Pathologist finds niche in blood banking, transfusion medicine
In addition to the scientific aspects of pathology, Melissa R. George, DO, relishes teaching trainees and interacting with patients undergoing apheresis. (Photo courtesy of Dr. George)
Many people, including medical students and physicians, harbor misconceptions that pathologists are unsociable and work only with the dead, says Melissa R. George, DO, who believes she was the only member of her class of some 250 medical graduates to pursue residency training in pathology. A broadly trained pathologist with two primary specialties and two subspecialties, Dr. George aims to dispel such notions through educating and mentoring others and leading by example.
The medical director for blood bank and transfusion medicine at Penn State Milton S. Hershey Medical Center in Hershey, Pa., Dr. George notes that her responsibilities are hardly solitary. She has direct contact with patients who are undergoing apheresis, manages a staff that includes nurses and technologists, and communicates constantly with physicians in other specialties. She also teaches and mentors residents, fellows and medical students.
A 2004 graduate of the Philadelphia College of Osteopathic Medicine (PCOM), Dr. George served a four-year combined residency in anatomic and clinical pathology at Thomas Jefferson University Hospital in Philadelphia. Preferring clinical pathology, she then completed two consecutive one-year fellowships—in hematopathology and blood banking–transfusion medicine at the same hospital. Her allopathic graduate medical training and certification notwithstanding, Dr. George, who is 33, strives to incorporate osteopathic principles into the practice of pathology
Following is an edited interview with Dr. George.
When did you decide to specialize in pathology?
My PCOM classmates and I were introduced to pathology during the first year of medical school, and I immediately took to it. Our pathology professor, Robert M. Fogel, DO, stressed how pathology is at the center of all other medical fields—a discipline that is pivotal to every physician’s decision-making. As Dr. Fogel put it, the pathologist is “the doctor’s doctor.” That really appealed to me.
Why didn’t any of your PCOM classmates choose to specialize in pathology?
While a lot of med students find pathology classes interesting, most don’t see the discipline as a career. Many people think of pathologists as just performing autopsies, which is simply one aspect of the field. Or they think that pathologists are chained to their microscopes. Partly from TV shows such as “Scrubs,” people often picture a pathologist as someone who produces reports and doesn’t like talking to people.
Many med students don’t realize that although we do a lot of lab work, pathologists need good interpersonal skills. As with radiologists, many pathologists don’t deal directly with patients. But pathologists are always on the phone with other physicians and interact in person with many different tiers of staff. We help other clinicians do their jobs. And at academic medical centers, pathologists often teach students and residents.
What’s more, those who steer clear of pathology because they want to interact with patients often aren’t aware of the subspecialty of blood bank–transfusion medicine, which calls for considerable physician-patient contact.
Because there are no AOA-approved residencies in pathology, did you opt to take the United States Medical Licensing Examination (USMLE) rather than the Comprehensive Osteopathic Medical Licensing Examination—USA (COMLEX-USA)?
This is an issue I have very strong feelings about. I did take Step 1 of the USMLE, as well as all parts of COMLEX-USA. But as I began to think about the matter more, I decided that I would not be comfortable at a residency site that does not accept or is not familiar with COMLEX. Academic medical centers that are DO-friendly—such as Thomas Jefferson University Hospital, where I trained, and Hershey Medical Center—do accept COMLEX scores.
I knew that I would not be comfortable at a place that doesn’t place DOs on an equal footing with MDs. I did encounter such bias at times. When I had an audition rotation at one pathology program, people asked me questions I thought were ignorant, such as “Can DOs prescribe medication?” If someone really doesn’t know about osteopathic medicine and is asking out of curiosity, I don’t mind answering the question. But when the question is asked in an arrogant manner that suggests DOs are inferior, I take offense. I knew I would not be happy in that particular program.
What led you to subspecialize in blood bank–tranfusion medicine and hematopathology after your residency?
Most physicians, including pathologists, don’t even think about the blood bank. They seem to assume that blood magically appears for surgeries and lack any understanding of all the effort that goes into the blood banking process. And there is even less awareness and understanding of apheresis—the process of withdrawing blood, separating it into its components, and returning certain components to the patient. It wasn’t until I was a third-year resident that I was exposed to blood banking, and I really loved it. I’m fascinated by immunology, by how blood cells work. That’s also why I subspecialized in hematopathology.
I also like the fact that unlike other facets of pathology, blood banks provide a product rather than just lab results. Blood is considered both a biological agent and a drug by the U.S. Food and Drug Administration and is inspected and approved accordingly. Because I understand the importance of FDA and other regulations and standards, I actually enjoy the details of ensuring compliance. And I take great satisfaction in providing patients a product that can save or improve their lives.
But another reason I served two fellowships was simply to broaden my expertise and enhance my career prospects. Although you can set up a private practice as a pathologist and contract out your services, most pathologists are employed by hospitals or large practice groups. During the economic slump, pathology positions have been harder to come by.
It’s a low-turnover field to begin with. Because the specialty is not physically demanding compared with surgical specialites, for example, pathologists often can practice well into their 70s and even into their 80s if they remain mentally sharp. When the stock market fell and everyone’s retirement savings took a hit, many pathologists who were planning to retire in their 70s chose to stay in practice longer. Because pathologists are retiring later in life, fewer jobs are available for younger pathologists. My four certifications have increased my marketability.