How many Fellow still do not have a job by June?

[davidMA]

Just wonder how the job market is … I know some ppl here just want to make it sounds like NO ONE can find a decent job nowadays, but most fellows I personally know can land a job, good or bad … So just wonder if there is a really a OK (not truly incompetent) fellow, really looking, could not find a job by this time. Lets don't count a friend's friend …

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[mlw03]

Obviously we're talking a different job market entirely, but all of the residents in the local program in Canada where I live either have fellowships or a job lined up (here, it's not uncommon to go straight from residency into community pathology practice).

 

[Inez2000]

of the four fellows that rotated with us, two have jobs, and two are doing additional fellowships.

 

[Sulfinator]

All of the fellows that I know relatively well have jobs lined up, among them are a couple of people who actually left their non-ACGME-accredited fellowship early in order to take jobs 'off cycle.' My co-fellow and I got our job offers in Dec/Jan. There are some fellows whom I know less well that are doing second fellowships, so I don't know whether or not these were planned (e.g., doing surgpath now but will be doing dermpath next year). A couple of people I know will be starting their second year of the two-year fellowship they signed up for (where you sign out cases yourself in the second year), so you probably don't want to count those.

 

[jp123ok]

Just wonder how the job market is … I know some ppl here just want to make it sounds like NO ONE can find a decent job nowadays, but most fellows I personally know can land a job, good or bad

I don't think anyone is seriously claiming that no one can find a job in pathology. The issue is that it is difficult for most trainees to find a job in a desirable location (of their choosing) that pays a reasonable salary. This is not a new problem. It has been an issue in pathology going back for 20+ years.

Read this thread:
http://forums.studentdoctor.net/threads/definitive-proof-of-horrible-path-job-market.688296/

 

[yaah]

The problem with that thread (and others) is complete and total lack of nuance.

On one side, you have arguments stating the hypothesis that, to sum up, "The job market is horrible and the only people who get good jobs are lucky, and it keeps getting worse. You're an idiot if you go into pathology."

Anecdotes which support the hypothesis become fact, worthy of citation and indicative of a huge problem. These anecdotes will then be reiterated and made to seem very common.
Anecdotes which do not conform are treated as "outliers" not worthy of consideration.

Thus, the "arguments" on these forums repeatedly deteriorate into the extreme position versus everything else. Any sense of nuance or gradation is heresy.

Much of where your opinion will fall will depend on 1) Your personal experience, and 2) Your definition of the words "most" "many" and "some" as well as what you think "a reasonable salary" is.

FACT #1: There are a lot of graduating residents who have trouble finding good jobs
FACT #2: There are a lot of graduating residents who get a great job they are happy with.

FACT #1 does not invalidate FACT #2, except on the internet.

What the absolute numbers are for the people qualifying for the two above scenarios is difficult to qualify. Which is more common? Insert bias and teeth-gnashing here.

There are also questions which you should answer for yourself
1) Is it acceptable to have a percentage of pathologists (not more than 5%, probably much less) be truly unemployed (only including those who want to work)?
2) What personal or professional characteristics make someone a pathologist that you would not hire, if you were hiring?

 

[mlw03]

As per usual, solid post from yaah. In forensic path, it's virtually unheard of for a solid fellow to not find a job. The need to move for work is pretty well accepted as fact in our world, but there are so few of us and such a strong demand that any good fellow completing their training in the US/Canada will find employment if they are willing to move for it, and I'm glad to see salary trends moving upwards in the last five years.

 

[jp123ok]

I agree with what you said Yaah. My reason for linking to the old thread was simply to highlight the fact that people have been complaining about the pathology job market for over 20 years. I'm one of the lucky people who found a good job after fellowship. However, one of my colleagues who did a dermpath fellowship with me last year could not find a job. So, my experience exactly fits the scenario that you outlined in your post.

Despite my good fortune, it was clear to me when I was hunting for a job last year that the job market for dermpath trained fellows was awful. In fairness, I did not send off my CV to every pathology practice in the phone book or cold call anybody. However, in a decent job market it shouldn't be necessary to do either of those things.

 

[turtle1966]

There are also questions which you should answer for yourself
1) Is it acceptable to have a percentage of pathologists (not more than 5%, probably much less) be truly unemployed (only including those who want to work)?

Is it even questionable whether "5% unemployment rate" is acceptable? Pathology is a relative "desert" in the midst of "oasis" which is American medicine.

 

[pongo]

You don't think there are at least a small percentage of board certified pathologists with serious personality or competency issues that are unemployable?

 

[Over9000]

You don't think there are at least a small percentage of board certified pathologists with serious personality or competency issues that are unemployable?

Of course there are, but there is anecdote and ASCP data that suggests that it may be the case that the job market is oversaturated. Surrogate markers such as number of fellowships completed and number of graduated residents who do fellowships suggest as such. True data is indeed hard to find, and the CAP makes assumptions without evidence yet claims it is as close to a definitive answer as they can muster.

Not to mention the CAP is not really a professional organization, but a for-profit enterprise masquerading as one. Case in point: the CEO once headed Accenture, a hedge fund that Peter Thiel lambastes in his book "Zero to One" as a business that adds nothing to mankind's progress - a polar opposite to businesses like Tesla or Google. Charles Roussel (sic?) cares nothing of the professional competence of pathologists nor the care patients receive, just the profits. So how can anyone believe them? There is so much upside to an oversupply for CAP that any data they publish must be assumed as biased.

(I can't believe groups, departments or anyone would still even consider using CAP as an accreditation body. But that's another topic...)

 

[yaah]

I do not personally believe there is significant true unemployment in pathology. I suspect there is some underemployment, however. And there are many people in jobs that they do not love, and who are looking to move. I know this because last time we advertised for a position 3-4 years ago about half the applicants were current fellows and half were people in existing jobs. Some wanted to move because of location, some because of practice style. There are some less desirable jobs out there, some of them can involve:

1) Being by yourself A LOT.
2) Getting sent hither and yon to cover offsite frozens, offsite labs, etc.
3) Abusive-type jobs where senior partners control everything and don't give non-partners much of anything, or jobs where call schedule, work load, etc are unevenly distributed (often inversely proportional to pay, of course).
4) "assembly line" type jobs where you get slides and have to churn through them
5) Variations on jobs that are either hyper specialized (only bone marrows, for example) versus hyper generalized (see everything from pap smears to marrows to skin to radical resections).

 

[BlondeDocteur]

I'm at a large institution with a large number of fellows, all of whom have been placed and placed well this year.

Forensic fellows x 2: both hired at the Dallas Medical Examiner's Office as assistant MEs
Cytology fellow #1: planned surg path fellowship in LA
Cytology fellow #2: private/academic hybrid practice job in cytology & general surg path, in Dallas
GI fellow: assistant professorship at UC Irvine
Hemepath fellow #1: private practice job in Dallas (heme, general surg path, and a CP lab directorship)
Hemepath fellow #2: planned molecular fellowship at Cornell
Micro fellow: planned molecular fellowship at ARUP
Chemistry fellow: 2-year spot (non-MD PhD)
Peds path fellow #1: assistant professorship at Baylor/Texas Children's Hospital (prior hemepath; will sign out heme and pedi surg)
Peds path fellow #2: planned dedicated research year
Breast fellow: Head & neck fellowship, MD Anderson
Neuro fellow: assistant professorship, MD Anderson (significant basic science research component)
Blood bank fellow #1: clinical heme-onc fellowship, UNC
Blood bank fellow #2: planned 2 year fellowship/research year
Cytogenetics fellow: no idea (non-MD PhD)

 

[jp123ok]

I'm at a large institution with a large number of fellows, all of whom have been placed and placed well this year.

Excluding forensics trainees, more than half the fellows on your list are either doing additional training or research. Therefore, it seems like a huge stretch to suggest that all the fellows at your program "have been placed and placed well this year". Does anyone seriously think that doing multiple fellowships is something that most pathology trainees want to do? If the pathology job market has deteriorated to the point where a fellowship paying approximately $50,000 a year is considered a good job then that it really concerning.

 

[tiredguy]

Your argument only holds water if people were scrambling into those fellowships after they tested the job market and couldn't find a job (or at least one they were wiling to take). I imagine most of the residents above signed up for the fellowships years before they had the chance to test the job market. People choose to do second fellowships for various reasons, oftentimes because a fellowship they want to do is filled up by the time they decide they want to do it, or because they need to "wait another year" for personal reasons (e.g. spouse has another year of training).

That being said, I do know of residents who sign up for second fellowships before testing the job market because they want to guarantee of staying in one city as long as possible (due to spouse) and fear that they might not find a job in the same area otherwise. And I know of fellowships that are often filled at the last minute because the fellow didn't find the job they wanted in time but this seems to be the exception, not the rule.

 

[BlondeDocteur]

Yes, I do. That's precisely why I said "planned fellowship." With only one exception, all of these second fellowships and research positions were lined up before they finished residency. It was the plan. Obviously they're quite complimentary: molecular + micro to be an academic micro attending focusing on molecular genetics of resistence, epidemiolgy and speciation; molecular + heme for obvious diagnostic and research reasons; cyto + SP to be broadly marketable in private practice (she already has a fantastic, cush PP job lined up after she finishes).

 

[deleted314957]

Yes, I do. That's precisely why I said "planned fellowship." With only one exception, all of these second fellowships and research positions were lined up before they finished residency. It was the plan. Obviously they're quite complimentary: molecular + micro to be an academic micro attending focusing on molecular genetics of resistence, epidemiolgy and speciation; molecular + heme for obvious diagnostic and research reasons; cyto + SP to be broadly marketable in private practice (she already has a fantastic, cush PP job lined up after she finishes).

Very,very sad compared to 30 years ago when I finished. Your litany is not a happy one.

 

[path24]

The majority of fellows doing another fellowship doesn't pan out well mathematically. They know and plan to do multiple fellowships because one won't cut it. Hoping their formula is correct otherwise guess what another fellowship. Sorry but more proof of a crap job market, just based on the numbers even.

Pathology is just the worst choice job market wise. Sad reality.

 

[Sulfinator]

They know and plan to do multiple fellowships because one won't cut it.

Um, I did not plan on multiple fellowships. I did one and that's all that I'm doing. And that does, indeed, "cut it."

 

[jp123ok]

Yes, I do. That's precisely why I said "planned fellowship." With only one exception, all of these second fellowships and research positions were lined up before they finished residency.

I agree with Path24. In my experience most people "plan" second fellowships either because they think that this will make them competitive in the job market, or because they want to stay in a particular location and wait for a "real" job to open up.

 

[Sulfinator]

In my experience most people "plan" second fellowships either because they think that this will make them competitive in the job market, or because they want to stay in a particular location and wait for a "real" job to open up.

Yeah, I agree with that statement, as well. I think most people who apply for their second fellowship before even finishing residency do so because they think it will make them a more desirable candidate when they do start looking at options for real jobs. A few do it for timing purposes (to co-ordinate with when their spouse or significant other is poised to re-locate) or because they think that they won't have to re-locate if they stick around as a fellow for another year (which does certainly seem to work out sometimes). I, myself, was pretty adamant that I was not going to do a second fellowship just because it would make me a more desirable job candidate. I was not at all convinced that I wasn't going to be able to cut it if I only did one fellowship. I did one fellowship and, about halfway through that fellowship year, landed a job that I think is going to be great.

 

[BlondeDocteur]

The majority of the people I mentioned who are doing extra years are doing it for personal reasons (spouse is a fellow in another field, graduating next year, want to go on the job search together, etc). But I think in general, there's so much more to know than there was 30 years ago, in all of medicine. It's the trend across the board, in every specialty except I suppose FM and EM. A very large percentage of people pursue ever more specialized training, both for job security and personal interest reasons, and also because practicing in a very broad, "know everything" field is intimidating. Since our fellowships are so quick and since our 4-year residency is so very broad, I don't think it's necessarily bizarre to pursue 2 fellowships, especially if they're highly complementary or highly desirable. I mean, you can go through your 4 years and only get a 1-2 months' exposure to whatever your subspecialty interest is.

 

[deleted314957]

The majority of the people I mentioned who are doing extra years are doing it for personal reasons (spouse is a fellow in another field, graduating next year, want to go on the job search together, etc). But I think in general, there's so much more to know than there was 30 years ago, in all of medicine. It's the trend across the board, in every specialty except I suppose FM and EM. A very large percentage of people pursue ever more specialized training, both for job security and personal interest reasons, and also because practicing in a very broad, "know everything" field is intimidating. Since our fellowships are so quick and since our 4-year residency is so very broad, I don't think it's necessarily bizarre to pursue 2 fellowships, especially if they're highly complementary or highly desirable. I mean, you can go through your 4 years and only get a 1-2 months' exposure to whatever your subspecialty interest is.

You make some good points. For example, immunohisto was in its infancy when I trained. We really had to have a very very good handle on morphology.

 

[turtle1966]

I'm at a large institution with a large number of fellows, all of whom have been placed and placed well this year.

Forensic fellows x 2: both hired at the Dallas Medical Examiner's Office as assistant MEs
Cytology fellow #1: planned surg path fellowship in LA
Cytology fellow #2: private/academic hybrid practice job in cytology & general surg path, in Dallas
GI fellow: assistant professorship at UC Irvine
Hemepath fellow #1: private practice job in Dallas (heme, general surg path, and a CP lab directorship)
Hemepath fellow #2: planned molecular fellowship at Cornell
Micro fellow: planned molecular fellowship at ARUP
Chemistry fellow: 2-year spot (non-MD PhD)
Peds path fellow #1: assistant professorship at Baylor/Texas Children's Hospital (prior hemepath; will sign out heme and pedi surg)
Peds path fellow #2: planned dedicated research year
Breast fellow: Head & neck fellowship, MD Anderson
Neuro fellow: assistant professorship, MD Anderson (significant basic science research component)
Blood bank fellow #1: clinical heme-onc fellowship, UNC
Blood bank fellow #2: planned 2 year fellowship/research year
Cytogenetics fellow: no idea (non-MD PhD)

I wonder how many of them, short five years ago, would have "dreamed" of the choices they have "now so thoughtfully planned in advance". I would say many have been "slow cooked to perfection."

 

[olivarynucleus]

I'm at a large institution with a large number of fellows, all of whom have been placed and placed well this year.

Forensic fellows x 2: both hired at the Dallas Medical Examiner's Office as assistant MEs
Cytology fellow #1: planned surg path fellowship in LA
Cytology fellow #2: private/academic hybrid practice job in cytology & general surg path, in Dallas
GI fellow: assistant professorship at UC Irvine
Hemepath fellow #1: private practice job in Dallas (heme, general surg path, and a CP lab directorship)
Hemepath fellow #2: planned molecular fellowship at Cornell
Micro fellow: planned molecular fellowship at ARUP
Chemistry fellow: 2-year spot (non-MD PhD)
Peds path fellow #1: assistant professorship at Baylor/Texas Children's Hospital (prior hemepath; will sign out heme and pedi surg)
Peds path fellow #2: planned dedicated research year
Breast fellow: Head & neck fellowship, MD Anderson
Neuro fellow: assistant professorship, MD Anderson (significant basic science research component)
Blood bank fellow #1: clinical heme-onc fellowship, UNC
Blood bank fellow #2: planned 2 year fellowship/research year
Cytogenetics fellow: no idea (non-MD PhD)

Yeah, but is doing another fellowship really a good outcome, I assume these people want jobs. Is it so hard to cut the number of residency spots in pathology? What would it take to do that? The cliff hypothesis has been touted for 20 years and hasn't happened yet, now everyone is banking on the "baby boomers getting older will need more doctors excuse."

 

[WEBB PINKERTON]

Don' t listen to anyone who says "baby boomers getting older will need more doctors ."

"Less is more" is the new mantra now. Look for a future with A LOT less specimens due to new guidelines, bundled payments etc. Our speciality is being propped up by waste and do you want your livelyhood counting on that going forward?

Make your money and be planning your exit.
"A man who's free can never die."
http://www.yourepeat.com/watch/?v=7x3YHoE115U

 

[gbwillner]

Here we are again... Lots of posts, but I don't see any from fellows who have yet to acquire a job.

Is the problem really as bad as it is portrayed on this forum?

I am not saying there is no problem in our field. We are different and there are bad signs as Webb mentioned above. Bundled payments are much more likely to negatively impact is than FM. I would argue with the notion that medicine is some sort of oasis. Reimbursements are getting cut for everyone and everyone is becoming an employee. Salaries are dropping across the board. You better like what you do, because it is becoming harder and harder to get rich in this business.

 

[Neopath]

Here we are again... Lots of posts, but I don't see any from fellows who have yet to acquire a job.

Is the problem really as bad as it is portrayed on this forum?

I am not saying there is no problem in our field. We are different and there are bad signs as Webb mentioned above. Bundled payments are much more likely to negatively impact is than FM. I would argue with the notion that medicine is some sort of oasis. Reimbursements are getting cut for everyone and everyone is becoming an employee. Salaries are dropping across the board. You better like what you do, because it is becoming harder and harder to get rich in this business.

I would bet that if a resident was only allowed to do one fellowship, there would be plenty of real life examples of pathologists without a job. Rather than face a dismal market, fellows grab an additional fellowship or two before finding a job.

 

[WEBB PINKERTON]

I have trouble believing more people don't know pathologists that are out of work. I can't be the only who knows geographically limited people stuck doing locum jobs.