Pathology in Military Medicine

[OnceARunner]

Hello all,

I’m curious to hear any current advice on pursuing pathology within military medicine. I’ve read through several past threads that have spoken about it in a positive light. Is it still a good field to enter within milmed? Have recent changes under DHA affected path significantly?

Thank you for any insights you can provide!

---

Members don't see this ad.

 

[orbitsurgMD]

Hello all,

I’m curious to hear any current advice on pursuing pathology within military medicine. I’ve read through several past threads that have spoken about it in a positive light. Is it still a good field to enter within milmed? Have recent changes under DHA affected path significantly?

Thank you for any insights you can provide!

Pathology is a varied specialty which includes laboratory, blood banking practice, forensic and surgical tissue pathology, itself very subspecialized, particularly with immunohistopathology, system-specific practice (e.g., derm). If you want to do a lot of tissue path, you need to go to a major center with a large and busy surgery department and with ties to a community that attracts outpatient pathology referral, preferably a center with a good relationship to a prominent academic medical center. There was a time when military medicine possessed one of the crown jewels in Pathology in the Armed Forces Institute of Pathology, but that institute is gone and with its disappearance, the military's eminence in the field has fallen.

As a surgeon who follows where specimens go for second readings (or third readings, sometimes) I get some insight into where community pathologists turn for help with difficult cases (e.g., Mayo, Michigan). If I were looking for a center for residency training, those are the places I'd want to go.

 

[armytrainingsir]

There was a time when military medicine possessed one of the crown jewels in Pathology in the Armed Forces Institute of Pathology, but that institute is gone and with its disappearance, the military's eminence in the field has fallen.

This bears repeating.

The fact AFIP was allowed to fall victim to BRAC demonstrates the idiocy of those calling the shots in military medicine as a whole.

 

[Mace1370]

Hello all,

I’m curious to hear any current advice on pursuing pathology within military medicine. I’ve read through several past threads that have spoken about it in a positive light. Is it still a good field to enter within milmed? Have recent changes under DHA affected path significantly?

Thank you for any insights you can provide!

For reference, I am a staff pathologist at a major military treatment facility. I did my residency at Walter Reed and did my fellowship at a civilian academic center.

I think pathology is one of the hidden gems of military medicine. The two residency programs for Army (Walter Reed and BAMC) will offer you very good training. Practicing pathology is also great in many of the military MTFs. You of course should be interested in joining the military for its own sake (same for any specialty), but if you do want to join then pathology is one of the few specialties I would say offers some perks not found on the civilian side.

As a medical student, pathology residencies are a buyers market. That means if you aren't tied to the military you can likely match into some very excellent programs. If you have the option to do that, then I would recommend doing so and then joining the military after. In my opinion, the Army military path residences are better than most path residencies on the civilian side, but they are never going to compete with the absolute cream of the crop on the civilian side. If you are already HPSP or USUHS, then you should have no reservations about doing a military path residency. They are excellent.

If you have any specific questions I would be happy to address those.

 

[Mace1370]

This bears repeating.

The fact AFIP was allowed to fall victim to BRAC demonstrates the idiocy of those calling the shots in military medicine as a whole.

I would like to point out that, while the AFIP was a very valuable resource, from the perspective of a pathology trainee not much has been lost. There are still many experts at the JPC to learn from if you do your residency at WR and want to do elective rotations there.

I agree that is was criminal to get rid of the AFIP, though. Such a waste.

 

[OnceARunner]

Thank you all for taking the time to respond. I appreciate the feedback- it will help me make an informed decision moving forward.

 

[Kilgoretrout 65]

Hello all,

I’m curious to hear any current advice on pursuing pathology within military medicine. I’ve read through several past threads that have spoken about it in a positive light. Is it still a good field to enter within milmed? Have recent changes under DHA affected path significantly?

Thank you for any insights you can provide!

I spent my career in Air Force pathology. I have been out for several years. If you are already into an HPSP or USU commitment it is not
a bad route to go. Almost no deployments, maybe for the Navy (?), assuming you don't want to do that sort of thing. The military training programs are adequate but not stellar as has been mentioned in this post. Pathology does benefit from time to read but learning from those in the field that write the articles and textbooks can't be beat. I do remember getting my desired slot in Pathology out of USU and my classmates asking me what internship I was doing and I said "Pathology Intern". Also already mentioned, you have to be stationed at a place with busy surgery departments or your skills will atrophy fast, especially if your initial training was on the weak side. This is true across the board though for most milmed specialties -hard to be a neurosurgeon when there are no cases to operate on. I was very fortunate in my career, did a civilian fellowship which counted towards retirement time in service, used the GI bill to send my kid to an expensive private college and now look forward to that direct deposit from uncle sam every month. The more rank you obtain the more you are eyed as an administrator and I managed to hold out to the end, white knuckled, by volunteering for sucky jobs in order to avoid those really sucky jobs. My civilian job search ended with several offers given my experience, connections, and no (known by them) baggage.

Pathology in the civilian world though has a subpar job market severely geographically restricted (i.e good luck finding a job in NYC, Southern Cali or Chicago), reliant on cpt code reimbursements constantly getting slashed (9% last go round) and an attitude of hospital CEOs that you are a commodity to be controlled and if possible to be reigned in, given a salary and chained to your desk so that the institution can profit off your work while you absorb the risk. The pathology locums market pays ~$800-1200 a day, likely much less than similarly trained specialties and by hour similar to my car mechanic and plumber. Not whining just the way it is. For pathology residents go to the pathology thread to be thoroughly depressed. For those in other specialties, go look for a good laugh.

And yes a shame the AFIP closed. Not the dumbest thing Congress has done and is about to do...