What’s with peds pathology ?

[M&L]

Applied to residency now . Relatively competitive, no red flags . From rotations alone I like peds path, and want to take a deeper look during residency . Noticed that very few ppl go for peds path . Why ? Is the market bad? Low pay ? What do I need to know ?

(Fyi - ideally trying to go to Texas for family reasons, but will consider anywhere)

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[Guest8]

Applied to residency now . Relatively competitive, no red flags . From rotations alone I like peds path, and want to take a deeper look during residency . Noticed that very few ppl go for peds path . Why ? Is the market bad? Low pay ? What do I need to know ?

(Fyi - ideally trying to go to Texas for family reasons, but will consider anywhere)

From what I understand it's just a small field and generally limited to large academic centers associated with large children's hospitals. You won't find many community hospitals or small private practices requiring a dedicated pediatric pathologist because all the big pedi surgeries and specimens will happen at a major children's hospital. The smaller practices can handle placentas and POCs without a fellowship-trained pedi path.

 

[M&L]

hmmm ok, so am i understanding you correctly that if i do peds path than private practice will be unlikely and i will take salary? (which is a pay cut vs being a partner). Unless I double board peds and something else and do both, - for example, do peds and cyto, and this will make me more hirable for private practice

 

[KeratinPearls]

Applied to residency now . Relatively competitive, no red flags . From rotations alone I like peds path, and want to take a deeper look during residency . Noticed that very few ppl go for peds path . Why ? Is the market bad? Low pay ? What do I need to know ?

(Fyi - ideally trying to go to Texas for family reasons, but will consider anywhere)

It’s mostly academic but I’ve seen some peds path people do peds GI in private practice. Expect to go to academic if that’s your thing. It’s so niche. Pay is academic level pay. You can prob do well for yourself salarywise if you get to the chairman level at a pediatric hospital just like most academic chairs.

 

[ScubaV]

From what I understand it's just a small field and generally limited to large academic centers associated with large children's hospitals. You won't find many community hospitals or small private practices requiring a dedicated pediatric pathologist because all the big pedi surgeries and specimens will happen at a major children's hospital. The smaller practices can handle placentas and POCs without a fellowship-trained pedi path.

Basically this.

Reevaluation of the US Pathologist Workforce Size estimates over 21,000 total pathologists in the US.

Society for Pediatric Pathology - Intersociety Council for Pathology Information mentions over 700 members in the US, Canada, and the world. Because of the academic nature of the field I bet there aren't many peds paths in North America who aren't members. I would therefore roughly estimate there are only a few hundred pediatric pathologists in the US; certainly less than a thousand.

It's a niche within a niche. I would wait until after at least your PGY1 to make fellowship decisions, but you should do what you enjoy. If that's peds path go for it.

 

[octopusprime]

It's a *depressing* niche within a niche.
Hated peds path--devastating pediatric tumors, pediatric autopsies, zero recognition even within your own department. Hard pass. Unless you want to be the world's foremost expert on something specifically pediatric, avoid. Then again, the fact you're drawn to it is maybe an indication you should do it. No one else is drawn to it.

 

[WEBB PINKERTON]

Didn't a pediatric pathologist used to post here years ago? Dr. Blonde, not to be confused with Mr. Blonde from reservoir dogs, or something to that effect. Might want to talk to her.

 

[M&L]

It's a *depressing* niche within a niche.
Hated peds path--devastating pediatric tumors, pediatric autopsies, zero recognition even within your own department. Hard pass. Unless you want to be the world's foremost expert on something specifically pediatric, avoid. Then again, the fact you're drawn to it is maybe an indication you should do it. No one else is drawn to it.

"no one else is drawn to it" i am crying hahha.... and laughing at the same time.

 

[octopusprime]

Honestly it takes the right temperament and academic curiosity because it is an academic subspecialty. Like someone said unless you combine it with something else, but it's inherently academic and not going to boost your job prospects if you combine it with GI or anything. It will be a year of your life you shouldn't waste unless you want to focus on it.

 

[M&L]

It's a *depressing* niche within a niche.
Hated peds path--devastating pediatric tumors, pediatric autopsies, zero recognition even within your own department. Hard pass. Unless you want to be the world's foremost expert on something specifically pediatric, avoid. Then again, the fact you're drawn to it is maybe an indication you should do it. No one else is drawn to it.

excellent point. I love it though.... but i am not sure i love it more than "freedom" of private practice opportunities.... Well, for now i will keep these things in mind, go to a residency where it is represented, work hard, and see what happens.

 

[M&L]

but i definitely, 100% do NOT want to go into academic-only set up. This will kill me hahahhaha. I am a "workhorse" mentality wise.

 

[Guest8]

excellent point. I love it though.... but i am not sure i love it more than "freedom" of private practice opportunities.... Well, for now i will keep these things in mind, go to a residency where it is represented, work hard, and see what happens.

To be fair you could specialize in pedi path and still go into private practice. It's just that you really won't see much pedi path at all in community hospital or private lab settings. You'll see POCs, placentas, and the occasional pedi specimen. But parents generally take sick kids to major children's hospitals for care, as they probably should. So the most interesting specimens are going to be at large, academic children's hospitals like CHOP or Boston Children's. I'm in community hospital private practice and we really don't see any significant pedi path other than GI biopsies (the regular GI guys handle those), some hemepath, some dermpath, and then POCs/placentas. Everything else is likely seen at the big children's hospital downtown.

 

[M&L]

Excellent point for sure …

 

[Dral]

It's the same in the derm world. Peds fellowship is for people who have a niche interest in that field and expect to be at an academic center (probably involved in research as well).

Will it help you with regular sign out sometimes if you are in private practice? Sure. Is a fellowship in it worth it to you for that reason? That's up to you, but in general I'd say no.

I'm at an academic center, we have a peds hospital, but we don't have a peds path here. Gen surg path people and the bone/soft tissue folks take the cases that come in. My experience from seeing the cases make me think "I'm glad I'm not the one that has to push the button on this case that decides if this 2 year old is going to get their arm amputated or not".

 

[M&L]

It's the same in the derm world. Peds fellowship is for people who have a niche interest in that field and expect to be at an academic center (probably involved in research as well).

Will it help you with regular sign out sometimes if you are in private practice? Sure. Is a fellowship in it worth it to you for that reason? That's up to you, but in general I'd say no.

I'm at an academic center, we have a peds hospital, but we don't have a peds path here. Gen surg path people and the bone/soft tissue folks take the cases that come in. My experience from seeing the cases make me think "I'm glad I'm not the one that has to push the button on this case that decides if this 2 year old is going to get their arm amputated or not".

Can you please explain the derm part ?

 

[Dral]

I was just making a parallel that exists in path and derm. I just mean that Dermatology as a field also has an option for peds fellowship. Like path, the training gained in peds fewllowship is very niche and specific. Derms learn as much as they need to know during residency in general to treat the pediatric population. Those who do peds fellowship are surely better at treating that population, but it's generally more than what is needed in the grand scheme of practice. As in path, those who do peds fellowship in derm are typically destined to be at a large academic center with a large peds hospital.

I hate to put it this way, but when you break it down, is a fellowship in a field that will not change your practice much in the end (if you go pp or don't really apply the fellowship training to it's full potential) worth a few hundred thousand dollars and a year of your life?

 

[M&L]

I was just making a parallel that exists in path and derm. I just mean that Dermatology as a field also has an option for peds fellowship. Like path, the training gained in peds fewllowship is very niche and specific. Derms learn as much as they need to know during residency in general to treat the pediatric population. Those who do peds fellowship are surely better at treating that population, but it's generally more than what is needed in the grand scheme of practice. I hate to put it this way, but when you break it down, is a fellowship in a field that will not change your practice much in the end worth a few hundred thousand dollars and a year of your life?

As in path, those who do peds fellowship in derm are typically destined to be at a large academic center with a large peds hospital.

am i understanding you correctly, that if i want to practice in peds (aside of those large academic centers), i STILL can do it without peds fellowship? (if i do something else and i am good with population). Derm, for example, GI, or whatever else?

 

[Dral]

That is a good question. I'm not the best person to answer that. I would think generally yes. You won't be as good at it without fellowship.

However, on the other side of the coin, if you are not at one of the large academic centers with a large peds hospital, you typically will not see enough peds cases to stay proficient, and knowledge decay would likely be an issue (thus, sorta a 'wasted' year of fellowship). However, I'll let one of the other pathologists here chime in to answer that question better than I.

 

[M&L]

That is a good question. I'm not the best person to answer that. I would think generally yes. You won't be as good at it without fellowship, but if you are not a large academic center with a large peds hospital, you typically will not see enough peds cases to stay proficient, and knowledge decay would likely be an issue. However, I'll let one of the other pathologists here chime in to answer that question.

because if thats the case - that is perfect. I have always been a "good at self study, dont need others to push me" type, and if that is an option, Ill just make sure that i take strong peds electives, maybe do some research, whatever and be ready to practice in peds without doing fellowship in peds. And instead ill do a fellowship in something else - cyto or heme. Well, its definitely something to consider. Thank you so much for the idea! I love peds so much, and I love the options that allow me to keep the door open without binding myself for the rest of my career

 

[Dral]

Those would be good choices and help with diagnosing certain peds cases. If you are interested in Peds, bone/soft tissue might also be an interesting one to pursue as well.

 

[M&L]

Those would be good choices and help with diagnosing certain peds cases. If you are interested in Peds, bone/soft tissue might also be an interesting one to pursue as well.

for sure! Very good options. very common conditions, and if i do heme, or heme/transfusion, i feel like this would make me pretty marketable in both adult and peds populations. Definitely something to think about.

 

[Dral]

Yes, you could probably get your peds derm fix so to speak if you applied the knowledge from other fellowships to your practice in general. These will likely help your practice more than a peds fellowship will in general, especially in the non-academic setting. While it sounds like you have rotated through a few things already, once you start residency and take more of a 'deep dive' into the different subspecialties, you will likely gain more clarity about what you want from your future practice.

 

[M&L]

Yes, you could probably get your peds derm fix so to speak if you applied the knowledge from other fellowships to your practice in general. These will likely help your practice more than a peds fellowship will in general, especially in the non-academic setting. While it sounds like you have rotated through a few things already, once you start residency and take more of a 'deep dive' into the different subspecialties, you will likely gain more clarity about what you want from your future practice.

Absolutely. And I am going in with “work hard and have an open mind” mindset . But still I feel like thinking about this is important because it will help me navigate through residency options , you know?

 

[M&L]

Yes, you could probably get your peds derm fix so to speak if you applied the knowledge from other fellowships to your practice in general. These will likely help your practice more than a peds fellowship will in general, especially in the non-academic setting. While it sounds like you have rotated through a few things already, once you start residency and take more of a 'deep dive' into the different subspecialties, you will likely gain more clarity about what you want from your future practice.

YeAh I did cyto, heme, forensics, peds twice, spent time in Surg path, did about 24 autopsies with minimum supervision, including peds autopsies . I really love this specialty . Pathology is my thing )))

 

[Dral]

Excellent. Always good to see people going into the field for the right reasons.

 

[M&L]

Excellent. Always good to see people going into the field for the right reasons.

i actually went to medical school because i wanted to be a pathologist (vs the discovering it later). It is literally a dream come true. hahhahaha

 

[octopusprime]

Peds in our community hospital amounts to: peds GI (which is mixed in with the rest of the GI stuff and something all us general pathologists do), pediatric/stillborn autopsies (which never yield any results, and if they potentially do, particularly if there's a medicolegal question, off it goes to an academic center), the occasional pilocytic astrocytomas and low grade gliomas, pilomatricomas/nevi/tonsils/appys, et al grab bag of garbage 88304s/88305s...and the rare malignancy...which as someone previously mentioned, gets shipped off when the kid is eventually seen at the nearest large academic center anyway so no point exhausting your diagnostic efforts on something that has minimal implications (since they're leaving anyway)--it's lots of easy basic stuff any adequately trained AP/CP pathologist can tackle, and occasional triaging for the academic centers.

 

[M&L]

Peds in our community hospital amounts to: peds GI (which is mixed in with the rest of the GI stuff and something all us general pathologists do), pediatric/stillborn autopsies (which never yield any results, and if they potentially do, particularly if there's a medicolegal question, off it goes to an academic center), the occasional pilocytic astrocytomas and low grade gliomas, pilomatricomas/nevi/tonsils/appys, et al grab bag of garbage 88304s/88305s...and the rare malignancy...which as someone previously mentioned, gets shipped off when the kid is eventually seen at the nearest large academic center anyway so no point exhausting your diagnostic efforts on something that has minimal implications (since they're leaving anyway)--it's lots of easy basic stuff any adequately trained AP/CP pathologist can tackle, and occasional triaging for the academic centers.

excellent! so from this i read that if i work hard in residency (so i am good at what i do), I can practice in peds without peds fellowship ))). LOVE LOVE LOVE this. Thank you so much . This makes me so happy. Literally makes my morning.

 

[SunBakedTrash]

There are too many variables to map out a career like this other than “I definitely want to do only pediatric pathology in academics and will just do a pediatric pathology fellowship.” I think you should go into pathology residency with an open mind and figure things out, because it may turn out that you hate baby autopsies and love arguing with clinicians over bags of platelets.

As far as some unsolicited personal advice, the less fellowships you do, the better. Pick one thing you really like and be great at it, work hard to be proficient in everything else, get a job and profit.

 

[M&L]

There are too many variables to map out a career like this other than “I definitely want to do only pediatric pathology in academics and will just do a pediatric pathology fellowship.” I think you should go into pathology residency with an open mind and figure things out, because it may turn out that you hate baby autopsies and love arguing with clinicians over bags of platelets.

As far as some unsolicited personal advice, the less fellowships you do, the better. Pick one thing you really like and be great at it, work hard to be proficient in everything else, get a job and profit.

Thank you ! Great advice . Especially about arguing with clinicians hahaha . I can see that hahaha

 

[LADoc00]

Okay dude are you trolling the pathology community or what?

"What's wrong with Peds path?"....That is like asking "What's wrong with wearing a bikini and walking outside in front of an advancing Russian column in Ukraine?"

 

[M&L]

Not trolling ! I just really really really love kids and was wondering why it’s not more popular as a specialty . Totally get it now though Hahshs

 

[LADoc00]

Not trolling ! I just really really really love kids and was wondering why it’s not more popular as a specialty . Totally get it now though Hahshs

Low pay, horrific work conditions, low respect from other health care team members especially peds surgeons, too small of a community to get any promotions, no private practice opportunities, literal slavery, no mobility, living in a basement tied to a dirty mattress, praying a bus takes your arm so you can file disability at 45, staring longingly at your local homeless camp wishing your life was that simple, death threats from patients' parents, death threats from bill collectors because you are so poor etc etc.

 

[M&L]

oh my.... such a lovely picture hahahhahha. i am TOTALLY sold (kidding)

 

[caffeinegirl]

Not trolling ! I just really really really love kids and was wondering why it’s not more popular as a specialty . Totally get it now though Hahshs

M&L - I really don't think you know what you're getting yourself into - and it's fine to ask questions here but you should first start your pathology residency before making decisions about fellowships. And, if you really love kids - pathology is not for you. Pediatrics is the way to go. You will not be interacting with kids as a pathologist - only their specimens. And you will be treated as a rudimentary part of the clinical team - just asked to regurgitate the diagnosis in most cases. Unless you are part of an academic institution and take part in research, will you actually make an impact in pediatric care as a whole. Your want to do private practice is in direct conflict with your questions about pediatric pathology.
The majority of private practices do NOT take specimens from children, other than screening pediatric GI (minority of GI specimens and mostly negative), and tonsils (gross only examination). Pediatric pathology is present in children's hospitals - and children's hospitals are academically affiliated. Also, a large portion of peds path is fetopsy.

 

[M&L]

Respectfully, I do know what I am getting myself into to an extent . I have a total of over a year of full time pathology experience in different fields including pediatric autopsy . And I personally , under limited supervision, did a few myself . I said I love to work with kids and peds - because I assumed that everyone on this forum will assume that I am talking about PATHOLOGY work, not work of a pediatrician (if I said that I prefer pediatric autopsy to adult ones I would look like a psychopath ).

Next - I think it’s very important to ask questions like these while you are selecting residencies . I am going through an interview season now, and availability of fellowships and exposure to those experiences is important to me . Some residencies have virtually no experience in peds - and I do want to decide if that is important to me or not before I decide between residencies that are half a country away .

Also - I know exactly why I want to be a pathologist . And I had a lot of exposure to it . However, I do not know what potential employments look like . And that is also important- which is why I ask questions , and people who are currently in pathology workforce share . And I am learning from that . And this is what this forum is for .

 

[M&L]

Your want to do private practice is in direct conflict with your questions about pediatric pathology.

How am I supposed to know that without asking that question ?

This is why I am here . I found peds path very interesting , and i am asking questions from people who know more about the field and workforce . Because I need to decide on the residency training. Can we please normalize asking questions ? This is what this resource is for .

 

[M&L]

And, if you really love kids - pathology is not for you.

Also - this is a bit of a narrow minded statement in my opinion . Please don’t generalize like that . You can love kids and be a pathologist at the same time hahaha .

 

[Daddydoc]

Not trolling ! I just really really really love kids and was wondering why it’s not more popular as a specialty . Totally get it now though Hahshs

I love kids. That's why I have kids and don't do pediatric autopsies.

 

[caffeinegirl]

Also - this is a bit of a narrow minded statement in my opinion . Please don’t generalize like that . You can love kids and be a pathologist at the same time hahaha .

If you love kids, pathology will not fulfill that love - you don't go into pathology because you love kids. See Daddydoc's post prior. It's good to ask questions, but also try to understand the responses that are given. Sometimes also being a little humble about it may help as well.
Edit - it also helps not to post the same questions in three different threads.

 

[KeratinPearls]

If you love kids, pathology will not fulfill that love - you don't go into pathology because you love kids. See Daddydoc's post prior. It's good to ask questions, but also try to understand the responses that are given. Sometimes also being a little humble about it may help as well.
Edit - it also helps not to post the same questions in three different threads.

Agree, if I interviewed you for a path residency or a peds path fellowship spot and you told me your future goal is to be a pediatric pathologist because you “love kids” I probably would think pediatrics would be a better field for you. You don’t go into pediatric pathology because you love kids. You go into it because you have an interest in diagnosing pediatric tumors (neuroblastoma) and have a research interest in it. If you love kids and are putting your research efforts into advancing pediatric tumor research, then ok that’s a different story.

It’s like saying “I like people” or “I love adults” when someone asks you why you are interested in pathology. It’ll leave a lot of people scratching their heads.

This reminds me of a story of when I was in residency. One of the senior residents interviewed a candidate for a path position and the candidate asked “when do we start rounding?” SMH.

 

[WEBB PINKERTON]

I'm glad you like kids M&L. Not sure why you can't use pathology to help kids. I wish I liked kids. I remember handing mine off to the au pair after they were born. Then I started interacting with them around age 10 or so. The au pair did good job. All of them grew up to be successful. None got arrested for running shine.

 

[M&L]

i honestly do not understand why you guys are twisting my words and using this thread as an opportunity to put me down. i am not going into pathology to fullfill my love for kids... when did i ever say that? I want to look into pediatric population as a pathologist because i had a great time during my several rotations in pediatric PATHOLOGY. I do not see anything wrong about having a specific interest towards specific patient population.
honestly, it is disappointing that instead of seeing support, i see negativity from some people. I honestly expected more.
But thank you for earlier responders for ANSWERING MY QUESTIONS. That did influence the way I am ranking my residency options now.

 

[gyngyn]

Closing.