Path job market questions

Aaargh said:

I need to make some career decisions quick.

Among the concerns I have about path is the astonishing increase in the number of residency positions. Can somebody speak as the realistic implications for the job market?

I am sure there is a two tier job market depending on whether you come from the Stanford's/BWI's of the world vs other programs -- what would a path coming straight from these residency programs expect to make starting and after 3 years. Ditto for the same candidate after completing a dermpath fellowship?

I have seen this question a hundred times but never an answer -- if you do a dermpath fellowship (with the clinical ed) can you set up shop (I know you "can, I mean realistically, ie get *reimbursed*) doing the clinical side too?

Is anyone actually DOING telepathology today. If not what is the best guestimate as to when virtual microscopy will actually be available?

Finally, what does one DO after completing a molecular path fellowship? (I already have a big name MBA ... does this change things?)

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After a mol path fellowship RIGHT NOW, you typically run a mol path lab for a commericial outfit or a university department.

I dont know about the future. Right now, mol path is fairly worthless IMO. I would avoid it. Alot of it has to do with how pathology is reimbursement, how the CMS assigns CPT codes to pathology tests but I dont think mol path will ever be a MD-driven speciality in the money making sense. Like stem cells, lots of hype and nothing more. Yes molecular testing for Bcr-Abl translocations for important, but NO it should not be a fellowship for path trainees.

As for income, it varies ALOT and by alot I mean there are people 2-3 years out of fellowship making 90K/year and others making 900K/year. Im completely serious a 10x fold difference and you know what?? Those numbers Im citing are from real people who trained at the exact same places, equivalent medical schools and did the same fellowship. So when you ask **realistically** what you could be making dont bother, because only YOU can answer that question.

Are you a business type?are you a leader or a follower? Are you a entrepreneur?

Yes people are doing telepathology, no, no one is making money from it.My best estimate for telepathology becoming the standard, how bout this: NEVER. There are a ton of reasons why and I dont have time to walk you through it.

The last thing I will say: the number of trainees has a HUGE HUGE impact on pathology economics. Far more than medicare reimbursement cuts, far far more. The new flood of trainees is far and away the biggest disaster to face pathology since the reduction of CP professional billing (which is making a comeback now).

For example, I sent out a want ad to hire histotech, cytotech and lab assistants for my new lab. I recieved 5 UNSOLICITED resumes from boarded pathologists, 2 from actual histotechs or cytotechs. There are probably 5x+ the number of pathologists as there are certified histotechs or cytotechs! Many pathologists would be FAR better off being PAs or physician extenders, hell they would even make more $$$!!!

why is it a shocker that some docs make 10x what others make?? Do all Ivy league MBAs make the same Goldman Sachs bonus every year?

Are there not MBAs making 50K while others rake in hundreds of millions?

Medicine is no different. There are primary docs struggling while others make millions. Hell, my old chiropractor had a newspaper article stating he made 2.1million in a single year! Other chiropractors eat leaded paint chips and sniff glue to get by.

Welcome to the jungle.

Aaargh said:

Since LADoc doesn't have time, can somebody walk me through why he believes virtual microscopy will *never* happen. This is a pretty important factor to me.

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Radiology images are infact already on a computer and have to be printed out.
Thus beaming them before/instead of printing them easy.

Glass slides are not on a computer. Computers/automated microscopes can not scan an enitre slide from low power and be worth while. This means multiple passes, and large file sizes. (plus the time per slide) And don't even get started with focus. That tissue is pretty flat but it is still actually 3-dimensional.

For individual slides and directed imaging ("resident, move to the left SLOWLY.") it might work, but scaning tens of thousands of slides?

1. Pay is fundamentally dependent on supply (number of boarded physicians in a given field) and demand (number of cases and how much you're reimbursed). All other things being equal, a larger number of residencies will obviously increase supply down the road. However, all other things are not equal. Frankly, it's currently very difficult to predict, especially as it's not really important what you'd make three years from now. Provided you're currently an MS3, you're looking at 5 years from now + 3 years after boarding = 8 years. Nobody can predict anything about that now. Even less so 30 years from now, when you'll still be practising.
My personal bet is that over that time span ALL fields will see decreased pay, as the current growth in healthcare costs is probably unsustainable over the longer term.

2. LAdoc00 is right. There's no meaningful "number" for general pathologists 3 years post boarding. As per Dermpath, few would make less than $250K, and those that do will most likely work less than full workweeks.

3. That's easy. You will NOT be able to do clinical Derm, unless you're boarded in it. As a Dermpath, you receive training in clinical Derm, but as the entire fellowship is 1 yr (sometimes +1 research yr), it's fairly obvious that you will not become a full-fledged Dermatologist. Same applies, obviously, for Derms doing Dermpath, which doesn't make them full-fledged pathologists. SO as a Dermpath (path) you can do Path+Dermpath, as a Dermpath (Derm) you can do Derm+Dermpath. In real life, money is better, even for a Dermatologist, doing Dermpath, so few would do it, even if they can.

4. I've tried both telepath and telederm. The technology is simply inferior, even for frozens and simple skin dx. Technology will obviously improve, but I just don't see it getting to the point where it can replace having the pt or biopsy in your hands. It "might" provide rudimentary services to very remote areas, but not more than that. And it certainly wouldn't make anybody unemployed.

5. Molec Path has so far lived a tumultous life. It promised so much, but so far, it's really only been succesful within haematology. However, there's some real progress now, both in stuff like sarcomas, and in selecting prospective pts for some of the new targeted therapies, like EGFR-status. I think Molec Path is a freight train, and it WILL pick up speed. However, it's not there yet, and for the foreseeable future it will complement traditional pathology, not replace it.

4A. Problem is, that it's still not entirely certain that molec path will be a MD-domain. PhD's are wrestling for control, and might just yet get it. Actually, the dominance of PhD's and research-only MD's in Molec path is, in my mind, one of the reasons why there's been so many disasters. I cannot recount how many times I've seen a PhD dream up some fancy new DNA-probe, and then testing it on an entire biopsy, with both malignant and benign tissue, not to mention the laser capture microdissection done on benign tissue, or even on something which simply isn't what they think it is. Personally, I think that molec path should have many more experienced pathologists, but that's an uphill battle, as there really aren't that many jobs out there yet.

PS: I think it's entirely probable that a molec path boarding wouldn't get you into Andy Fire's lab. The guy's doing basic sci, for chris'sakes! Knowledge of tumor pathology wouldn't get you very far, when your lab is studying the C. elegans!!! (kudos for his Nobel 'n' all, but his work isn't exactly something which will be useful in cancer diagnostics the day after tomorrow).

Aaargh:

With anything, whether it be an MBA, an MD, or a subspecialty, if you go into it for the cash, you are going to get burned at some point or another. With 90K a year, you will not starve. Any business-saviness you have will help to add on extra earnings. Also, IMHO, to make an important career decision based on an explanation from an anonymous forum may not be the best move. Here's the order in which I would proceed: 1) Go with what you like, 2) get really good at it, and then 3) market it wisely and make some real cash. This can pretty much apply to anything in medicine.

This is admittedly unrelated, but does anyone know anything about the job market for medical microbiologists (i.e. pathologists who have done micro fellowships)?
I have heard that micro labs have a hard time finding MDs to run them, so then end up hiring pHds (but, would rather hire MDs).

My job isnt to encourage people at all in fact I would perfer to DIScourage as much as possible to separate the wheat from the chaff and really select those who want to do pathology.

No one is going to hand a six figure income to you, not in business and not in medicine.


How bout this: why dont you put "pathologist" into salary.com with the location where you want to practice and see what the salary bases are like??

Alot of people here are somewhat past the salaries, oversupply issue of trainees and what nots because we have TONS of threads on this we have already beat to death.

Yes, there is a HUGE disparity in pay between pathologists.

Yes, there is a HUGE oversupply of residents that has created this disparity and the recent huge increase in the boards pass rate (after lots of people bitched and moaned about it being so low) will only make the pool of boarded pathologists that much more overfilled.

No, pathology residency is NOT a vehicle for working in a top notch basic science lab, academics call that vehicle a PhD and a post-doc.

No, telepathology is constrained by a multitude of technology constraints that may take 50+ years to overcome and a cultural attitude that makes trying overcome those constraints pointless. When pathology is all digital, then all of life will be digital....complete telebusiness and telegovernment...etc... That day may come but likely not in my or your lifetime. I have followed telepath from its inception and watched it pretty much crash and burn. Some small things have survived and thrived (virtual flow and IHC for one), but true H+E slides will never be cost effective to send in digital formats on any large scale. The military via Iron Mountain was the true leader in telepath for years and spent millions if not BILLIONS on developing it for.....jack and **** results.

Now, does that help you? Or are you gonna to whine some more?

I apologize for the harshness of my response but we literally see these questions asked 20x a month. I have a very very elaborate thread on the market forces in pathology and why they are FUBAR but you would have to search for it using the search function. Think it was last year some time.

Hi Aargh,

here are my two cents, no one , and i mean no one in this forum or anywhere else can predict what the job market is going to like, say five or ten years down the road. Is it going to be so bad or is IT already so bad that pathologists have to apply for histo-tech positions, i dont know about that. but i agree with LaDoc, no can assure you before you join the residency and finish the fellowship that you are going to earn 250 or 300 K in the future. and obviously, if you do well in your residency and your fellowship, you will have a good starting job, now where you go from that point onwards is completely dependent on you. I mean, yes, if you have MBA from a ivy league school and if you have administrative and people skills then you will do much better in the real life ( monetarily speaking) than say another pathologist with equivalent training and skills but no people personality. So, my opinion is that medicine and all its subspecialities have some job security ( compared to IT or computer science) but in order to progress you need the complete package like everything else in the world. So, its extremely difficult for anyone in this forum or anywhere else to put a realistic figure down for you in terms of income.

Regarding your question about basic research and whether pathology helps you out there, I have a little bit more experience in that are being a PhD myself. If you are interested in basic research, you can actually become a post-doc after your med school (you DONT need a PhD), you dont even have to do a residency. But if you are looking for clinical/translational projects, Pathology is an extremely good option because you have direct access to precious tissue samples, and if you have the ideas and the knowhow, you could implement your own projects.

But I know of many clinicians too (int. medicine, general surgery) who got interested in research during their fellowships and ended up completely changing their career plans and spending a substantial amount of time doing research. correct me if am wrong, but isnt Judah Folkmann ( the Martin Scorcese of the scientific world, hopefully he will get the Nobel prize someday) a surgeon?

Sorry about the long post, aarhgh, but to summarize, and having to use the cliche again, do Pathology if you are interested in it , the money varies but its decent in most cases, and path residency definitely has no bearings on whether some one enters Andy Fire's lab or not .

Have you ever considered, that answers are seldom better than the questions? Based on your questions, MBA seems to be a better career option, as pathologists are mostly concerned with trying to help diagnose patients better, not salary standard deviations, telepath file sizes or careers which has ZERO clinical exposure.

But as it seems that your plans are in basic sci, the salary question becomes so much easier to answer.
Your ABSOLUTE maximum will be $183,500/year, as that's the salary cap from what's likely to be your main sponsor, NIH. Mind you, that's for a highly experienced PI, likely with a couple of hundred publications under his/her belt.
For your "3 years out" scenario, you'd be making around $60K in a basic sci only position, around $120K if you're at assistant prof level, with some clinical responsibilities.

As per your other questions, I refer to my esteemed colleague, LADoc00.

Aargh, even for dermpath the "low limit" of $250k is not entirely accurate, dermpaths in academia don't make much more than surgical pathologists in academia. And pathologists in academia are similarly compensated to other physicians. The surgeons will always make more in these types of jobs, I am not sure why, but it is true. Internists will make less. I am not sure why you are surprised or disappointed by this, it's pretty much a fact everywhere. Of course there are exceptions to the rule, some academic institutions are pseudo-private hospitals and will pay more while maintaining a partial aura of academia.

It almost sounds like your questions involve someone trying to guarantee your salary 8 years ahead of time, and tell you how things will go. That's impossible, as everyone is telling you. If you want to be disappointed, go ahead, but the fact remains that there are a few individuals in every field who will be making tons of $$$ while others make very little, and the majority fall somewhere in the middle. Personally, I don't know of anyone who trained at a decent institution who is making $90k a year 3 years out of training, unless they are mostly to blame themselves.

If you train at a good program and work hard, you should have no trouble finding a great job. If people want to say this is a rosy view of things, perhaps it is, but from my experience even the crappy residents who have graduated from here have found jobs that they seem to like a lot in areas they wanted to be in and in locations they wanted to be in. There are a lot of residency programs, and a lot of them are frankly subpar. If you go into pathology and train at a subpar institution you might have to work harder to make your own way, but it very doable. Sometimes I think people expect things to be handed to them.

If you have an MBA and want to use it in the molecular field there should be some opportunities for you. You might have to work for someone for awhile to get experience and credibility, however. As I said nothing is going to be handed to you. All of medicine is in a bit of a crisis and it is going to continue. Costs are skyrocketing, and physician salaries are likely going to be one area that people will look to cut back on - it certainly isn't going to be drug costs or technology costs because that is where the money comes from and politicians only see that part of the equation.

As far as increased numbers of trainees, part of this stems from the fact that ACGME decreased the number of years that are in a pathology training program (from 4 to 5) and as a result, many programs were left with more funded spots that become emptied. Instead of using that money to fund 5th year fellowships (because it is harder to do) they are increasing overall training spots.

I asked Dr Silva of USCAP about this when he came to visit here, and his response was that there are not too many pathology training spots, and that they anticipate there will be an increase in demand for pathologists over the next few years. Take it for what it's worth. I don't know if he has a vested interest in increasing the number of training spots. I would wager he would want to keep it at an adequate number and not oversaturate the marker, but perhaps not.

Bear in mind also that most fellowship training programs are geared towards future academics. This is not where a lot of the demand is, and it is unfortunate, yet it is a fact of life. People who express a strong interest in private practice and who want to get a dermpath fellowship (or any type of fellowship) are going to be marginalized. You can lie, if you want, but obviously one does that at their own risk.

As far as MBAs not having a 10x difference in low-high income, that is crap as well and I'm not sure why you can't see it. I know MBAs who make 40-50k per year (from good institutions), and as said above, many make millions. When he says that pathologists make from $90k to $900k that doesn't mean a whole lot, as he says. You will find that the majority of academic pathologists make $110-$180, and in private practice it will be higher (maybe $100k higher at most as an average).

A lot of it depends on what you are willing to put up with, what you want for a job, and what you put into it.

yaah said:

Aargh, even for dermpath the "low limit" of $250k is not entirely accurate, dermpaths in academia don't make much more than surgical pathologists in academia.

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Actually, ALL Dermpaths in academia makes the industry-standard $1.5MM that Phil LeB. at UCSF pulls in. Obviously, ppl like Cockerell and Bernie A. (pre-retirement) made considerably more... But of course that's only possible, because most Dermpaths don't really care about money - as witnessed by the (honestly) shabby dress standards at the annual ASDP meetings.

so it is harder to get fellowships if you plan on doing private practice?
I have heard that in other specialities that it does not matter that much where you do your residency if you just plan to do private practice (opposed to academia). Is this generally true for path?

Well, the thing about fellowships is that there aren't that many of them. For hemepath and cyto, there are enough and the demand is such that if you want to do private practice you are unlikely to have much trouble. You might not get one at certain places (like our institution is now making hemepath a 2 year fellowship which is clearly going to be discouraging to private practice wannabes), but you shouldn't have trouble overall. Dermpath is different, there aren't that many out there, and competition is such that training directors can afford to be selective, and they want to be the ones who will train the future academic leaders, not the future private practicers (again, none of this is universal, obviously people get dermpath who want to do private practice).

For the subspecialty surg path fellowships, it's different because a lot of these are academic by history. There wasn't as much need in the past for surg path subspecialties in general private practice, and even if there was, they aren't boarded fellowships anyway. And that remains the truth - good luck getting a GU fellowship if your goals are to answer the ads for a GU pathologist at a pod lab. It's possible, but you might have to be deceptive about your career goals. The community is developing increasing needs for people who have special training in surg path areas like GI and GU, but again, they are not boarded fellowships so there is no real regulation involved. The fellowship directors would rather train someone who is going to publish and teach in the field. Wouldn't you?

Whether it matters in path where you do your residency is open to debate, it's a very individual matter. Training at a great residency program will definitely open doors for you, mostly because of connections, and it will also generally train you more effectively because of the case load, consult volume, educational opportunities, etc.

[/QUOTE] And the ULTIMATE irony? Responses like the one's I've received here (welcome to the jungle indeed) don't encourage folks who love path to get into the field, but exactly the opposite -- it encourages only folks who want to go into business and see path as nothing more than a vehicle to that. [/QUOTE]

um...so would that be you? your desire to land a molec fellowship is to exploit molecular diagnostics to make money? looking for investments? i don't even get where you're coming from...how can anyone answer your questions when it's not even clear what you strive to get out of a pathology residency.


unless this is what you want to get out of it:

[/QUOTE] So I ask, again, is path a vehicle that will allow one to get into basic science research at a top lab? [/QUOTE]

i thought you were an mba? you don't get into top basic science labs w a pathology residency and certainly not w an mba....the people qualified for such positions are talented in basic science research, they usually have years of experience (and yes this is where the phd trumps your mba), several top-notch publications, tremendous technical abilities, a depth of knowledge not covered in any meaningful detail in med school and finally, creativity and drive....i mean come on, do you expect to roll off the street and land such a position? (and yes you can do a pot-doc but let me say that judah folkmann, the pediatric surgeon, is a rare bird...people like him do not represent the bulk of the scientific community).

honestly, if you were qualified to get such a position then you wouldn't need a pathology residency to get it. trust me, i've seen people w the right credentials and those folks my dear, have to question whether they should even bother to do a residency!!!! not only because they are good at science but because there is nothing else they rather do.

[/QUOTE] What are the actual constraints to telepath. File size (how big -- does 5gb per sound right?) and pipeline? [/QUOTE]

is this because your looking to develop it or avoid it? i'm not sure if you're trying to explore pathology as a career or develop a bussiness plan. and if its a bussiness venture you're looking for, do you really have to do an entire residency?


I think its reasonable to be concerned about the job market and salary but as it has been explained to you, those questions cannot be answered in a way that satisfies you.

if i were you, i would stick w investment banking since that is where you say you find tremendous consistency. good luck.

I think the moral of the story here is that, at least right now, Path is not like a Cards, GI, derm, or Rads where there is a huge demand and not near enough supply. There are way too many pathologists already, and the number of applicants are sharply increasing. While the volume of specimens is also increasing, it doesn't appear to be keeping up with the number of docs in/entering the field. Thus, as everyone has said, to be highly successful in this environment you are going to require a keen business sense, ingenuity, luck, and hard work. It can be done, and I am sure your MBA training and work ethic will help succeed if you choose to enter this field....but because the supply/demand is out of whack it is not as smooth a road as some of the other specialties. I wish programs would help curb this but it isn't going to happen. The worst was when I interviewed at WashU where one faculty member tried to convince me that there is actually a massive UNDERSUPPLY of pathologists, and that the training slots needed to be dramatically INCREASED. Obviously this is rediculous but it shows how out of touch some people are.

As for mol path, I think it could take off in a big way if mol techniques beyond immunostains could ever be applied to heterogenous tissue samples (i.e. surg path and biopsies) in house similar to the way they are in hemepath (where it is easy to separate cell populations). If that would ever happen, it could help the field out tremendously in my opinion. There's your translational research avenue in path. The telepath scenario is not going to happen for a long, long time (knock on wood!).

This guy Aaargh is a weirdo.

Don't go into path. Do Cards and help develop/market the next big drug-coated stent, or do RADS and perfect non-invasive colonoscopy imaging and sell it to the hospitals looking for an upgrade.

It only takes one jackass up in DC to say that "doctors are making too much and putting a burden on the health care budget," pass a bill "rectifying" this, and have all of us be totally screwed again.

Do I want a nice "return on my investment" of schooling? Hell yes. But is path the most lucritive field out there? Hell no. I've got buddies coming out of plastics right now having offers of over 300K to start. No f***ing joke. But dude, do I want to do recon and aesthetic plastics? No.

So again...find something you LIKE as a student, since that's the only thing you have to base anything on. If things change later, then you make a switch. But don't bitch because we're not telling you that Path is the definitive way to get into whoever's lab is the hottest s*** these days so that you can start your mol path biz.

Is the chance there? Yes. Is it likely? Probably not without some major time put into developing your research resume (see others' posts for info regarding this).

BTW, I am about ~2 months from finishing my MBA and I can tell you that MBAs have the biggest(BIGGEST) disparity in pay. I have friends making 40K as buyers and some others making 140K in investment companies.

I have a quick question guys: What is it about pathology that gives residency programs the incentive to continue to increase their training spots? Obviously it is not the demand for pathologists. I know most residency programs claim they loose money when they train residents, but I am beginning to think pathology programms actually gain from this. We need a lot more dermatologists but I don't see those guys throwing their doors open any time soon, so why is pathology whoring itself out on the street corner like this?

the only incentive i can think of for the increase in residency spots is slave labor...i guess that's kinda simplistic but a few extra residents seems a lot cheaper than more PAs, techs, etc...


but you're right... there is a shortage of derms yet residency slots remain few...the reason i have been told is that medicare will not fund additional spots b/c they don't view it as necessary for whatever reason (i am sure that there are economic reasons). hence, less derm spots w the result being a better market for these folks. besides the cosmetics angle and procedures, that's the only other major factor contributing to the financial success of private practice derms...volume...there is a lot to see and it takes little time.

the situation in pathology is a bit perplexing especially when you look at some place like ucsf who is taking 10 residents this yr...i don't even think the volume is that horrific that it would require 10 new residents. but again, institutions such as these hope to track residents into academics and maybe it takes gambling on 10 people for the hopes that one or two of them will go into academics (research tract, not clinical)??? i have no idea what the thinking is at places like this...and i don't know why medicare feels it necessary to train so many pathologists.

sequela said:

the only incentive i can think of for the increase in residency spots is slave labor...i guess that's kinda simplistic but a few extra residents seems a lot cheaper than more PAs, techs, etc...


but you're right... there is a shortage of derms yet residency slots remain few...the reason i have been told is that medicare will not fund additional spots b/c they don't view it as necessary for whatever reason (i am sure that there are economic reasons). hence, less derm spots w the result being a better market for these folks. besides the cosmetics angle and procedures, that's the only other major factor contributing to the financial success of private practice derms...volume...there is a lot to see and it takes little time.

the situation in pathology is a bit perplexing especially when you look at some place like ucsf who is taking 10 residents this yr...i don't even think the volume is that horrific that it would require 10 new residents. but again, institutions such as these hope to track residents into academics and maybe it takes gambling on 10 people for the hopes that one or two of them will go into academics (research tract, not clinical)??? i have no idea what the thinking is at places like this...and i don't know why medicare feels it necessary to train so many pathologists.

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There is no thinking past what institution X wants. If it isnt benefitting the ivory tower then the rest of the pathology community be damned. Pathology suffers from perhaps the worst leadership from academia outside of FM.

Seriously, it is Katrina/Walter Reed levels of mass incompetence.

yaah said:

Dermpath is different, there aren't that many out there, and competition is such that training directors can afford to be selective, and they want to be the ones who will train the future academic leaders, not the future private practicers (again, none of this is universal, obviously people get dermpath who want to do private practice).


.

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I don't know how many fellowship directors you have talked to (I guess you are trying to do dermpath too), but there are plenty of dermpath people in community practice and all of them trained all over the place. The FDs I talked to (and I talked to about 9-10) want people that really want to do dermpath and be experts in it. You don't need to go to academics to do that. In fact you can see a lot more derm in private practice as in academics you only sign-out 2 weeks a month at most and the sign-out pile is often lighter.

Dermpath might be the least academic of all the fields as it is the most pattern-oriented. It is kind of like prostate biopsies except the differential diagnosis is much much much broader.

worst was when I interviewed at WashU where one faculty member tried to convince me that there is actually a massive UNDERSUPPLY of pathologists, and that the training slots needed to be dramatically INCREASED. Obviously this is rediculous but it shows how out of touch some people are.

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Hahahaha, let me translate that: I feel Im spending too much time reviewing autopsy results, grossing or other crappy task X and need free government subsidized labor to help my lazy sorry azz do my job. Talk about a "ME" cultural. Do they care if all these extra residents are sweeping floors at BK or end up as junior associates for 20+ years? HELL NO.

I have seen some crazy crazy stuff going on outside of academia as the result of their FAILED policies. I think we should fire the entire ABP staff and change the entire leadership of the CAP for STARTERS.

CHECKLIST:
Fire everyone at the ABP and do I mean everyone, every secretary, admin person etc. in fact disestablish the entire ABP as the credentialing agency for ABMS. Reestablish a NEW credentialing agency that allows locally adminstered tests for certification that cost something more reasonable than the 8 gazillion dollars they want. Has everyone seen the ABP facilities in their full glory in Tampa? It is obscene. And they have the AUDACITY to yell at pathologists when they sit on the dirty floor outside the testing room if they cant waddle their fat azzes to the drinking fountain as quick as they like. These people deserve our contempt and nothing more. I have never seen people so mistreated and Ive worked in prisons before!

Fire the entire CAP leadership. Everyone. Disestablish the CAP immediately and combine its functions with a new credentialing agency.

FORCE all MDs older than 65 to retest on their credentials. No repeat tests, you fail you retire.

Pass legislation to ban ALL non-Pathology boarded MDs or DOs from owning OR operating pathology services anywhere in the US. END Quest, END Ameripath. Knee cap these POS's.

Cut training slots by 60%. Close 50% of all programs immediately. Guess what academia, you can gross too, you are just pretending to forget. Get in the grossing room and STFU or hire a PA and take a pay cut.

Aaargh said:

I am astonished by some of the responses I have received. And more than a little disappointed.

No, there is not generally speaking a 10x disparity in what folks who got MBAs with me were earning 3 years out. I could pretty easily give you a tight range that would cover (1 probably 2 std deviations) most of my classmates. Sure there were some making 30 bars. And others became photographers. But that doesn't prevent me from trying to be helpful by answering the quesions, and I would find it easy, for example to try to help prospective students by letting them know what they could reasonably anticipate earning.

For reasons beyond me folks seem to be unable to do that for me in path. Though I can certainly get that info for pretty much any other specialty in medicine.

Telling me $90,000 is ample is so naive it had to come from somebody who has never held a job. I doubt most could even service their debt. They certainly could not if they wanted to add HBO to their cable lineup. I know paint store managers who make substantially more. Telling me multiple BC paths are applying for histo/cytotech jobs on sdn and then suggesting that it really shouldn't be a consideration ... what the hell am I supposed to make of that?

And the ULTIMATE irony? Responses like the one's I've received here (welcome to the jungle indeed) don't encourage folks who love path to get into the field, but exactly the opposite -- it encourages only folks who want to go into business and see path as nothing more than a vehicle to that. Who in their right mind would enter this field to be hired as a histotech? I guess if you are an "entrepreneur" there's a great market niche. But of course I could make way more as an investment banker. So instead I just wanted to know how much the doctors make.

Telling me to do what I love is similarly naive. I might, might have an idea what I love 1/2 way through my fellowship. I've done two path electives and talked to senior residents who still don't have a clue themselves. That goes for every specialty (or job). At this point its just a guess, and there's not a single professional I've ever met (doctor lawyer banker whatever) who thinks you have a clue what your job is actually like until you actually start doing it. Been there done that. Don't need advice from people I don't know who don't know me telling me to "do what I love."

There are questions I'd like answers to, however.

So I ask, again, is path a vehicle that will allow one to get into basic science research at a top lab?

What are the actual constraints to telepath. File size (how big -- does 5gb per sound right?) and pipeline?

Who are the leaders in the still nascent field (from a path/MD perspective).

What is the deal with the increased number of trainees? No explanations of the theory of supply and demand please, I'm more interested in the stuff I asked about. If they double the number of residency slots and risk destroying your profession, you would think that I'd get some more sophisticated discussion of the issues, responses, etc.

I think I asked some pretty reasonable questions. Even if this is an anonymous forum. They are certainly pretty serious. I am trying to make career decisions which I will live with for years. And beyond confirmation of some of the terribles, and some pontificating about how I should view life, medicine and business, I don't feel like I've really got all that much that's all that responsive to what I actually asked.

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This is the single best post I have ever read on this forum. I agree with every word of it. Every single word.

Judd

better yet this sums it up:

LADoc00 said:

CHECKLIST:
Fire everyone at the ABP and do I mean everyone, every secretary, admin person etc. in fact disestablish the entire ABP as the credentialing agency for ABMS. Reestablish a NEW credentialing agency that allows locally adminstered tests for certification that cost something more reasonable than the 8 gazillion dollars they want.

Fire the entire CAP leadership. Everyone. Disestablish the CAP immediately and combine its functions with a new credentialing agency.

FORCE all MDs older than 65 to retest on their credentials. No repeat tests, you fail you retire.

Pass legislation to ban ALL non-Pathology boarded MDs or DOs from owning OR operating pathology services anywhere in the US. END Quest, END Ameripath. Knee cap these POS's.

Cut training slots by 60%. Close 50% of all programs immediately. Guess what academia, you can gross too, you are just pretending to forget. Get in the grossing room and STFU or hire a PA and take a pay cut.

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i absolutely think that legislation to ban all non-path boarded mds/dos from profiting from pathology services should be passed...but could we actually stop quest and ameripath? i can't imagine the resources those a-holes have put into lobbying for their profits...where do we start? maybe your response would be to start by disestablishing the abp or cap (as i assume they are the people who should be lobbying for the integrity, protection and survival of our profession) ...and so i ask you, how would we go about doing that?

i don't know about forcing mds to retire but i do agree that residency slots need to be cut or at the very least, these subpar residencies should be closed. it benefits no one to have an inadeqately trainined physician, esp. the poor md/do who had to endure 4-6 yrs of residency only to be left in the dust.

dermpathlover said:

I don't know how many fellowship directors you have talked to (I guess you are trying to do dermpath too), but there are plenty of dermpath people in community practice and all of them trained all over the place. The FDs I talked to (and I talked to about 9-10) want people that really want to do dermpath and be experts in it. You don't need to go to academics to do that. In fact you can see a lot more derm in private practice as in academics you only sign-out 2 weeks a month at most and the sign-out pile is often lighter.

Dermpath might be the least academic of all the fields as it is the most pattern-oriented. It is kind of like prostate biopsies except the differential diagnosis is much much much broader.

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Hahahahaha... Dermpath is kind of like prostate biopsies? That gotta be the best one yet! It's just wrong on so many levels.

Also, the statement that Dermpath is the least academic of all fields is equally wrong. Obviously, you can be a good dermpath without doing research, but the statement is just plain wrong. Dermpath is grounded in academic medicine, and stating that you really don't care about research is about as likely to get you into dermpath, as a statement that you'd only want to do cosmetics in Derm, or boob jobs in Plastics. Anybody telling you that an interest in research doesn't matter simply isn't saying the truth. That's not to say that you'd need 15 published first authorships to land a Fellowship, but I have NEVER met a DP director who said (s)he didn't really care about research.

Finally, the argument that many dermpaths go into "community practice" is flawed too. Yes, you have a lot of ppl not working in academic centers. However, Derrmpath, by definition, is a very narrow subspecilization field. And the setting of your workplace doesn't necessarily say much about the work you perform. Heck, Bruce Smoller runs one of the finest dermpath practices (and fellowship programs) out of Arkansas -- not exactly the center of the universe. Cockerell works for the dreaded Ameripath conglomerate out of Dallas, and David Weedon is working in a private group in Australia. And to take another field, Juan Rosai still does tons of US consults working in Milan, Italy.
However, despite their work settings, I don't think anybody would claim that these individuals are working in a "community practice"... (or that they're not research-oriented).

juddson said:

This is the single best post I have ever read on this forum. I agree with every word of it. Every single word.

Judd

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You're kidding, right?

jayman said:

You're kidding, right?

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sarcasm?

If someone is looking for a nicely packaged, candy-coated version of the truth, you might want to consider pediatrics not pathology. The characters you encounter on this board are certainly representative of the people you will train with, be trained by and spend the rest of your career kissing up to if you want to make your way to the top. We don't have to deliver bad news. Perhaps we lost such social graces along the way to becoming accurate diagnosticians, but I would argue that it is just our nature. We diagnose the GBM, we tell the surgeon "GBM," We don't go out to the recovery room and tell someone to get their affairs in order. We are usually blunt and to the point because that is what is required of our job. How can you be offended to blunt but truthful answers? If it offends you, you might want to look elsewhere.

Now someone will say that we are the heartless, humorless, automatons that everyone stereotypes pathologists to be. Also not true. We don't envy the surgeon that has to tell the patient about their inoperable grade IV brain tumor. We are glad we don't have a face to go with that awful diagnosis. We like to say "GBM...next case."

Actually, I think a lot of posters on this board would love the same information as the OP. After all, med students are almost as obsessively focused on their "numbers" ($$$) as investment bankers are. Only such a shame, that such numbers doesn't exist in any meaningful way. Perhaps the best thing would be to institute a socialized health system, like in the UK, where everything is based on a fixed pay scale, and an attending (consultant) basically receives the same amount of £££, regardless of specialty or location.

simonsays said:

If someone is looking for a nicely packaged, candy-coated version of the truth, you might want to consider pediatrics not pathology. The characters you encounter on this board are certainly representative of the people you will train with, be trained by and spend the rest of your career kissing up to if you want to make your way to the top. We don't have to deliver bad news. Perhaps we lost such social graces along the way to becoming accurate diagnosticians, but I would argue that it is just our nature. We diagnose the GBM, we tell the surgeon "GBM," We don't go out to the recovery room and tell someone to get their affairs in order. We are usually blunt and to the point because that is what is required of our job. How can you be offended to blunt but truthful answers? If it offends you, you might want to look elsewhere.

Now someone will say that we are the heartless, humorless, automatons that everyone stereotypes pathologists to be. Also not true. We don't envy the surgeon that has to tell the patient about their inoperable grade IV brain tumor. We are glad we don't have a face to go with that awful diagnosis. We like to say "GBM...next case."

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Very true. I'm often asked how I *feel* when handing down that Big C diagnosis. Truthfully, I rarely feel anything, except in certain cases where kids are involved. After all, I rarely, if ever, actually see the pt.

In fact, I and a lot of other pathologists, are fascinated by cancers. They can be exceedingly beautiful sometimes (although obviously very deadly).
In our line of work, we have to be factual and thorough, rather than compassionate. Surgeons will almost literally cut people to pieces, if we say there's cancer, and oncologists will poison their bodies to kill the malignant cells. So we HAVE to get it right, when we make our call. If we say it's benign, nothing gets done. If we say it's malignant, the whole cancer-killing arsenal swings into effect. Either way, consequences of wrong calls are immense. So I don't really care if people comment on my social skillz (or lack of same), as long as they don't comment on my dx skillz.

In terms of the "are there too many residents" question I think the problem is not with programs like UCSF taking 10 residents, it is that there are bad programs out there. So it's not that there are too many residents, it's that there are too many unqualified residents and too many bad programs. It's kind of harsh to say, but such is part of the truth. I really don't think the market is that oversaturated for good applicants - people who train at good programs are now and will continue to be in demand, despite what other people say. To some extent that depends on your definition, of course.

There aren't many derm programs out there, plastics, etc, and every graduate is in demand. But it's also true that the percentage of derm or plastics residency spots that are taken up by mediocre programs is much smaller than it is in path.

dermpathlover said:

I don't know how many fellowship directors you have talked to (I guess you are trying to do dermpath too), but there are plenty of dermpath people in community practice and all of them trained all over the place. The FDs I talked to (and I talked to about 9-10) want people that really want to do dermpath and be experts in it. You don't need to go to academics to do that. In fact you can see a lot more derm in private practice as in academics you only sign-out 2 weeks a month at most and the sign-out pile is often lighter.

Dermpath might be the least academic of all the fields as it is the most pattern-oriented. It is kind of like prostate biopsies except the differential diagnosis is much much much broader.

Click to expand...

I'm not doing dermpath. I considered it but it is not for me. No ****, there are dermpaths in community practice? I didn't realize that. My point was that dermpath is far more competitive now than it ever was, and fellowship directors can afford to be selective. And there are very few who would choose people destined for private practice over those destined for academics, all things being equal.

Dermpath is very academic. Tons of research opportunties, collaborative opportunities, teaching, etc. Other people already said it better than I could. If you truly are doing dermpath then by all means enjoy it, I hope it gives you what you want out of life.

yaah said:

And there are very few who would choose people destined for private practice over those destined for academics, all things being equal.

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Why are those who go into private practice less noble, less desirable than those in academics? You have been brainwashed if you believe that.

dermpathlover said:

Why are those who go into private practice less noble, less desirable than those in academics? You have been brainwashed if you believe that.

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Actually, brainwashing is not involved. It's called selection bias. The majority of Dermpath (and other) Fellowships are at academic institutions, where Directors have a strong bias for research and education, and have chosen to stay in academic medicine, even though they could probably make more in the private world. So, obviously, they will prefer applicants with a similar profile to themselves.

Personally, I think it's a fairly healthy bias, as I consider both research and education of new physicians essential in any field. Of course, some physicians in private practice also do those things, but it's a minority. (then again, I'm solidly in the academic camp mesself).

PathOne said:

Actually, I think a lot of posters on this board would love the same information as the OP. After all, med students are almost as obsessively focused on their "numbers" ($$$) as investment bankers are. Only such a shame, that such numbers doesn't exist in any meaningful way. Perhaps the best thing would be to institute a socialized health system, like in the UK, where everything is based on a fixed pay scale, and an attending (consultant) basically receives the same amount of £££, regardless of specialty or location.

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Awesome idea, maybe we should suspend the Constitution and form a national socialist government, appointing Cheney as Reich Chancellor or even better yet let the poor and downtrodden lead a revolution of proletariat and estable a medical collectivist state.

Awesome, youre a genius really....now please go away and STFU.

yaah said:

Dermpath is very academic. Tons of research opportunties, collaborative opportunities, teaching, etc.

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One term, Birt-Hogg-Dubé Syndrome

LADoc00 said:

Awesome idea, maybe we should suspend the Constitution and form a national socialist government, appointing Cheney as Reich Chancellor or even better yet let the poor and downtrodden lead a revolution of proletariat and estable a medical collectivist state.

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Dude, there was a smiley on the end of that, I think it was sarcastic...
Lets not just burn down the AFIP, just yet... oh wait.

Just by virtue of the share volume of "path job market" threads on this forum, I am going to say the job market is pretty suspect.

sirus_virus said:

Just by virtue of the share volume of "path job market" threads on this forum, I am going to say the job market is pretty suspect.

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by that logic pathology residencies, pathology fellowship and people matching in pathology are all pretty suspect.

I'm not confirming nor deny the conclusion, just pointing it out.. (which is pretty suspect)
I don't want to say too much, and get caught Columbo style in my own answer.

sirus_virus said:

Just by virtue of the share volume of "path job market" threads on this forum, I am going to say the job market is pretty suspect.

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QFT

I think perhaps one of the reasons so many people post questions about pathologists' salaries is that many pathologists seem unwilling to discuss salary issues with trainees (i.e. residents). I too would like to know what pathologists make in different areas of pathology and how those salaries shift from academic to community medicine. Obviously this will be different depending where you are but nontheless some examples would be nice.

There are different areas of path that I consider persuing for subspecialty training, however if upon completing the training my salary is going to only be 75,000 a year then I'm pretty much screwed when it comes to paying back my 150,000 med school loan. This is one reason why I think it would be nice to know the salary difference between different path areas. Especially for jobs that are primarily CP oriented such as transfusion medicine, medical microbiology, molecular, etc. I truly have no idea what these people make...

Dermpaths seem to be the only subset who are willing to talk candidly about their salaries - maybe this is becasue they make so much -

Part of the reason there are fewer job openings in pathology is because there are fewer jobs overall in pathology. You can be an internist or a gastroenterologist in any small town or hospital in the country, basically. But not everyone needs a pathologist.

path15 said:

--------------------------------------------------------------------------------

I think perhaps one of the reasons so many people post questions about pathologists' salaries is that many pathologists seem unwilling to discuss salary issues with trainees (i.e. residents). I too would like to know what pathologists make in different areas of pathology and how those salaries shift from academic to community medicine. Obviously this will be different depending where you are but nontheless some examples would be nice.

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People in path do talk about their salaries, but a lot of it is based on benefits, bonuses, etc, especially in private practice. And I don't know where people have been if they think we don't talk about salaries on this forum, I have seen hundreds of posts which refer to the fact that if you are in academics you are going to make between about $110 and $180 depending on rank, and higher in private practice. Why is that so hard to follow? If you're asking why people aren't specifically posting their own salaries, perhaps it's because most of us are residents or med students. I make $46000 per year. Today alone I talked with two different attendings who, without any prompting, told me about private practice salaries.

CP oriented jobs aren't going to make as much. That's because there aren't many, and many can be done by PhDs who will make less.

sirus_virus said:

Just by virtue of the share volume of "path job market" threads on this forum, I am going to say the job market is pretty suspect.

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I love this forum because if one person posts that they can't find a job (which has not happened yet, as far as I can tell, other than hearsay), there will be 30,000 posts in the next week about how no one can find jobs. And if someone posts (as many of us do) about people getting great jobs, that is ignored.

dermpathlover said:

Why are those who go into private practice less noble, less desirable than those in academics? You have been brainwashed if you believe that.

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No personal offense here, but you're kind of thick (or at least your online persona is). Did I ever remotely say that? It remains a fact that many program directors will favor academic-inclined individuals over non academically inclined individuals. As Clint Eastwood said, "deserve's got nothin to do with it."

I dunno though, people who stay in academics often work harder, get paid far less, and are responsible for training the next generation. Sounds noble to me. But who cares whether it's more noble or not. That doesn't even mean anything. You have to do what you want to do, and what you like. Some of us prefer to aim towards academics, at least for the first part of the career. Others don't. To each his own. It isn't (or it shouldn't be) a competition.

I hate jobs threads. They're like premed threads. What is more prestigious? Will prestige help me get fellowship x? Will fellowship x get me more money? Will prestige get me more money? GO INTO RADIOLOGY. I will take my more than adequate and ample compensation and be happy.