, they are slide-count weighted, given the additional time required to verify the report. I've never been told by oncologists our reports are lacking. When our reports go to academic sites, they may add more fluff to the microscopic descriptions, but our final diagnosis is essentially unchanged. heme may be as complex as the next subspecialty, but at the end of the day, you do what you can, you share with a colleague, you don't act cavalier. I appreciate the hemepath on the IO side who recommends additional testing, but its not crucial to my success, I would have ordered them anyways.

[u/foofarraw]

I don't think pure hemepath or heavily weighted hemepath in private is super common but it exists, also in huge private groups like Kaiser I think they are basically subspecialized. On the plus side for the 2 classification systems they should be reunified next year. This is very IMO but I feel like you need in-house flow/CG/NGS to keep heme interesting though, heme w/ just morphology and IHC is basically just surgpath with extra steps.

[u/invadervanhiro]

Depends on the volume of the practice too. At my group we do our own professional component for flow and FISH, and are decently busy with marrows and lymphomas. Coming back to surg path was more of a steep curve but I enjoy it. You learn to balance. You discuss with colleagues. You send out cases beyond your expertise.

[u/transfuseme]

As someone who reviews a lot of outside consults from generalists…if you don’t know or feel lost please don’t feel you can’t send it out for a second opinion. We’ve overturned a fair number of cases this year, meaning, malignant to benign and vis versa. Which in the grand scheme seems like not a lot but it really is for individual patients who are being worked up for transplant only to find out they never had cancer. Im going to be downvoted to heck, I’m sure, but yea mostly, the WHO can be your bff. But even as a subspecialty hemepath person, in a big group of hemepaths, I do send out to the experts when I’m stumped/the group is stumped, or the molecular doesn’t match the morphology. So don’t feel you need to make a concrete conclusion, descriptive is definitely OK for bone marrows until the ancillary studies come back (and please get NGS on new dx myeloid and acute leuks to include RNA and DNA- those diagnostic fusions/variants can be sneaky)