Pathology: Is it worth it?

I've also been having similar feelings. I have been reading this board for some time now and it seems the job market isn't great right now and the best jobs are by word of mouth, which sucks in itself because if you aren't in the right program, you don't know the right ppl, you're out of luck. Having said that, there's the issue of overtraining in pathology, which LaDoc and others have brought up numerous times before.

To give yourself an advantage in the marketplace, you have to do a fellowship in a high demand subspecialty, but these are highly competitive. If you do your residency in a program without these high demand fellowships, then it'll be that much tougher. Nowadays, it seems like anyone who is interested in surgpath or a surgpath subspec. (like myself) will do at least a surgpath fellowship. As a result, surg path fellowship training will eventually or has been the norm to survive in the marketplace. It seems as if you don't have at least a surgpath fellowship under your belt, you will struggle to find a job, unless you get lucky or know the right ppl.

Most of the jobs I've seen are academic jobs. However, from what I've read here, most academics start off at 100K-120K, which to me is quite low considering all the years we've been in school/residency and our huge debt incurred throughout medical school.

What I have stated above are the conclusions I have made from the information gathered from this board and from talking to other residents. If there's anything I've said that's incorrect, please correct me.

for what its worth, i'll input that i love pathology and am willing to endure whatever challenges exist in the job market . . . c'est la vie . . . i

but i have noticed - as far as talk goes - that optimism in the job market seems to be more common than it used to be.

nonetheless, i say job market issues - what makes someone competitive in the job market that is - are musings best left to those in residents, fellows, and attendings that are in the mix of it all . . .

KeratinPearls said:

To give yourself an advantage in the marketplace, you have to do a fellowship in a high demand subspecialty, but these are highly competitive. If you do your residency in a program without these high demand fellowships, then it'll be that much tougher. Nowadays, it seems like anyone who is interested in surgpath or a surgpath subspec. (like myself) will do at least a surgpath fellowship. As a result, surg path fellowship training will eventually or has been the norm to survive in the marketplace. It seems as if you don't have at least a surgpath fellowship under your belt, you will struggle to find a job, unless you get lucky or know the right ppl.

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I think the first part of your statement is an overestimation. A lot of people think that the fellowships will get them jobs. Fellowships do help, yes, but fellowships do not compensate for deficiencies in communication, common sense, general overall skill, etc. Private practice people don't necessarily need experts, they need competent pathologists. You can have five fellowships and be a bad employee. A fellowship, in extent, "proves" that you have competence in a certain field. This is becoming more important in areas of pathology.

The second part of your statement is more accurate, it is likely hard to find a decent job (unless you get lucky) if you haven't done any fellowships. Whether that is surg path or something else, that's open to personal choice and debate.

I find the job market discussions confusing and nebulous. Clearly some people have trouble finding jobs. Others do not. In my experience, people who are good communicators and good team players, and bring something to the table OTHER than attitude, laziness, poor interpersonal skills, and selfishness have a far easier time finding jobs, and fellowship status becomes a lot less important.

There are a lot of crap jobs in path, many times these are the ones you hear about. It's hard to say where the job market is going in the future due to reimbursement issues, etc, but the point is is that pathology as a field continues to grow, and the country is going to need new pathologists. How many it will need and whether there will be an oversupply is another debate, but what is not under debate is that the country will continue need new pathologists. If you work hard and set yourself up as someone who is desirable to work with and good at what you do, the job market will be a lot better.

I have yet to talk to someone established (i.e. more than a few years out) in private or academic practice who says that doing multiple fellowships automatically makes you a better candidate or makes you a better pathologist. The majority give you quizzical looks, it seems, especially if you are doing surg path + a subspecialty in surg path. Other combos get a better response.

And yes, the issue of "overtraining" is a common topic here. I agree, I think there are too many programs training residents. I have talked to a couple of residents at less competitive programs and a lot of times their days consist of spending 6-7 hours grossing, if they're lucky they get to sit in with an attending on signout for awhile, but oftentimes the attending just leaves the slides with them after signout. No preview time. This is not the way to train. Programs like this don't deserve residents. There are also programs that some residents like because they don't demand a lot (again, no preview time, minimal work hours, etc). Just because the residents have a happy lifestyle doesn't mean they are learning! These are residents that often DO have to do multiple fellowships, at other institutions, because their training wasn't that great. They may delude themselves and think they are competent, etc, but there really is no substitute in this field for seeing and doing a lot, not just reading or reviewing stuff that you already know the diagnosis for. This is WHY many private practice people want pathologists with "signout experience." I was talking to an attending here who trained at a small community program and his description of it was not good. He said it was a major struggle to land a good fellowship elsewhere. But yes, connections help. Many private jobs don't need to advertise because they have a network of people who will recommend applicants to them (i.e., attendings at big programs, societies, etc). I mean, heck, I called back a consult a while back and the guy who sent the consult basically offered me a job for probably well over $200k a year without me even bringing anything up. He said I should just skip my fellowship and come work for him. The issue is that there are a lot of mediocre programs training residents, who then flood the market. It brings down even the better jobs for whom these residents are not really even competitive for. But still, if you are a good resident at a solid program, many of these issues become much less important.

As someone who might end up having input in hiring people some day, I would recommend the field for anyone with a passion for it and a demonstrated work ethic. These are the people I want to work with. For people who say, "eh, I kind of like pathology but hear it has a great lifestyle!" or something like that, go somewhere else. Sure, maybe you'll discover you love it, that would be great, but maybe you won't. Maybe you'll be the one always trying to leave early and sticking me with the difficult cases. Maybe you'll be the one making the mistakes that I might have to fix. Maybe I'll be the one making mistakes and you won't be able to help me or advise me. I don't know. All I know is I don't what the future of pathology to consist of mediocre candidates because the good ones were scared away by fearmongering about the job market.

In response the the title of this thread...nothing in this profession is "worth it". You just have to choose the path of least resistance.

Getting a job in Pathology, I think, largely depends on what sub-specialty you want to practice and where you want to be. It may be hard to find a certain type of job in a certain place.
As far as sub-specialty, forensics is desperately in need of pathologists. Dermpath is not so devoid of willing participants. One thing I have noticed is that a lot of pathologists are older and will soon die or retire, whichever comes first.
I figure we will soon need people to fill those spots. Just my humble opinion. I also agree with much of what yaah posted.

getunconcsious said:

There are a lot of horror stories on here about Pathologists working as histotechs and stuff like that. My question is, how prevalent is this stuff *really*? It seems like everyone tells these stories but there seem to be a decent number of path attendings rolling around here and I've really only seen one person who consistently posts about having trouble finding a job.

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So far in my travels I have heard of 1 foreign pathologist who was working as a Path Assistant while passing the time towards completing boards etc. in the US. Obviously that case, if true, has nothing to do with the job market, as the individual had not completed boards (USMLE?) yet. Otherwise I have never come across such a thing, despite looking for it.

Additionally, there is LADoc's statement that when hiring histotechs, he received multiple resumes from Pathologists. My interpretation was that they were looking for unadvertised attending positions in the new practice, rather than being the histotechs, themselves. If the latter is the case, then that story is much more bleak that I had imagined.

Anyhow, otherwise I agree with yaah's statements. The opinions of the job market at residency programs may be biased, but I have not heard of major difficulties from either them or private practice attendings.

We should seriously start a counter for these threads... this has to be Job Market Thread #5 or 6 just in the year or so I've been reading the forums here.

getunconcsious said:

Hey guys,
So I know the title of my thread probably looks totally troll-ish but it absolutely isn't. I just want to know how bad the job market *really* is for Path. I am toward the end of M3 and I really do think Pathology is what I would most enjoy doing. However, I don't want to go into something that I'll never find a job in. There are a lot of horror stories on here about Pathologists working as histotechs and stuff like that. My question is, how prevalent is this stuff *really*? It seems like everyone tells these stories but there seem to be a decent number of path attendings rolling around here and I've really only seen one person who consistently posts about having trouble finding a job.

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Hopefully you're talking to these attendings you see, and residents you know, and not relying solely on an anonymous message board for your information about the job market. Also, I'd say you should look back over those previous threads. To borrow terms from the stock market, there are certain people around here who are always very bearish on the job market. Other people have a lot less "doom and gloom" outlook. I wouldn't let the opinions of a few anonymous people, on either side of the coin, sway you too much.

getunconcsious said:

I would really like to do Pathology and I'm not intent on making a huge amount of money but I can't stomach having no job in the field at all. I did enjoy Psychiatry and Pediatrics and would probably try for the triple board if I don't go for Path but I really do like Path much better! It's just that a reasonably enjoyable job is better than no job in a field you love. (Incidentally, triple board essentially ends up in Child Psych, which has the best job market ever).

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Child psych seems to be a world away from Path, but to each their own. For what it's worth, when I did psych it seemed like every psych resident and their dog around here was trying to get into a child psych program because of this "plentiful job market" - so who's to say what it will be like 5 or 10 years from now? This is the other thing, you're an MS3... so you're looking at, at best, probably 5 years before you're looking for employment, likely more. Trying to project at this point is difficult at best, especially given the current economic and political climate change that is and will be occuring...

getunconcsious said:

So...I guess my question is based on your own experience, would you advise people to stay the hell away from path due to the poor job market, or would you say go for it if it's your passion? Would you do path again or would you do less enjoyable work as a clinician due to their better job prospects?

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This is a question you have to answer for yourself. What if I told you I decided to be a plastic surgeon, because although I love path, I decided to do something I hate because jobs are plentiful and the money is good? Why should you even care?

I'm sorry, I know this has been a bit of a rant, but it seems like a month can't go by that we don't have another NEW thread about the job market, with a lot of hand wringing and people wanting us to somehow make up their minds for them. I know it can be tough to decide what speciality you want to do, etc, but it is ultimately a decision you have to make on your own, with your own values, and the information you'll get out of this fantastic but highly limited incredibly skewed "sample" of pathology aspirants, residents, fellows, and the occasional attending is not going to be of much use to you - or at least in my opinion shouldn't be.

Just my two cents...
BH

getunconcsious said:

Hey guys,
So I know the title of my thread probably looks totally troll-ish but it absolutely isn't. I just want to know how bad the job market *really* is for Path. I am toward the end of M3 and I really do think Pathology is what I would most enjoy doing. However, I don't want to go into something that I'll never find a job in. There are a lot of horror stories on here about Pathologists working as histotechs and stuff like that. My question is, how prevalent is this stuff *really*? It seems like everyone tells these stories but there seem to be a decent number of path attendings rolling around here and I've really only seen one person who consistently posts about having trouble finding a job.

I would really like to do Pathology and I'm not intent on making a huge amount of money but I can't stomach having no job in the field at all. I did enjoy Psychiatry and Pediatrics and would probably try for the triple board if I don't go for Path but I really do like Path much better! It's just that a reasonably enjoyable job is better than no job in a field you love. (Incidentally, triple board essentially ends up in Child Psych, which has the best job market ever).

So...I guess my question is based on your own experience, would you advise people to stay the hell away from path due to the poor job market, or would you say go for it if it's your passion? Would you do path again or would you do less enjoyable work as a clinician due to their better job prospects?

Thanks for your time

Click to expand...

Is pathology worth it?

Yes.

Sean2tall said:

So far in my travels I have heard of 1 foreign pathologist who was working as a Path Assistant while passing the time towards completing boards etc. in the US. Obviously that case, if true, has nothing to do with the job market, as the individual had not completed boards (USMLE?) yet. Otherwise I have never come across such a thing, despite looking for it.

Additionally, there is LADoc's statement that when hiring histotechs, he received multiple resumes from Pathologists. My interpretation was that they were looking for unadvertised attending positions in the new practice, rather than being the histotechs, themselves. If the latter is the case, then that story is much more bleak that I had imagined.

Anyhow, otherwise I agree with yaah's statements. The opinions of the job market at residency programs may be biased, but I have not heard of major difficulties from either them or private practice attendings.

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Yes, the pathologists who send me resumes, usually 1-2/mo are fishing for unadvertised positions. One person even made the mistake of sending their resume directly to the CEO of the hospital...that is a HUGE mistake and something you can get blackballed for, in addition to looking socially ******ed.

I would say 80-90% of all the 'fishing' resumes from 2007 were from FMGs, meaning they are having a far more difficult time finding jobs than AMGs.

The job market in Pathology is very complex and very different than say direct manpower type positions like GenSurg, Peds, FM etc etc. I would rather suck it up and sign out more cases and be more efficient than hire someone who I cant socially get along with. Social skill is paramount really.

I think alot of predictions of increased need for pathologists was flat out erroneous. As volume has increased, practicing pathologists like myself have simply become more efficient in sign outs, decreased spending time at conferences and consolidated their CP admin duties. Hours are longer, vacations shorter, but overall there simply isnt a big need for new pathologists.

The demographic issue tho is big: Women and FMGs simply do not want to practice in Redneck country and those that are willing to try, are not wanted by the current inhabitants of the 'Hinterlands' and frontier communities of the far west and midwest as well as the south US. Meanwhile, most pathology trainees are women and FMGs who for whatever personal reasons like to stay near large super saturated metro areas.

LADoc00 said:

The demographic issue tho is big: Women and FMGs simply do not want to practice in Redneck country and those that are willing to try, are not wanted by the current inhabitants of the 'Hinterlands' and frontier communities of the far west and midwest as well as the south US. Meanwhile, most pathology trainees are women and FMGs who for whatever personal reasons like to stay near large super saturated metro areas.

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I think that's a good point, and even including AMG males, a large % aren't willing to work in communities under 200k.

My hometown is ~75k...there are 2 path groups in town at competing hospitals, each with 5 or so pathologists, but they cover a huge area and drive to satellite hospitals like many other specialties. But the volume is still low enough that they can't hire a dermpath to look at skin biopsies all day...so if you're a graduating dermpath fellow looking for a high salary and skin only position, it's harder in the midwest.

Pathology is definitely worth it. It is a fanatastic career which allows one to engage in a variety of professional pursuits, ranging from pure clinical to basic science to adminstrative, or an interesting blend.

The job market will almost certainly be strong. That has been carefully worded, since no can state definitively that plenty of positions will be available for every pathologist who finishes a program in 5 years.

The data indicating that jobs will be available include
Pathologists registered in the AAMC database of physicians are currently the third oldest group of practicing physicians.

If pathologists continue to stop practicing (retire or die) in the next 5 years at the same rate that they have in the past 5 years, there should be about 600 new positions available each year.

With the aging of the population, there is a looming physician shortage which will impact all aspects of medicine, including the need for pathology services.

Academic medicine is sensitive to the future projected workforce demands and does reduce training slots when necessary. In anticipation of CLIA 88, several programs reduced the number of pathology trainees because of the strong probablility that there would be a reduced need for pathologists. This occured 5 years before CLIA was passed, to keep training positions consistent with future demands.

I encourage anyone with an interest in a career in pathology to apply for a pathology residency. There will virtually always be positions for intelligent, hard working pathologists.

Dan Remick, M.D.
Chair, Department of Pathology and Laboratory Medicine
Boston University School of Medicine

schrute said:

I think that's a good point, and even including AMG males, a large % aren't willing to work in communities under 200k.

My hometown is ~75k...there are 2 path groups in town at competing hospitals, each with 5 or so pathologists, but they cover a huge area and drive to satellite hospitals like many other specialties. But the volume is still low enough that they can't hire a dermpath to look at skin biopsies all day...so if you're a graduating dermpath fellow looking for a high salary and skin only position, it's harder in the midwest.

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10 pathologists in a area of 75K pop even if they are travelling to satellite areas is huge oversaturation, should be more like 3, maybe 4 if travel is that extreme. In fact I would say best to keep the # at about 1 pathologist per 30,000 total inhabitants. Right there is an example of what the future holds, as these people retire they simply wont be replaced by new trainees, the groups will merely contract.

My guess in your hometown, you have a small cadre of elderly pathologists who do little, suck alot of $$$ out of the revenue and need to be kicked to the curb ASAP.

-----
He will rebuke the sea, and make it dry, and dry up all the rivers: Bashan languish, and Carmel, and the flower of Lebanon languish...

LADoc00 said:

10 pathologists in a area of 75K pop even if they are travelling to satellite areas is huge oversaturation, should be more like 3, maybe 4 if travel is that extreme.

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Perhaps, or perhaps that 75K is the tip of the iceberg in that area. The city in which I attended medical school has a population of 110K in the city proper, but the greater metropolitan area has over a million inhabitants. It may not be unreasonable that 300K people are being serviced by those two groups.

Or I might be wrong.

LADoc00 said:

The demographic issue tho is big: Women and FMGs simply do not want to practice in Redneck country and those that are willing to try, are not wanted by the current inhabitants of the 'Hinterlands' and frontier communities of the far west and midwest as well as the south US. Meanwhile, most pathology trainees are women and FMGs who for whatever personal reasons like to stay near large super saturated metro areas.

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LADoc do you think that practices in the so-called "frontier communities" have difficulty filling compared to practices in the metro areas?

for what its worth, i vouch for getunconscious's coolness . . .

HRantz said:

LADoc do you think that practices in the so-called "frontier communities" have difficulty filling compared to practices in the metro areas?

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Umm yes, that is exactly what I said in the post.

There is mismatch between the type of person training programs are producing (metro-centered, hyper reliant on subspecialized consult services, err feminine types...) and the type of person needed in small community hospitals (masculine, self reliant and doesnt take crap).

This is your average trainee
http://www.estatevaults.com/bol/%20%20%20metrosexual-tm.jpg

this is what groups are looking for

getunconcsious said:

I'm sorry if I came off as dumb or arrogant or whatever.

(...)

I really didn't mean to offend anyone, and I'm sorry if I did. But I do think that after all the blood sweat and tears we've poured into medical school it's a valid question.

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No reason to apologize, if anything I'm the one that came off as arrogant... I was having an off morning... it is a valid question and I think you got some good info here. Best of luck!

BH

getunconcsious said:

Someone mentioned academic positions that pay 100-120k per year...that would be more than enough to keep me happy!

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getunconscious, I am not picking on you for making this statement, as I was once making similar statements in medical school. In fact, I don't think you can get through medical training without a certain sense of naivity. But let me ask posters this....After medical school loans hanging over your head for a number of years (medical school + residency + fellowship), don't you feel that the financial incentives are going to keep more and more pathologists away from academics? I seriously considered staying in academics, but every junior faculty at the institution I finished at had a spouse that was also a physician (usually in private practice), or a similar high paying job. In fact, I talked to some and they said that without their spouse's income, they wouldn't be able to stay in academia. It's pretty obvious why there is a paygrade difference between the private world and academia. But I just don't see how an academic salary will be enough for most people right out of training.

BU Pathology said:

Pathology is definitely worth it. It is a fanatastic career which allows one to engage in a variety of professional pursuits, ranging from pure clinical to basic science to adminstrative, or an interesting blend.

The job market will almost certainly be strong. That has been carefully worded, since no can state definitively that plenty of positions will be available for every pathologist who finishes a program in 5 years.

The data indicating that jobs will be available include
Pathologists registered in the AAMC database of physicians are currently the third oldest group of practicing physicians.

If pathologists continue to stop practicing (retire or die) in the next 5 years at the same rate that they have in the past 5 years, there should be about 600 new positions available each year.

With the aging of the population, there is a looming physician shortage which will impact all aspects of medicine, including the need for pathology services.

Academic medicine is sensitive to the future projected workforce demands and does reduce training slots when necessary. In anticipation of CLIA 88, several programs reduced the number of pathology trainees because of the strong probablility that there would be a reduced need for pathologists. This occured 5 years before CLIA was passed, to keep training positions consistent with future demands.

I encourage anyone with an interest in a career in pathology to apply for a pathology residency. There will virtually always be positions for intelligent, hard working pathologists.

Dan Remick, M.D.
Chair, Department of Pathology and Laboratory Medicine
Boston University School of Medicine

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Dr. Remick,
I must disagree with the statement that academic medicine is sensitive to future workforce demands, particularly in pathology. If this were true, we would not have seen the utter devastation that occurred in the pathology job market in the late 1990's. See link: http://members.tripod.com/~philgmh/pjm4.htm

In no other specialty in medicine has there ever been a need for a group such as the tripod group. The pathology job market even now is still weak with many grads underemployed and others unable to find employment. In what other field of medicine do you see residents doing three fellowships? I suggest you go to the CareerMD job fair on September 23, 2008 in your city of Boston to get a first hand look at the pathetic pathology job market. While other specialists are hotly recruited at these fairs, pathologists see almost no interest from the employers/recruiters. see link: http://www.careermd.com/careerfairs.shtm
In fact, I would encourage any medical student interested in pathology to visit one of the job fairs so they can get a first hand look.
If the pathology job market was not problematic, you would not see it discussed so often. How many threads do you see by dermatology or radiology residents concerned about whether they will be able to find a job?
ASCP Job Market Survey 2007: http://www.ascp.org/careerLinks/pdf/2007ResidentJobSurvey.pdf
The 2007 ASCP Job Market survey indicates that 76% of graduating residents and fellows who applied for jobs received a job offer. This means that 24% RECEIVED NO JOB OFFERS. If the U.S. as a whole had 24% of the population without a job, we would be in a severe depression.

Bravo to ExPCM's post! I completely agree!

I think that we all should actively do something about this issue. I think the ACGME SHOULD cut down on the number of residency slots offered per year. Instead of churning out close to 600 graduates (and certifying a total of 1000 per year --- this is the number Betsy Bennett quoted in the CAP Town Hall Meeting in Denver), we should maybe just have slots for 300 PGY-1 residents annually.

There is certainly a lot more demand for Dermatologists and yet they have kept their residency slots to less than 400 per year (about 380 I think). Not only do Dermatologists have the best job prospects among all medical specialties, they have also managed to become the most competitive field to get into (because there is a disproportionately larger number of residency applicants for the number of slots offered). Dermatology is a good model to follow and they even have somebody who has dedicated her career to studying the epidemiology of the Dermatology workforce --- Alexa Boer Kimball at Harvard.

Reducing the number of residency slots is the first, most important step to solving this seemingly insurmountable job market problem in Pathology.

exPCM said:

Dr. Remick,
I must disagree with the statement that academic medicine is sensitive to future workforce demands, particularly in pathology. If this were true, we would not have seen the utter devastation that occurred in the pathology job market in the late 1990's. See link: http://members.tripod.com/~philgmh/pjm4.htm

In no other specialty in medicine has there ever been a need for a group such as the tripod group. The pathology job market even now is still weak with many grads underemployed and others unable to find employment. In what other field of medicine do you see residents doing three fellowships? I suggest you go to the CareerMD job fair on September 23, 2008 in your city of Boston to get a first hand look at the pathetic pathology job market. While other specialists are hotly recruited at these fairs, pathologists see almost no interest from the employers/recruiters. see link: http://www.careermd.com/careerfairs.shtm
In fact, I would encourage any medical student interested in pathology to visit one of the job fairs so they can get a first hand look.
If the pathology job market was not problematic, you would not see it discussed so often. How many threads do you see by dermatology or radiology residents concerned about whether they will be able to find a job?
ASCP Job Market Survey 2007: http://www.ascp.org/careerLinks/pdf/2007ResidentJobSurvey.pdf
The 2007 ASCP Job Market survey indicates that 76% of graduating residents and fellows who applied for jobs received a job offer. This means that 24% RECEIVED NO JOB OFFERS. If the U.S. as a whole had 24% of the population without a job, we would be in a severe depression.

Click to expand...

Here is the relevant paragraph from the ASCP data:

Of those 461 who had either already applied or were planning on pursuing a job, 50% hadn’t formally applied,
while 232 had already applied, with 30% applying for 1-3 jobs, 10% for 4-6 jobs, 5% for 7-10 jobs, and 6% for
>10 jobs. Out of those 232 who formally applied, 194 formally interviewed (85% interviewed for 1-3 jobs, 13%
for 4-6 jobs, 2% for 7-10 jobs, and 1 person for >10 jobs). Seventy six percent of those who formally applied for
a job and 93% of those who formally interviewed for a job received job offers (180 people), with 58% receiving
1 offer, 27% 2 offers, 9% 3 offers, and 6% >3 offers.

Here is my interpretation:

Since 93% of those who interviewed for the jobs received offers, the market is not as bad as your claim that 24% of path graduates cannot find a job. Seems like those who applied and not interviewed yet were either rejected up front, or they applied recently and their application was not reviewed that. I dont' know which is the case. In any case, even if a ballpark of 10-15% of graduates cannot find a job, it is a sign that pathology job market is poor.

Conclusion: Pathology job market is weak, and the number of pathology residency spots should be reduced.

Nilf said:

Here is the relevant paragraph from the ASCP data:

Of those 461 who had either already applied or were planning on pursuing a job, 50% hadn't formally applied,
while 232 had already applied, with 30% applying for 1-3 jobs, 10% for 4-6 jobs, 5% for 7-10 jobs, and 6% for
>10 jobs. Out of those 232 who formally applied, 194 formally interviewed (85% interviewed for 1-3 jobs, 13%
for 4-6 jobs, 2% for 7-10 jobs, and 1 person for >10 jobs). Seventy six percent of those who formally applied for
a job and 93% of those who formally interviewed for a job received job offers (180 people), with 58% receiving
1 offer, 27% 2 offers, 9% 3 offers, and 6% >3 offers.

Here is my interpretation:

Since 93% of those who interviewed for the jobs received offers, the market is not as bad as your claim that 24% of path graduates cannot find a job. Seems like those who applied and not interviewed yet were either rejected up front, or they applied recently and their application was not reviewed that. I dont' know which is the case. In any case, even if a ballpark of 10-15% of graduates cannot find a job, it is a sign that pathology job market is poor.

Conclusion: Pathology job market is weak, and the number of pathology residency spots should be reduced.

Click to expand...

I agree that the pathology job market is weak and that residency spots should be reduced.
Only 76% of those who applied for jobs got a job offer, hence 24% did not.
The RISE exam is given in May each year. If you are finishing residency or fellowship in June and have not had a job offer by May, I see that as a bad situation.
Here is a link to the summary provided by the ASCP (see link: http://www.ascp.org/AboutUs/newsroom/forReporters.aspx)

The exact quote from the link is as follows (note: if I was writing the paragraph below I would have changed "relatively strong" to "relatively dismal"):
"2007 ASCP Resident Council Fellowship & Job Market Survey 12/1/2007
Continuing the practice begun last year, the ASCP Resident Council has again administered its Annual Fellowship and Job Market Survey to graduating residents and fellows in conjunction with the annual Resident In-Service Exam (RISE), which is administered by the ASCP. The job market continues to be relatively strong, with some fluctuations from last year. Of those residents and fellows applying for jobs, 76% received job offers, down 8% from last year, but similar to 2005. Click here to read the full results"

exPCM said:

Only 76% of those who applied for jobs got a job offer, hence 24% did not.
The RISE exam is given in May each year. If you are finishing residency or fellowship in June and have not had a job offer by May, I see that as a bad situation.

Click to expand...

Fair enough, but why had only 50% formally applied for a job? That's bizarre and calls into question the whole survey! Are they actually measuring and reporting what they intend to? Who are these 50% who haven't applied for a job yet want one?

I hate to sound like a broken record but the path job market IS NOT good.

yaah said:

Fair enough, but why had only 50% formally applied for a job? That's bizarre and calls into question the whole survey! Are they actually measuring and reporting what they intend to? Who are these 50% who haven't applied for a job yet want one?

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The ones that did not apply probably applied for fellowship.

As I've gotten farther along and heard of more people's experiences, the job market (at least for our graduates) is not nearly as bad as usually portrayed here. Is it a magical fairyland full of pots o' gold? No, of course not. Is it worse than most other medical fields? Yeah, probably. However, once you do land the right job, it beats the crap out of most other medical jobs.

Most of my observations have pretty much jived with what yaah has said before. It seems like everyone has gotten a job that is perfect for them. One person got a job where they will be working 2.5 weeks a month (but for slightly less money than most private jobs) and another person has a job where they're making buckets of money (but it's a high throughput practice, so you work your butt off). Both situations fit their personalities perfectly.

Are these jobs advertised? Absolutely not. There is still an "old boy's network" sort of mentality in pathology and most jobs fill that way. Private groups are much more likely to call up their old drinking buddy from residency for a job lead rather than a recruiter. When a grad has wanted to go to a city where we have no contacts, they have cold-called groups and scored interviews that way (this technique probably requires you to be at a well-respected dept).

I heard one guy say that his group will NEVER advertise another job opening. They did it once and were barraged by a parade of losers and the whole ordeal turned into a giant waste of time. A lot of the applicants either couldn't communicate in english or were just plain idiots.

Have our grads gotten jobs in such "desirable" places as NYC and SoCal? No, I don't think anyone has wanted to go to those places yet. Do all our grads go to small towns? No, some do, but others have gone to cities such as Boston, Nashville, Cleveland, Richmond, etc.

Are places only hiring GI, GU, and derm people? No, two people even got good jobs with such unsexy fellowships as neuropath and peds path. As LADoc's other post mentioned, most private groups (at least for now) are still looking for good generalists. While attending the Society for Hematopathology meeting at USCAP, I ran into one of our old grads. I was surprised to see him there since he had trained in cytopathology. It turns out that his group's main heme person was on a health-related sabbatical, so he had been made the group's hemepath person by default.

Sorry for the length of the post, but I've been collecting observations for a few weeks (USCAP is a great place to gossip) and hadn't had time to post them.

trent05 said:

The ones that did not apply probably applied for fellowship. Many people don't even bother to apply for a job and secure a fellowship long before the end of their 4th year. MANY residents who do fellowships do them because of percieved poor job prospects without them, this includes me. Furthermore, while some on this forum question the less than saintly motives for wanting marketable fellowships like Derm, GI, and GU, many feel that this is one way to compete in the horrific job market of pathology. This includes those of us at solid university programs with excellent communication skills. This is reality.

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No, the fellowship people were considered in a different category. That's why I have such a hard time with that survey. People are making sweeping conclusions about it without actually trying to see if it makes sense. It doesn't make sense unless they are leaving a lot of information out! The fact of the matter is that 50% of residents do not wait until april or may of their fourth year (or the end of their fellowship year) to start looking for jobs or what the heck, another fellowship. But that is what the survey is saying (unless, as I said, they are leaving things out or are confused). It is pretty tough to get a decent fellowship 2 months before it starts. Yes, I agree, having it say that 24% of people didn't get a job or whatever sounds terrible. But the way the rest of the data presents itself I have no idea how to interpret it. Take, for example - it says "636 were PGY-4 or greater (including fellows)...Of the 174 who weren't pursuing a job, 7% intended to apply for a fellowship." Huh? Two months before the end and you're only planning? It doesn't make sense. If these were people doing another fellowship anyway, wouldn't they be considered in the other category? And if they are considering people in multiple categories, then how many of those "applying for a job" were doing that for the current year? How many were doing another fellowship but getting an early start on job applications? There are so many additional questions you could ask that any meaningful conclusions you can try to draw out of the survey are basically shot.

As has been said above, and was reiterated at USCAP, you don't necessarily make yourself that much more marketable by doing a subspecialty fellowship. You may make yourself more marketable for certain jobs, but it won't help you with others. General skills and the other intangible factors, however, make you more marketable everywhere. It sounds trite and naive, but unfortunately it's true. I am NOT denying the importance of fellowships or suggesting people not do them, not by any stretch of the imagination. But the amount of importance that is put on doing multiple fellowships, or doing a "more competitive fellowship" by many people, including some who post on here, is a bit off the charts. Ask yourself what you are making yourself more marketable for. Anyone who knows people in the real world will tell you that employers would much rather have a competent, skilled pathologist without a subspecialty than a ***** with one.

I think part of the problem is that people think too much in terms of black and white, A vs B, etc. Either the job market is great or it's terrible. Either a fellowship makes you a better candidate or it doesn't. Things don't work like that. There are gray areas. There are bad parts to the job market and there are good things about it. Doing a fellowship is good thing in almost everyone's eyes. You get more training, more confidence, you gain expertise in an area, but this is only part of the equation. If you keep focusing on this and neglect the rest, it isn't going to help you much.

However, doing a subspecialty fellowship will definitely make you more competitive for pod lab jobs or mega lab jobs, if that is what one wants. It also helps you for academics provided you want to focus on that area. And of course, it can help you in private practice too, but it isn't the panacea.

I suggest that those of you who are confused or having difficulty understanding the ASCP survey should consider contacting the ASCP Resident Council Chair Dr. Anna Moran (email: [email protected] ).
I think that all attempts at trying to put a happy face on the data are akin to trying to make a silk purse from a sow's ear.

exPCM said:

I hate to sound like a broken record but the path job market IS NOT good.

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We get it. You're unemployed. Fix the record already.

These threads are getting really tiresome....

Can't we all just STFU? Or, complain some more. See if I care.

The money is an afterthought here, but an important one.

I want to do path. It's a good fit for my personality and among the minority of medical careers that I could see myself enjoying for a very long time. I know the sort of work that residency entails, and it is going to take a lot of patience, effort, and humility on my part to get the most out of four years and be ready to sign out cases.

My observation is that it is not easy to excel in this field, that autonomy and social grace are not only desirable but necessary attributes for employment anywhere, and that not all graduates of dream programs are able to find their dream jobs in dream locations even if they have completed one or more dream fellowships. Might have to move an hour outside of the city or settle for a less than perfect contract if location is a top priority. Probably won't have to relocate to some one-horse-town and wait for the current guy to die so you can have his spot. That's not what I'm hearing.

Probably easier to work your way into an academic job if the reported salary is really what is being offered. I hope the money in academia is better. The new attendings work very hard. While none of us run the risk of starving on those salaries and I'd personally rather be underpaid in my career than uninspired, some friends of mine who are single would be unable to afford living in one of the big cities while paying off their debts on that sort of a salary. They would have to find a second source of income or through some miracle defer repayment of their loans. Something doesn't sound right.


There, I'm guilty of it.

EtOHWithdrawal said:

We get it. You're unemployed. Fix the record already.

These threads are getting really tiresome....

Can't we all just STFU? Or, complain some more. See if I care.

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Actually I am fortunate to be a pathologist with a job. I know several pathologists without jobs.
I guess many things are tiresome such as:

-Real estate prices are crashing
-Gas is 3.00+ a gallon
-Food prices are escalating
-The federal budget deficit is at an alltime high.
-Medical school tuitions are escalating
-Physician reimbursement from Medicare is slated to be cut 10% on July 1 and an additional 15% on Janaury 1.
etc.

Yes, I say we should not talk or complain about anything. Let us just bury our heads in the sand. Let us be like many people during World Wars I & II, the Korean War, the Vietnam War, etc. who dared not speak about atrocities and then claimed afterwards that the atrocities never happened. Yes, ignorance is bliss. If we do not talk about problems then they will be sure to disappear.

exPCM said:

I know several pathologists without jobs.

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What are they doing and how long have they been unemployed?

getunconcsious said:

Is there no consensus as to my question? Would you or would you not advise students who most like pathology to pursue it? Or do you think it would be a better idea for us to pursue other specialties that we maybe weren't crazy about but could live with? Maybe I'll apply for path and then if i'm unemployed do a 2nd resideny in psychiatry

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You will not find a consensus answer. You will get different answers from different people with varying experiences. Here are some of my friends' experiences:

Friend 1: Job right out of a GU fellowship making >300K.

Friend 2: Job right out of a Dermpath fellowship making 375K.

Friend 3: Job right out of a Hemepath fellowship making 250K but partner in 3 years and will then make 600-800K.

Friend 4: Been practicing for 20 years, lost her job after their lab got bought out, now working as a Pathologist in Abu Dhabi, United Arab Emirates.

Judge for yourself. Enter Pathology at your own risk.

EtOHWithdrawal said:

We get it. You're unemployed. Fix the record already.

These threads are getting really tiresome....

Can't we all just STFU? Or, complain some more. See if I care.

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ORLY?

The data from ASCP survey are more reliable than any anecdotal evidence. Don't believe when somebody tells you that 'all residents from my program got jobs'. Anecdotal evidence is unscientific and often misleading. The survey is the most comprehensive existing source of information on the current state of pathology job market. If you know a better one, please share it with everyone.

Here is what should be done:
1. Show these data to your program director or whoever is responsible for recruitment. Discuss the rationale of increasing the number of residency spots with him.

2. Email ASCP for further clarification. [email protected]. Ask them why they think that 'job market is relatively good'.

3. Call AND email USCAP about it. Try to get directly to Fred Silva.

4. Make sure that every resident in your program knows these numbers. Encourage them to repeat points 1-3.

My point is not that I think the job market is good, or that physician reimbursment should be cut or that I want to buy a hummer that gets 3 miles per gallon...rather my point is that complaining anonymously on SDN is akin to doing nothing. It's boring to read everyday. It's the same argument all the time.

So maybe instead of STFU, I should have said "If you are this upset about the state of pathology training and reimbursement, stop talking and get involved in whatever way you see fit."

my two cents:

Do what you enjoy doing. Sure we can all predict the future, but no one can predect or future better than you can. So once again: Do what you enjoy doing.

I can't tell you how many people have told me along the way, "medicine is not what you want to do, go take up drawing because you are so good at it!" and once I got into medical school, " there is no way that you can find funding for your research in this economy," ect... But in the end I had to blow everyone off, because it's my future, not theirs. Sure I've hit bumps in the road, but you push through them.

If you want to be a pathologist, just DO IT. Once again: In the end, no one can predict your future better than you can. (have I repeated myself enough?)

getunconcsious said:

Blech, I don't doubt that you are right it's just that this is another one of those "confusing information" conundrum type things. Everyone wants to know, "why another thread complaining about the job market?" Well I'm not complaining about it, I just want to know whether I should enter it at all or not!

I think I will still go with Path because that is what I most like and also because (dare I say it on SDN?) I think I really have pretty strong numbers. So I suppose I'll see. But the recent posts on this thread have sort of confused me. Is there no consensus as to my question? Would you or would you not advise students who most like pathology to pursue it? Or do you think it would be a better idea for us to pursue other specialties that we maybe weren't crazy about but could live with? Maybe I'll apply for path and then if i'm unemployed do a 2nd resideny in psychiatry

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If a student likes something else just as much as path, I would probably advise them to do that. If path is what they like most then they should do path.

One thing about those universal surveys that should be taken into account: in pathology there is a huge discrepancy between the respectable programs and the bottom tier places. This is different from just about any other specialty. A mediocre surgery or medicine resident at some terrible community program is almost certainly going to have a job when they finish. The same may not be true for pathology.

Nilf said:

ORLY?

The data from ASCP survey are more reliable than any anecdotal evidence. Don't believe when somebody tells you that 'all residents from my program got jobs'. Anecdotal evidence is unscientific and often misleading. The survey is the most comprehensive existing source of information on the current state of pathology job market. If you know a better one, please share it with everyone.

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Data, in general, doesn't have as much of an impact on individuals as it does on groups and overall trends. And since most people here are individuals, that's often more important. What happens with your own program is often more instructive than what happens with other programs. So yes, everyone finishing my program gets a good job. To me, that has far more relevance and interest than the experiences of people outside, of whom I know nothing. Are they good pathologists? Are they poor communicators? Do they know how to balance a checkbook? Do they have a drug problem? I don't know these things. There are all kinds of reasons why people can have trouble finding a job. The data speaks to the fact that there are plenty of people having difficulty finding jobs, and is cause for concern, but we already know that anyway. You have to make yourself a competitive candidate.

And as I said above, you may think the data from the survey is compelling, but when you look at the data and the conclusions that are stated without further explanation it doesn't make any sense. Perhaps it makes sense to you, but is that because you are reading what you want to from it?

As far as your suggestions, if you're the one who is terribly concerned, then you should be the one doing the contacting. To me, the bigger concern than too many residency programs is too many mega lab and pod labs proliferating. Those are the factors that are hurting the field far more.

To getunconscious - if path is what you want to do, then do it. You can basically look at any data or opinion and have it make whatever conclusion you want it to. If you are a good candidate with good numbers you are likely going to get into a good program, and if you perform well you will succeed and likely get a good job. Might you have to sacrifice some things (location, salary, whatever) in order to find the best job for you? Probably so, but path is not family practice - there isn't a huge shortage of people going into it.

I'm kind of in the OP's position. Right now I'm a second year med student who is planning out his 3rd and 4th year schedules, and I am rethinking my decision to take a path elective. Path has been interesting the past two years, and I've long thought that I would probably go into it. I went into med school thinking I would end up in pathology. But over the past two years, I've found other fields interesting as well.

Ideally, I would find a job in a certain competitive job market, because that's where my family is. Location is important. Instead of exploring a field with reportedly small prospects in competitive regions (path), perhaps I should just use my time to explore other fields like rads or psych.

If the job market is really that tough, is it even worth it to take an elective in pathology?

Going into a field just because you really like it is simplistic IMHO.
If somebody told you they really loved VCRs and wanted to become a VCR repairman would you tell them to go ahead and do it. I would tell them that VCRs will be obsolete in the near future. If someone told you they really wanted to be a switchboard operator, meter reader, typewriter repairman, etc, would you tell them to go ahead as well. Medical students often have large debts and unfortunately I do think that being able to repay those debts may have to be factored into specialty selection. Now I am not saying that going into pathology is equivalent to becoming a VCR repairman but I think that we should not overemphasize the positive aspects and gloss over the downsides of pathology.

CameronFrye said:

If a student likes something else just as much as path, I would probably advise them to do that.

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That is really sad that we ourselves, i.e. Pathologists, do not think that our specialty is good enough to enthusiastically encourage our medical students to choose it over all other fields. But you know what, that is the sad truth. Pathologists in practice have told me several times to pursue getting into a Dermatology residency after my Dermatopathology fellowship because I would be much better off becoming a Dermatologist than a Pathologist.

I guess the one positive thing about medical students choosing not to do Pathology is that it will become harder and harder to fill the residency slots. Then maybe the ACGME will wake up and finally reduce the slots and restrict them to large academic centers.

deleted

I know two unemployed pathologists who are now stay at home moms due to lack of available jobs in their regions. I know two others who are working at cosmetic skin clinincs (they do not have dermatology residency training).


Here is an example of a pathologist doing cosmetic dermatology work
http://www.learncosmetics.com/learncosmetics/bio.html

Here is an example of a pathologist now working as a Vein Doctor. http://www.stlveindoctor.com/

Here is a pathologist working as an ER doc
http://www.ochsner.org/page.cfm?id=1564&action=detail&ref=479

This is older material but it is interesting and not totally irrelevant to the current situation
http://members.tripod.com/runker_room/ap/ap_jobs.htm

Are you not a Dermatopathologist? So, even then, with all this hype about Dermpath being so great, you still think that Pathology should be pursued only if there is no other option available to one who is deciding which specialty to get into?

exPCM said:

I know two unemployed pathologists who are now stay at home moms due to lack of available jobs in their regions. I know two others who are working at cosmetic skin clinincs (they do not have dermatology residency training).

Here is an example of a pathologist doing cosmetic dermatology work
http://www.learncosmetics.com/learncosmetics/bio.html

Here is an example of a pathologist now working as a Vein Doctor. http://www.stlveindoctor.com/

Here is a pathologist working as an ER doc
http://www.ochsner.org/page.cfm?id=1564&action=detail&ref=479

This is older material but it is interesting and not totally irrelevant to the current situation
http://members.tripod.com/runker_room/ap/ap_jobs.htm

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The path job market isn't great like rads, but it's not crap. However, I wouldn't read much into the examples you bring up above.

Born in New York City, Dr. XXX graduated from Duke Medical School in 1964.
He completed 5 years of training in anatomic, clinical pathology and hematopathology. After serving 2 years as a Major in the armed forces, Dr. XXX located to Florida where he has been in practice ever since. In his practice he specialized in cancer diagnosis for 25 years. He also headed an 11 physician group, ran business affairs, and was president elect of the AM Foundation of Pathology, a national medical organization.
"Dr. XXX saw the tremendous potential
in medical aesthetics"

After a successful retirement of 3 years, Dr. XX saw the tremendous potential in medical aesthetics and retrained, starting an entire new career. His training included the use of dermal fillers such as Cosmoplast/derm; Restylane and Radiance™ as well as Mesotherapy.
Dr. XXX has now been doing facial aesthetics specializing in BOTOX® and facial fillers for over 4 years. He is an active member of the BOTOX® Cosmetic Physician's Network and he also teaches other physicians in all of these areas.
Dr. XX currently practices in Jupiter, Wellington and Boca Raton.
------------------
C'mon, the guy was in pathology for 25 years! Plus, he probably saw the opportunities in aesthetics and decided to go into it, not because he was unemployed (btw, he is retired). He saw a business opportunity and took advantage of it. Probably still made a good living in retirement.

Unless you know these guys, I wouldn't read much into it. People do different things for different reasons.

Of course, the path job market now isn't at the level of rads or derm. Your chances of landing a job in rads coming from a community program are much better than coming out of a community path program.

I was at Fred Silva's talk several months ago and he didn't say anything to the fact that the path job market was horrible. He seemed to have an optimistic tone to his talk. So why is this guy saying there will be jobs for graduates at talks over the country when there are posters here who are saying the job market sucks? I think that's why we have so many posts on this topic...because there's no consensus.