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Welcome to our first podcast episode, sponsored by the Digital Diagnostic Summit and Lumea! Today our guest pathologists Jonhan Ho, MD, and Swikrity U Baskota, MD, share their top three things they wish they’d know about being an attending pathologist.

Podcast Transcript:

James Thackeray: Welcome to the Ask a Pathologist Podcast sponsored by Lumea and the Digital Diagnostic Summit. The idea behind this podcast is to provide meaningful information and resources to both current pathologists, but also those pathologists just getting into the field early. And what better way to get that content than from pathologists themselves? And so we’re really excited about the guests that we have that we’ll introduce here in a minute.

I am James Thackeray, the head of the Digital Diagnostic Summit and the Chief Commercial Officer for Lumea. And I want to give, like I said, a really warm welcome. We’re so excited to have both of our two distinguished guests here today. I’m actually gonna let them introduce themselves and also introduce our topic. And we’ll kind of go from there. So, Dr. Ho, why don’t we start with you, if you wouldn’t mind introducing yourself. That’d be great.

Jonhan Ho: Yeah. Sure. So my name is Jon Ho. I am the director of Dermpath at UPMC and also the program director of the Dermpath fellowship at UPMC, we have two fellows a year. Been here for about, I can’t do math that fast in my head, I think it’s somewhere between fifteen and twenty years. And it was my first job and maybe it’ll be my last job. You know, who knows? But I also am a heavy in the digital pathology world, do a lot of research, and helped found Omnyx, which is a digital pathology company. And I’m also the founder of KiKo stands for Knowledge In, Knowledge Out. It’s a social platform for doctors.

James Thackeray: Wonderful. Thank you, Dr. Ho. Dr. Baskota, do mind introducing yourself?

Swikrity Baskota: Thank you so much for the invitation. Hi Dr. Ho, nice to see you here. My name is Swikrity Baskota. I’m currently at Columbia University Medical Center as an assistant professor of both cytopathology and surgical pathology. Before this I trained at University of Pittsburgh. I was once a trainee of Dr. Ho. And this is my second year of practice. I am also a part of KiKo as a KiKo25 Group, a group which was founded by Dr. Ho. And I’m also a founder of, which is a website dedicated to helping people get into pathology. It’s great to be here. Thanks for the invitation.

James Thackeray: Oh you bet. Boy, we’re excited about this. Dr. Ho, do you want to introduce the topic that you guys would like to discuss today?

Jonhan Ho: Yeah. So um, you know, when you graduate fellowship and you start your first job, there’s a big, obviously, a big transition that happens but it’s also kind of a perspective shift, and you’ll never be a trainee anymore. And when you become an attending you never become vice versa. When you become an attending you’ll never be a trainee anymore. And when you’re a trainee, you’ll never be vice versa again. So um, that flip happens very quickly and when you change sides, ah, it’s very valuable because you can be like “Man, I wish I had known this. Or these are the things that I never thought about before.” And so I thought, it’d be very interesting for new attendings and old attendings, like myself. New attendings like Swikrity, Dr. Baskota, and old attendings like me to kind of, um, tell trainees what they might not have expected about becoming an attending. So that’s why the topic.

James Thackeray: Well let’s dive into it. I love it. Let’s go for it.

Jonhan Ho: Okay. So we each have three things that we’ve thought of. And I don’t know what, Dr. Baskota’s three are. And I actually have three plus one, like a bonus one. So um, maybe Swikrity can start off with the first one.

Swikrity Baskota: The first one I’m gonna start with both a positive thing and a negative thing. Okay, it’s actually negative, the thing that I struggled with. The positive thing is I did not realize the freedom that I would get as an attending. No more reporting to the attending at 7 AM or 8 AM in the morning with all the case previews.

You make your own schedule. You struggle with it no matter how long you want to struggle for and come up with a diagnosis and see whether your colleagues agree to it or not. That was the best part. I can just close my door if I am so stressed out, put on loud music, and take forever to struggle with a case. That’s the thing that I appreciate, which I could never appreciate as a trainee because I was following my attending’s schedule. 

The other thing that, you know, somewhat I realized was it was so easy as a training to take leave on Friday afternoon. You know, at twelve pm I would just go and knock at the attending’s door and say, “hey, I’m going out of town for the weekend. I’ll see you Tuesday.” Boom. That’s it. You know, that doesn’t happen anymore. The minute you switch and put on the attending level to yourself, every case that runs by your desk is your responsibility. Whether you are going to stay late Friday night or come back Tuesday morning to a big pile. That’s on you.

Jonhan Ho: Yeah. So I was going to say something very similar, also, for my first one which is your schedule autonomy. And this is probably one of the greatest things about pathology is, you know, when you’re a med student, even when you’re a resident, you’re like, I gotta be here at this time for this lecture. I gotta be here no matter what or somebody says that I have to be here. Somebody says that I have to be here at a certain time. And you know, for example, we will work with a lot of dermatologists, and they have to be there when the clinic opens at 7:30, because they have patients at 7:30, and they have a whole bunch of patients. And you can’t just show up whenever you want to. 

Now, um, this is, in this world, in pathology, there’s all kinds of different practices, you know. For example, like in the Path department at UPMC they have an overnight call service for transplant pathology. So obviously you can’t be like, I’m not gonna go in for call. But I know attendings who love to do mixed martial arts and they train and during the day and they get there at like 5 pm and then they sign out from like 5 pm to midnight or something like that. And I’ve known other attendings who are the complete opposite, who would get there at 3 am because they just love getting there at, you know, Dr. Baskota knows who I’m talking about. And so they’re there at 3 and they leave by, like 9 or 10 in the morning. So you have a lot of control over your own schedule. And I think residents don’t understand how important that is. 

You know I think of the ER docs all the time where they go from one night shift like four times in the month and then they go to day shift and or nurses or whoever. Lots of people in medicine have this sort of changing shift. And um, there’s a lot of body stress that happens with that. And there’s a lot of stress when you’re supposed to be somewhere and you can’t be there, for whatever reasons that are outside of your control. Like ah, you live further out, and then you have a meeting at like, even not a ridiculous time, like nine o’clock. And then you’re like, I gotta get there. I can’t. And then you’re calling in and you’re like, I’m gonna be late and stuff like that. You know, in pathology you get there. You just have to get all your stuff done, and then you can leave and whatever that schedule looks like, um, is completely up to you. 

Now I happen to love going into the office. I loved talking to the trainees. I love seeing the dermatologist. And so I don’t want to be an exclusive at home job. But um, number one you know, if you have kids and the kid’s sick or something like that or for whatever reason, they have a doctor’s appointment and you know, you can drive them and then go back to work or pick them up if they’re sick at work. And then ah, then go back to work. Or work you know, half a day at home and a half day at work. You know. So it gives you a lot of schedule autonomy and that is highly, highly under-rated. I see trainees who come out and they’re always like, looking for a job, “how much does it make? You know, ah how many days am I there?” And stuff like that. But when you have complete control over your own schedule. Um. That is very rare. That contributes significantly to the cost of life. You know, that’s worth a lot of, if you’re gonna think in terms of how much extra do I get paid versus how much more am I going to enjoy my life, um, there’s a lot of, you know, a ton of value there. Um. 

And I would say, with things going digital now, that gives even more power to the young pathologists who are looking for jobs who, they have the option to either go in or do cases, you know, at home. So I think this trend is going to be even in more favor of young people that are going into pathology. So that’s the first thing that I would say. 

So we said the same thing, um, Swikrity, Dr. Baskota, but ah, I think it’s not exactly the same at every practice. And I think it’s good that we both said the same thing as our number one, because it really is a big draw to pathology. 

James Thackeray: I can’t believe you didn’t coordinate. That was so good. I just, that you both came up with that and the fact that at least the technology seems to be even enhancing that or potentially could enhance that autonomy is such a great thing. And everybody’s jealous of the radiologists forever, you know, because they’ve been doing things that allow them to sometimes do remote work as well. So that’s exciting. Anyway, I didn’t mean to butt in. I just was really excited about the answers.

Jonhan Ho: No, not at all.

Swikrity Baskota: OK. Now it’s time for the second point?

Jonhan Ho: On to number two. Let’s see if these are the same between us.

Swikrity Baskota: Yes. Here’s mine. So I never realized as a trainee the implication of my diagnosis actually makes on the clinician and the future aspects of the therapeutic signals. For me, as a trainee, it was enough to get to the diagnosis. But the procedure that follows afterwards, what ancillary tests to order, what the morphology might suggest in the molecular testing and what molecular findings would implicate in the patient’s therapeutics. I think it was a sharp learning curve for me in my first two years of practice.

And the other, which was very surprising to me, was how to phrase even the most benign and the digital things correct, so that the message I’m trying to give is received correctly by the treating clinical team. You know, they have to put whatever we give as a diagnosis to the patient presentation and clinical symptoms. I think that’s one of the major challenges. So I would like to suggest the trainees who are towards the end of their training or even during fellowship. Try to focus on the ancillary test. Make an effort to go back and look at the molecular test results once they come back. I know most of our schedules are scheduled that way that we are already off that rotation when most of these ancillary tests are made available to you.

On top of that, make effort to read PD-L1 assays, even HER-2, even the hormone receptors assays. You know, try to make it your individual effort to report that so that you are concording to other colleagues in your practice once you start signing them out on your own.

James Thackeray:  That’s a great one. Can I just say one thing to that? Because I can’t, I get so excited. I’ve watched how that works just from, kind of, my side of it, um, where the clinicians are driving that ancillary downstream testing. Right? And they’re the ones who are being marketed to by the molecular companies, and they’re kind of pushing it down, but their understanding sometimes is limited to what it actually, how it impacts the full diagnosis and obviously the therapeutics to follow. So it’s so great to have pathologists kind of take the lead and be the experts in that whole, you know, how does this all fit together puzzle? So I apologize for jumping in, but I just – that’s so well said. Sorry, Dr. Ho.

Jonhan Ho: No. Not at all. Not at all. So we’re going to be two for two here. So um, what I was going to, how I was gonna phrase it is that I didn’t realize how much I would learn from the clinicians from the you know, in my case it would be the dermatologist. And ah, what I mean by that is something you know, similar to you is that you know, their treatment – I wouldn’t say, I mean, in many ways, it depends on us, but it’s not, you know, a one-way street.

And um, I’m constantly finding myself asking, like, okay, if I phrase something this way, what are they going to think differently? If I phrase it this way? If I phrase it that way? What are they going to think differently? And how are they gonna approach it differently? And a lot of times, they’ll text message me or they’ll call me or whatever, uh. 

And so the importance of number one, having that open channel between you and your clinicians is incredibly important because they’re gonna save your butt sometimes, and you’re gonna save their butts sometimes. And I always tell the trainees that the most important product that you can produce is trust. Trust in you. And so you have to constantly, um, invest in these relationships because they’re going to teach you things that you didn’t know, and that you never would know, um, if you didn’t reach out.

And they’re interested in what you say. You know, the dermatologists are very sophisticated about Dermpath, and they know what things look like under the microscope. Um. And so, you know, I’ve even had clinicians say, well, “isn’t there this rare variant of such and such?” And I said, “OK,” so, um, so definitely there’s clear impact there. And I love to learn from the dermatologist as much as they love to learn from us.

Swikrity Baskota: I can’t agree with you, Dr. Ho, more You know, when I started, I was that arrogant trainee who’d just transitioned to an attending. You know, who was so confident about every diagnostic phrase I used. But when, now, I have like learned more from clinicians I understand whatever I’m trying to say might not be received the same way because clinicians are trying to put things into perspective.

So I think for the first two years now, I have been losing my confidence and maybe pausing before I actually fill that sign out tab to think about. Okay. Whatever I’m trying to say, you know, whether it gets transitioned to the clinician in the proper way or not. And like, you mentioned, text message through, you know, Epi chat has made, so much easier, our life so much easier.

Even a simple message. “Hey. This is what I see. But I’m not definite about this,” because this is, you know, especially in cytology we deal with so much of small scanned specimen. “Hey. I am really concerned about this here, but I cannot be definite. You know, if you think this is what the patient is suffering from, please send us more samples” or whatever, you know. I think that bridging that gap helps us build the mutual trust between two teams very much.

Jonhan Ho: Yeah. And the other kind of changing dynamic right now for young trainees is that there was a new law that came out that says that when, ah, when a result is resulted, when a final result is resulted, the system cannot delay the patients’ access to the diagnosis. So um, instantly now, um, you know, patients are getting a text message that says your report has been signed out. Like the instant I hit sign out they get a notification and most of the time the dermatologist hasn’t even had the opportunity to look to, to even know.

So the patient will be like, “hey, what does this mean?” And the dermatologist is like, “I didn’t even know that it resulted,” you know what I mean? So now we have this different dynamic where the things that we phrase, we have to be aware that the patients’ rights are to have it right away.

And so this makes communication with the dermatologist even more critical. Um. So ah. You know, that’s one of the things that is changing. But um, you know, that just hammers home the point that you’ve got to trust your clinicians and your clinicians have to trust you. And you have to keep an open line of communication and you’re gonna learn a lot from them. You know, I see the trainees come through and all they want to do is get the right diagnosis.

Well sometimes you have to give people options. Especially in dermatology. You have to be like, “this is the pattern I see. This is what I favor, you know, in my number one, my number two and my number three. And if you see this happening, this something specific happening clinically, then you could consider four,” you know what I mean? So I’ve come to kind of embrace, in certain situations like, you gotta give them options so that they can match what they see clinically with what you’re talking about on path. But you know the trainees want to be like, “this, is it. This is the one thing it could be”, and the clinicians are like, “c’mon, man. It’s not scabies.” You know what I mean? 

This is the art. And you have to do things like this the same way every time so that your clinicians start to get to know your reports. And if you miss, like, I missed.. We have quick text and I left the word conceivably in there. I always delete that word. And one time I forgot to delete the word and I got a call from the clinician. He’s like, “what do you mean, conceivably Psoriasis? Because usually you just say, you know, ah, Psoriasis and I take that to mean that Psoriasis is the most likely thing. But this time you said, conceivably. Does this mean that you really don’t think it’s Psoriasis?” So, you know, they really do pay attention to the reports and how you write. 

And just kind of as an aside, my high school English teacher, who was very good and very well respected, he said in his class “English will be the most important class you ever take.” And I was like, “no, what about all the discoveries that come out of math and science and this and that?” And it took me really like twenty years to figure out that writing is how you communicate. And if you don’t communicate clearly, um, there is going to be problems. 

And so, these are two long-winded ways of saying that, you know, we learn from our clinicians and we try to communicate as best as, well, as best as possible to establish trust in relationships.

James Thackeray: I love it

Swikrity Baskota: I’m just curious. Have you changed your, like especially, approach to giving an unexpected diagnosis on a Friday evening after the changes that happened where a patient gets their report immediately.

Jonhan Ho: We haven’t changed anything, yet. You know, I definitely support the patient’s right to have instant access to their information. I definitely think we need to talk to the dermatologist to see where things could get screwed up. And, you know, for example that’s one of them. It might be that we always, if there’s something unexpected, we always try to get a hold of them as we’re signing it out or something like that. I don’t know. We’ll just have to talk to them to see what the best way for both the clinicians and the system are. It’s definitely something that we need to adapt to.

Swikrity Baskota: Yeah, I agree.

James Thackeray: So communication, trust. I mean, those are the staples to good relationships with your clinicians. And I’ve watched pathologists like yourselves who have that relationship where the clinicians just start to trust more their expertise even downstream into the ancillary orders and all those things and start to, “hey, you may know more than I do in this subject. Please advise,” you know. I’ve even watched, you know, the way they turn that back over to the pathology. Um anyway, that, that’s awesome. Great. Great stuff, okay. 

Swikrity Baskota: Okay. Now the third one.

Jonhan Ho: The third one.

Swikrity Baskota: Okay. Don’t say the same thing, Dr. Ho. Otherwise people will really think that we actually made these known to each other, okay?

Jonhan Ho: Well I still have, also, a bonus one. So ah, we’re for sure not going to be the same.

Swikrity Baskota: Okay.

Jonhan Ho: But I also think that you will agree with my bonus one, but we’ll see.

Swikrity Baskota: Sure. Okay. My last one is, you know, my training in my perspective was comprehensive and made me a competent pathologist from day one. But I think, you know, billing and compliance is one thing that was never emphasized throughout my training. You know, now I realize when I’m an attending what, you know, that I need to report each and every immunostain I order whether they are not contributory or it did not work due to the lab failure. I need to specify or need to put a proper billing code. And this is more important. And I think, really, we all need to talk about it more. Given the you know, recent Medicare pay cuts and everything, we need to be sure that our revenue is being generated in the way it is supposed to be.

And throughout these two years at Columbia, we do our own billing codes. So I have been efficient and prudent about which billing code I should be using, how frequently should I use, you know. But it was stressful when I started the transition of a trainee into an attending when it was one more additional thing to address and keep in mind of. But I’m thankful for my billing team who keeps on reminding me with the nicely phrased email at the end of each month.

Jonhan Ho: Yeah. So um, I don’t know how many trainees… I didn’t know this when I was a trainee, but if you don’t bill properly.. Of course you know you, you might not get paid properly, um. But ah, if you bill improperly… 

So one thing is not billing something and the other is not billing properly. Like if you don’t bill properly, ah you… and let’s say you have a billing team that does this, which you know most institutions do. Um there are, there are penalties for this sort of thing and there are legal penalties. And you know, besides just you know that you did it wrong, we’re not going to pay you. Um. In some situations, um, if you don’t do it right that could be fraud, even though you didn’t intend to deceive anybody. Like if you billed for something that you weren’t supposed to and you had no idea, and it was all done by somebody else, but it’s under your name, you are still responsible.

Um. You know the University, you know, has some responsibility, too, and things like that. But you are equally responsible, probably. You know, I don’t know the exact letter of the law. But when I tell this to trainees, they’re always like, “but I didn’t do any of it. You know, I didn’t, I didn’t do any of the billing” – it doesn’t matter. You know, that’s just the way the system is. You, one way or another, are going to be on the hook for everything. So that wasn’t my third one, but I completely agree with it. 

So my third one is something that I’ve seen a lot of young pathologists struggle with. And some, you know, some older pathologists, too or veteran you know, longer, more experienced pathologists, ah, who may or may not have gray hair. You know, who knows? But um, it’s that nobody is one hundred percent perfect. I mean, it’s impossible. 

The best pathologists in the world do not have a one-hundred percent hit rate. And I, you know, I’ve seen, um diagnoses that were a little bit wrong, and it doesn’t matter. And I’ve seen diagnoses that were a lot wrong, and it did matter. Um. But um, what I think… 

So I’ve seen a lot of people who have loved pathology and then they got out to be an attending and all of a sudden, everything changes. And you know, they start sweating more, because it is. Maybe you know they feel too much responsibility. And they can’t, ah, yeah. They have a real hard… they really, emotionally struggle with what if I was wrong? What if I was wrong yesterday? What if I was wrong earlier this week? You know? And I’ve seen some pathologists that come in on the weekends and look at all the cases again. Just to double check. And sometimes people can’t let that go. What if I was wrong last month? What if I was? And then the more you practice the more cases, you have to be wrong. And it just kind of compounds.

And so yes, we have a lot of schedule autonomy, but probably the thing that I’ve seen young pathologists struggle most with is that, um, “I just can’t deal with, not only um, may I have been wrong before? But I’m going to be wrong again in the future at some point. Because I can’t be perfect from now until the end of time too.” So um, you know, it just kind of snowballs in our minds. Like what if I’m wrong and somebody dies, you know?

And I’ll just feel like crap and I won’t be able to get over it. And what if I’m wrong again after that? And so, um, that’s the struggle. Now you can deal with this struggle in a couple different ways. One you can just accept that you’re not perfect, and try to do everything you can to catch mistakes that happen whether they were your fault or whether they weren’t your fault. You know, you have to have a good system around you. And they’ve studied medical error, and usually at least two things go wrong before something you know, really goes wrong. So if you, if you have a safety net to catch things. Ah. You know whatever they happen to be, you know, yet have a system that’s designed for that sort of thing. 

The other way to kind of deal with it is the wrong way, which is to be kind of cavalier. And some people come out and they’re already cavalier. And they’re like, I’m not going to make a mistake. It’s not gonna matter. And then that’s the kind of pathologist you’ve got to watch out for. Like those other really dangerous ones who are overconfident. 

And so I think there’s an appropriate level of paranoia, um. And over time, and this goes along with the establishing a reputation thing. You know, over time if you’re like well, um, I haven’t killed anybody yet, so I must not be doing too many wrong things.

And ah, you know, the counterpoint to that is, not a counterpoint, but corollary to that is that in, you know, in academia or probably all practices the longer time you go without screwing something up the more respect you get. So like when you, when you start out as an attending it doesn’t matter if you went to Harvard or wherever or you got all these trainings, ND PhD, you’re nothing.

You’re not trusted until you’re kind of a known entity. And the only way you can get a known entity is to establish a history of not screwing them over. So that’s my third one.

Swikrity Baskota: I couldn’t agree more to that, Dr. Ho. In the beginning I was so paranoid. And you know, like you said, I would go back and look at the same slide like a thousand times before I read my report a thousand times before hitting that sign out tab.

And in my experience, if you have some mistakes and somebody points out it to you sometimes, you know, they won’t be too polite like you would expect. And that hurts you even more and your ability to become a successful pathologist. I also went through some sleepless nights when I learned that, okay, I need to double the to better train myself and my eyes. I had printed a sheet of things that I want to do before I hit the sign out tab for the first month. And I think that helped me a lot to be methodical and not miss a few things that were, that I was missing in the beginning of my sign-out.

Even now it has become like, ah, you know, um, a header in my, a pointer in the back of the mind, when I’m looking at a complicated case. Okay. I need to write in the diagnosis. I need to make sure it is a millimeter. And even in the Synoptic, it is millimeter and not centimeter or otherwise, because those are the most common mistakes you will make, and that has a huge clinical implication. Like cancer is one millimeter away from the margin versus one centimeter away from the margin. So these are the few things you want to double check. And to minimize that, maybe you just want to use one way to measure either millimeter or centimeter and stick to it. You know, don’t change it.

And the same way. Even um, like for cytology, it is too tedious to go from one end of the slide to another end. Always make a rule. I’ll start from the left and go to the right or vice versa, whichever you are adapted to and stick to that. No matter what.  

James Thackeray: So great. Sorry, I just get excited. So great. Yeah. Go ahead, Dr. Ho.

Jonhan Ho: Yeah. Just one more thought to add to that. I forgot that there’s one more possible response to this kind of stress. It’s that you leave everything wishy washy. You’re like “it could be this and it could be that. It could be benign, and it could be malignant, or it could be…” And that’s probably the worst thing for the clinicians, because they’re looking for you to give them some guidance. And if you give them a report that gives them no guidance, um, then they, you can’t build a trusting relationship that way. And I’ve seen people do that sort of thing too. 

Swikrity Baskota: I agree.

James Thackeray: That’s great, you know, recognizing this isn’t an exact science. And I think sometimes, you know, people certainly outside of pathology are like “oh they gave me this diagnosis and it is exactly this way,” and recognizing that even your training, wherever that – that’s a variable in the standardization of whatever your field of study might be, maybe a little different than some other academic institutions. So it’s not standardized fully across the board. And it’s not an exact science. So knowing that going in but doing everything you can to perfect your trade as much as you can is great. Sorry. I just wanted to interrupt and say that. I don’t know why. But I did.

Jonhan Ho:  Yeah. No. I understand. So I have a plus one. Um. I don’t know if you have a plus one Dr. Baskota, but I have a plus one.

Swikrity Baskota: Go ahead, and I can, I will try to match up to you.

Jonhan Ho: So ah. So this isn’t actually a plus one, but it’s a subtraction. So um. I ah, I’ve heard many, many young doctors, you know after they finish fellowship and they’re in training right now. Ah. They get their first paycheck…

Swikrity Baskota: Very recent.

Jonhan Ho: You know their first paycheck and they’re just in shock. They’re in shock by, you know, “I thought I was gonna make this much money. But my paycheck only says this much money.” And then they see the tax, ah, that gets taken off and they… You know, I’ve seen more than one new attending go to the admin to be like “I, I think you didn’t pay me right,” you know? And the same story every time is “nope, that’s just taxes.”

And they’re like, “wait a minute, you know? How can this much… How can I be taxed this much? That can’t be right.” But it’s always right. And so that’s something that young attendings are never ever prepared for because they’re like “I’m paying more in taxes this year than I got paid all of last year.” Like that does, that’s you know, even if you logically know that emotionally like, it’s a big like, I don’t even know what to call it. But it’s a big surprise. And you don’t really know it until you do. So it’s a good problem to have, obviously. It’s a good problem to have. But it still, um, takes some time to sink in.

Swikrity Baskota: I agree. I kind of had a sense that you’re going to talk about finances. I’m glad I actually guessed it right. But I just want to add one thing to what Dr. Ho is saying which, at least being an international medical graduate immigrating to this country I did not know about, you know? There are ways where you as an attending also are even hitting the high tax bracket.

There are tax savvy ways where you can invest and make, um, achieve the finance and freedom in your years to come. But I believe when you’re starting in the first few months it is overwhelming to go through everything, but at least when you settle down and you feel like you are doing okay with your job, take some time to read about the financial advice. For me the first step to that, it was my husband of course, he helped me maximize my retirement account. But after that I started reading about WCI and even Bobblehead wiki, which has been really helpful for me to make my own choices of what I want to do with my remaining after I spend a ton and, stop, enough. I’m kidding. I just mean to say that if you want to achieve your financial freedom later on in your life, try to understand the financial nuances associated with it.

Jonhan Ho: And that’s how she ended up with a Ferrari.

Swikrity Baskota: Oh no. Long way to go. 

James Thackeray: So great. Well, this has been great. Any last things you want to add? This is so good. You know, I could go forever on this. This is awesome.

Jonhan Ho: No. I think we could go forever too, but I want to just kind of boil it down to the top three.

James Thackeray: Love it.

Jonhan Ho: And so, um, I think those in my mind are definitely the top three. And I think that’ll give young trainees a lot to chew on. 

Swikrity Baskota: I agree. I totally agree.

James Thackeray: Well you both are great. And we’re so excited that you guys would take some time to kind of be with us today. We definitely would like to have you back on. I think both of you could help us understand some of the newer technologies, especially on the digital side. Certainly, we play in that space and we understand that fairly well, but it’d be great to get pathologists’ perspective on the role of artificial intelligence as it comes in, digital pathology, the benefits. So we’ll tee that up for another time, because I think both of you would have a lot to offer on that side, and certainly would be important for those getting into the field of pathology to better understand. And what it is, and what it isn’t, and some of the challenges that probably are there, but we’ll save that for another time.

Well thank you, both.

Jonhan Ho: Yeah, sure I’d be happy to be back.

James Thackeray: Yeah. It would be great to have you both back. Dr. Baskota, thank you so much, Dr. Ho. You guys are great. We really appreciate the time and honestly would love to have you back. So we’ll ping you soon for a date to get you back on.

Jonhan Ho: It was a pleasure. Thank you

James Thackeray: Thank you both. We’ll see you.


Tune in next month for our next podcast. Thank you to the sponsors of our program, our listeners, and our guests for making this possible and for your support. 

About Jonhan Ho, MD

Jonhan Ho is the Director of Dermatopathology at the University of Pittsburgh. He is also the medical director for two CLIA licensed laboratories within the Department of Dermatology. Additionally, Dr. Ho is the Director of the Dermatopathology Fellowship program at the University of Pittsburgh. He is also the founder of KiKo (Knowledge In, Knowledge Out).

About Swikrity U Baskota, MD

Swikrity U Baskota is a cytopathologist and surgical pathologist in Columbia University’s Department of Pathology and Cell Biology. She completed her anatomic pathology residency and cytopathology fellowship training at University of Pittsburgh Medical Center. Dr. Baskota is currently a board of directors at College of American Pathologists Foundation. She is also appointed as a member of the global pathology committee and development committee.

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