2020 Match - Pathology Continues to be Less Competitive

[KeratinPearls]

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Offers for FM where I am are 200k-250k/yr M-Th 8-5p and Friday 8-12noon. 25k sign on bonus.

IM hospitalists are getting 250-300k/yr and nocturnists 300k-350k/yr for 7 days on/off, and ~25k sign on bonus. I am already receiving these offers as a PGY2 IM.

You will never get offers as a resident in pathology. I don’t know anyone who has.

Those numbers line up with how much paths are averaging. I only came across two jobs who offered a signing bonus. One was for a job in the middle of nowhere for up to a $10,000 signing bonus. The other was a $50,000 signing bonus in a city near the Canadian border. Salary was $375 if you can believe it. Those were the only two signing bonuses I saw on paper.

 

[yaah]

My utter nonsense comment was a general statement and was not targeted at you or your opinion. I stand by that statement, and all I was trying to say is that most American medical school graduates are aware of pathology as a specialty/career choice.

That may very well be true. I may have been particularly ignorant when I was that age. But when I talk to aspiring health professionals, a lot of them have very little idea of what we do day to day.

 

[D1b()4]

That may very well be true. I may have been particularly ignorant when I was that age. But when I talk to aspiring health professionals, a lot of them have very little idea of what we do day to day.

They are ignorant on the details (e.g. steps of tissue processing, TAT, various testing options), but they know who to call if someone has a mass, and they need a definitive diagnosis. I am talking about our non-pathology colleagues in general, including recent American medical school graduates.

Regarding aspiring medical professionals, it is not surprising that medical school applicants or first-year medical students don't know much about pathology, but they will usually learn about it by the end of the second year.

 

[D1b()4]

The other was a $50,000 signing bonus in a city near the Canadian border. Salary was $375 if you can believe it. Those were the only two signing bonuses I saw on paper.

Why haven't you taken it? Is living near Canadian border a bad thing?

 

[Splenda88]

You will never get offers as a resident in pathology. I don’t know anyone who has.

Those numbers line up with how much paths are averaging. I only came across two jobs who offered a signing bonus. One was for a job in the middle of nowhere for up to a $10,000 signing bonus. The other was a $50,000 signing bonus in a city near the Canadian border. Salary was $375 if you can believe it. Those were the only two signing bonuses I saw on paper.

It's unfortunate that path is like that. PGY2 residents I am friend with in my program are getting these offers weekly... One PGY3 in my program signed a contract for 450k/yr (18 shifts/month nocturnist), 25k sign on bonus + quality improvement (whatever that means) bonus monthly.

 

[KeratinPearls]

Why haven't you taken it? Is living near Canadian border a bad thing?

I wasn’t considered. They went with someone else although I did have a phone interview. That’s as far as I got. The phone interview.

 

[D1b()4]

It's unfortunate that path is like that. PGY2 residents I am friend with in my program are getting these offers weekly... One PGY3 in my program signed a contract for 450k/yr (18 shifts/month nocturnist), 25k sign on bonus + quality improvement (whatever that means) bonus monthly.

But who wants to be a nocturnist? It is bad for your health.

 

[D1b()4]

I wasn’t considered. They went with someone else although I did have a phone interview. That’s as far as I got. The phone interview.

Got it, I have misinterpreted your statement.

 

[KeratinPearls]

It's unfortunate that path is like that. PGY2 residents I am friend with in my program are getting these offers weekly... One PGY3 in my program signed a contract for 450k/yr (18 shifts/month nocturnist), 25k sign on bonus + quality improvement (whatever that means) bonus monthly.

Yes it’s unfortunate but in my opinion the supply demand curve in pathology is shifted more towards supply than demand. If there was a demand for pathologists, then we would see employers offering jobs to residents or residents not having to do a fellowship.

 

[KeratinPearls]

Unty,
I think your arguments here (particularly #1) are highly flawed. This survey got responses from 346 practices (citing your post above), out of an estimated 1400 practices (also from your post above). This is a 24.7% sample.

Out of roughly 25% of practices, there were 246 positions (also quoting you). I don't think these facts are in dispute.

IF these 25% of practices are representative of all path practices, then accounting for all such practices the jobs out there for last year would be 996 jobs in the field. This means there are roughly 1.7 jobs out there for every path resident graduating. Claiming that the SAMPLE number is the actual jobs available and then concluding that means the job prospects are poor is disingenuous at best.

Now, you could argue that this sample is NOT representative of the overall marketplace (your second argument). a sample size of 25% is HUGE compared to most survey samples. You can use statistics to demonstrate this is an adequate number, and I believe it probably is. You could also argue that this sample is biased in some way, that labs not hiring are less likely to fill out the survey, or something else, but what evidence do you have for that, or even what practical hypothesis do you have beyond trying to support your own conclusions????

There was definitely not 996 jobs through my job search and believe me I put a lot of work into looking for jobs.

 

[Splenda88]

But who wants to be a nocturnist? It is bad for your health.

Well, someone has to do it...

 

[D1b()4]

Well, someone has to do it...

Yeah, but that's not an easy job, even for 450k. I know of one recent pathology fellowship graduate who got 450k straight after fellowship in a desirable location. So, people do get those high-paying jobs in pathology as well, but it is rare.

Here is the distribution of pathology salaries among the people I personally know who have accepted offers this year straight after fellowship in non-academic setting:
200-250k: 1 person
250-300k: 2 people
300-400k: 2 people

 

[Spikebd]

It's unfortunate that path is like that. PGY2 residents I am friend with in my program are getting these offers weekly... One PGY3 in my program signed a contract for 450k/yr (18 shifts/month nocturnist), 25k sign on bonus + quality improvement (whatever that means) bonus monthly.

18 shifts a month as a nocturnist sounds so painful to me. Noooooo thank you. I don’t even think I could make it past one year.

 

[KeratinPearls]

Yeah, but that's not an easy job, even for 450k. I know of one recent pathology fellowship graduate who got 450k straight after fellowship in a desirable location. So, people do get those high-paying jobs in pathology as well, but it is rare.

Here is the distribution of pathology salaries among the people I personally know who have accepted offers this year straight after fellowship in non-academic setting:
200-250k: 1 person
250-300k: 2 people
300-400k: 2 people

Weird the places I interviewed at started at 180k, one at 200k. Salaries go up over time but I never saw those salaries as a starting job offer. Most of my friends started 180k and 190k or low 200s.

The 450k is a dermpath? Hospital based or corporate lab? GI biopsy only?

 

[D1b()4]

Weird the places I interviewed at started at 180k, one at 200k. Salaries go up over time but I never saw those salaries as a starting job offer. Most of my friends started 180k and 190k or low 200s.

The 450k is a dermpath? Hospital based or corporate lab? GI biopsy only?

The 450k is a general hospital-based position with a very high volume. The area is desirable, but the cost of living is also pretty high. The lowest offer I have personally heard of this year was 210k in a corporate lab.

Seriously, what's the point to start at 180k if you can get low 200s in most academic places with plenty of off-service time?

 

[KeratinPearls]

The 450k is a general hospital-based position with a very high volume. The area is desirable, but the cost of living is also pretty high. The lowest offer I have personally heard of this year was 210k in a corporate lab.

Yeah that corporate lab job was me lol. The caseload isn’t high though.

My friends like I said had a starting salary in a smaller corporate lab for 190k. I interviewed for a job in the middle of nowhere hospital and salary was 220k with 10k signing bonus.

Yeah higher volume expect higher pay but then again you’ll be working hard.

 

[V5RED]

Shame on you for your anecdotes!

In all seriousness, the two fields are vastly different. Not just patient contact vs no patient contact. Just curious, what makes you like both?

I have always liked histology. I was drawn to taking the pathology electives to see what else there was. In the first elective, I got hands on experience grossing and helping prep frozens. I also got to present a case to the department and help refresh them on how to read a CT and aspects of the clinical history not often discussed in the department. In the second, I observed/very lightly assisted with autopsies, more grossing, and was given a fly through of the various parts of the pathology department. It was all very engaging and the kind of work I would enjoy.

For Family Medicine, I felt I was the most helpful to my team on my Family Medicine clerkship/electives. I am a people person and like building the relationships and the longitudinal care. My advisors were shocked to hear I had an interest in pathology for exactly that reason. They said they would not expect me, of all people to want to avoid patient contact.

I like having the option to do basically whatever I want with my career. If I want to focus on OB, I can. If I want to be procedure-heavy, I can. I can be a hospitalist. I can be semi hospitalist semi outpatient. I can provide almost all the care underserved populations need. A huge factor is that I can take care of a whole family and if I put in the work to build the skills that are in my scope of practice, people that would otherwise not get the care they need can come to me for most of their needs. Technically, the money is less, but it isn't like I will be financially hurting in FM. It pays much more than I need to be happy.

 

[KeratinPearls]

I have always liked histology. I was drawn to taking the pathology electives to see what else there was. In the first elective, I got hands on experience grossing and helping prep frozens. I also got to present a case to the department and help refresh them on how to read a CT and aspects of the clinical history not often discussed in the department. In the second, I observed/very lightly assisted with autopsies, more grossing, and was given a fly through of the various parts of the pathology department. It was all very engaging and the kind of work I would enjoy.

For Family Medicine, I felt I was the most helpful to my team on my Family Medicine clerkship/electives. I am a people person and like building the relationships and the longitudinal care. My advisors were shocked to hear I had an interest in pathology for exactly that reason. They said they would not expect me, of all people to want to avoid patient contact.

I like having the option to do basically whatever I want with my career. If I want to focus on OB, I can. If I want to be procedure-heavy, I can. I can be a hospitalist. I can be semi hospitalist semi outpatient. I can provide almost all the care underserved populations need. A huge factor is that I can take care of a whole family and if I put in the work to build the skills that are in my scope of practice, people that would otherwise not get the care they need can come to me for most of their needs. Technically, the money is less, but it isn't like I will be financially hurting in FM. It pays much more than I need to be happy.

Good for you. Sounds like you enjoy interacting and caring for your patients directly. I think FM was a good choice.

 

[V5RED]

thanks for chiming in here. And good for you for doing your own research /r job market family med vs path.

did you by chance glean what is typical starting package for fam medicine regarding compensation, sign on bonuses, loan repayment, etc. If so would you mind sharing?

Good luck with your career. Having a little more knowledge of path and lab medicine will be a help for you in family medicine.

Thank you. I don't recall the starting packages. I was mostly just concerned with my options for where to live/work and being able to start straight out of residency. I am an older student and want to get started as soon as I can. Since both pay much more than I would ever need(not a big spender except on cookware and items for other food prep) I was not too concerned with the salaries.

 

[V5RED]

Good for you. Sounds like you enjoy interacting and caring for your patients directly. I think FM was a good choice.

Thank you. I believe so too. I will definitely miss the things I got to do in pathology, but at a minimum the pathologists I send specimens to will not be getting tiny, nearly useless specimens. I also have a better appreciation for their work and building a good rapport with the people I will send specimens to.

 

[Alteran]

Offers for FM where I am are 200k-250k/yr M-Th 8-5p and Friday 8-12noon. 25k sign on bonus.

IM hospitalists are getting 250-300k/yr and nocturnists 300k-350k/yr for 7 days on/off, and ~25k sign on bonus. I am already receiving these offers as a PGY2 IM.

Things must have changed since I was in medical school. I don't ever remember IM being that well compensated. That starting range is just short of what some private practice pathologists make in partnership.

 

[Splenda88]

Things must have changed since I was in medical school. I don't ever remember IM being that well compensated. That starting range is just short of what some private practice pathologists make in partnership.

IM outpatient salary is just like FM (not very well compensated), but hospitalists are doing well. The market is extremely good right now and If an employer is not prepared to offer 250k+ with all the benefits, you will have a hard time getting IM physicians on board. I don't know any PGY3 in my program that got less than 250K for 7 days on/off. The ones who signed nocturnist contracts got 300k+

 

[Med Director New England]

Was I even responding to you? That post wasn't targeted at anyone - there were a couple that said my opinion was utter nonsense and that my opinion that exposure to path in med school was only ONE factor was crap. It wasn't crap for me and some others that I know personally, that's what I said, which to me means it's not utter nonsense. Sorry if it doesn't jive with what you want to believe. I don't really get what you're upset about.

I said it was for me. My experience. You're not an expert on my experience.

I have never said my own opinion is the only one that matters. I have a pretty standard track record here - I post my opinions when asked, never say they are valid for everyone, and ask for data. And then some of you guys get mad from time to time and say I'm making wild unsubstantiated claims. I post about what is being talked about in the literature and such to generate discussion. A lot of the things that you guys argue with me about are based on your own anecdotes or personal opinions (but yet anecdotes that don't support your opinions are somehow less important). When I ask for data many of you get mad or claim bias. At least there has been some discussion of data in this thread since then. This is good! I like data. I have been asking for 15 years on this forum for more data, I have felt the ABPath is in a good position to provide it, especially these days since everyone has to go through MOC. But these studies are not easy.

Most of the things on this forum that I get involved with are things I have questions about. It's hard to know the truth! So many things are multifactorial. Different experiences and different opinions are important. I'm not sure why mine is less important than yours. I have never said anyone's opinion is less important (except maybe the "flee pathology now" people) - I do post frequently when people are certain about things and I post my own experience which counters that, but it doesn't mean my experience or opinion is true for everyone. Just because I am arguing or posting a contrary opinion doesn't mean I don't respect yours.

And by the way, however, this issue is being formally studied. There are actually working groups and committees looking at the potential future shortage of pathologists and the declining number of US grads going into pathology. That is where this paper that I cited came from, and where others are likely to come from in the future. There is a LOT of interest from national organizations into the reasons for this. Perhaps you should contact the individuals who are working on these papers and help them out since they are so wrong.

So you don’t think Examing the data ABP has with MOC/cc would be helpful. It is right there: % path employed, % path employed part time, % paths leaving US to work elsewhere, # fellowships/ diplomate.

And all this trended over time for > than a decade.

What better data is there ?

+ the ABP has already reserved the right to study this data so long as it is de-identified, diplomates cannot object.

You gotta wonder why it hasn’t been looked at already.

 

[Alteran]

And by the way, however, this issue is being formally studied. There are actually working groups and committees looking at the potential future shortage of pathologists and the declining number of US grads going into pathology. That is where this paper that I cited came from, and where others are likely to come from in the future. There is a LOT of interest from national organizations into the reasons for this. Perhaps you should contact the individuals who are working on these papers and help them out since they are so wrong.

I think at a minimum most of us would like a formal acknowledgement from national organizations that there is in fact a problem with getting US medical students into pathology, rather than just dancing around the issue. There is a lot of heated back and forth on this forum, but I like to think we're all on the same page here. There really is no other reason for most of us to take time out of our day and post here if we didn't legitimately care about the integrity of our field.

If I may play the optimist for once, which is highly unusual for anyone who actually knows me personally, I think we're going to start seeing some serious talk at the national level on this in the next year or so because the rug they've swept all this under is so full of crap its starting to rival a small mountain. The pathology academicians I know personally are status quo people who like predictable routine. For them to actually take the time to put these studies together and publish them means they're motivated by something they find to be very unsavory. Just as we don't like to work with bad pathologists who at best are an annoyance and at worst a medical-legal nightmare, they must have reached a breaking point with either terrible trainees and/or a lack of prestige and subsequent blow to ego to have this kind of motivation.

Now, do I believe that anything is going to happen? That's an open question. It's one thing to write papers, its a whole other thing to actively enter the Machiavellian blood sport that is modern medicine and get your hands dirty.

 

[yaah]

I think at a minimum most of us would like a formal acknowledgement from national organizations that there is in fact a problem with getting US medical students into pathology, rather than just dancing around the issue. There is a lot of heated back and forth on this forum, but I like to think we're all on the same page here. There really is no other reason for most of us to take time out of our day and post here if we didn't legitimately care about the integrity of our field.

If I may play the optimist for once, which is highly unusual for anyone who actually knows me personally, I think we're going to start seeing some serious talk at the national level on this in the next year or so because the rug they've swept all this under is so full of crap its starting to rival a small mountain. The pathology academicians I know personally are status quo people who like predictable routine. For them to actually take the time to put these studies together and publish them means they're motivated by something they find to be very unsavory. Just as we don't like to work with bad pathologists who at best are an annoyance and at worst a medical-legal nightmare, they must have reached a breaking point with either terrible trainees and/or a lack of prestige and subsequent blow to ego to have this kind of motivation.

Now, do I believe that anything is going to happen? That's an open question. It's one thing to write papers, its a whole other thing to actively enter the Machiavellian blood sport that is modern medicine and get your hands dirty.

But there are initiatives looking at this - CAP has one called the pathologist pipeline initiative. The papers come from people who are involved in starting or participating in these committees. The video talks about what they are doing and the committee(s) being formed. One of the initiatives stated is that they want to provide credible information about the pathology workforce. A lot of you have such strong opinions, you should try to get involved.

 

[yaah]

So you don’t think Examing the data ABP has with MOC/cc would be helpful. It is right there: % path employed, % path employed part time, % paths leaving US to work elsewhere, # fellowships/ diplomate.

And all this trended over time for > than a decade.

What better data is there ?

+ the ABP has already reserved the right to study this data so long as it is de-identified, diplomates cannot object.

You gotta wonder why it hasn’t been looked at already.

Of course I think it would be helpful. I have said this 100 times. It's a captive audience. However I don't really have any idea what specific data the ABPath tracks - they clearly are tracking clinical activity because it's a specific part of the MOC. I don't know what percentage of active pathologists are grandfathered out of MOC though and aren't tracked - I am one of the oldest MOC era pathologists and I am over 20 years away from average retirement time. But it would still help to look at it.

 

[yaah]

You will never get offers as a resident in pathology. I don’t know anyone who has.

Those numbers line up with how much paths are averaging. I only came across two jobs who offered a signing bonus. One was for a job in the middle of nowhere for up to a $10,000 signing bonus. The other was a $50,000 signing bonus in a city near the Canadian border. Salary was $375 if you can believe it. Those were the only two signing bonuses I saw on paper.

True, although there is one kind-of exception. Some people get specifically targeted or recruited while still in residency by groups that know about them or whatever. We have targeted a couple of trainees who hadn't started their job search yet - I got targeted myself by a specific group while I was in my last year of residency. Recruiters do occasionally target practicing experienced pathologists for jobs, but yeah, it's nothing like fields like primary care or high-demand subspecialty fields.

I don't have any knowledge about whether signing bonuses are a thing or not in path - I would think in any field they would tend to be more common in salaried positions and may be called relocation expenses or something. I haven't ever encountered it in path, except for some people getting a couple of thousand bucks for moving expenses.

 

[y2k_free_radical]

His/her anecdotes are incredibly important - they are an individual experience. For this person, the key considerations were ability to be location limited and have lots of different job choices. That's important! And it's also a problem path has to deal with in recruiting future practitioners. It's hard to solve because the number of family med jobs is so much higher than the number of path jobs, but obviously it is a factor for some people. Not true for everyone of course, because not everyone is as OK with practicing in both path and FM, but obviously it's true for this person.

And those doing the study and crunching the numbers ARE COMPLETELY UNBIASED ,i'm sure.

 

[deleted314957]

It might have been true like 40 years ago, when you were in medical school. Excuse me, the whole second half of Robbins is a watered down version of what you can find in a general surgical pathology textbook.

Exactly. “ watered down” considerably. That is why i used the archaic term ” morbid anatomy”.


Sent from my iPad using Tapatalk

 

[KeratinPearls]

True, although there is one kind-of exception. Some people get specifically targeted or recruited while still in residency by groups that know about them or whatever. We have targeted a couple of trainees who hadn't started their job search yet - I got targeted myself by a specific group while I was in my last year of residency. Recruiters do occasionally target practicing experienced pathologists for jobs, but yeah, it's nothing like fields like primary care or high-demand subspecialty fields.

I don't have any knowledge about whether signing bonuses are a thing or not in path - I would think in any field they would tend to be more common in salaried positions and may be called relocation expenses or something. I haven't ever encountered it in path, except for some people getting a couple of thousand bucks for moving expenses.

Signing bonuses in my 6 month job search experience were for those jobs that were in rural or remote areas. I saw a $50,000 and a $10,000 signing bonus.

Getting recruited by path groups in residency is not the norm although there are people out there who get recruited and I’m thinking it’s at well known training programs with a good reputation.

 

[Alteran]

But there are initiatives looking at this - CAP has one called the pathologist pipeline initiative. The papers come from people who are involved in starting or participating in these committees. The video talks about what they are doing and the committee(s) being formed. One of the initiatives stated is that they want to provide credible information about the pathology workforce. A lot of you have such strong opinions, you should try to get involved.

I sat through the entire presentation and I seriously hope this isn't a recent presentation (edit: is just noticed it's from this year 😱). While I'll give him credit for recognizing there's a serious problem, he's either in total denial or completely ignorant of why pathology is unattractive. You can bring a horse to water, but you'll never get them to drink if the water is fetid. Low starting salary and limited geographic choice are almost universal deal breakers. Either the starting salaries are going to have to double so that you really won't care where you live until you find a place that you want to be or job openings are going to have to open up much more frequently and be much more accessible to new graduates. Since neither are likely to happen under the current leadership (although I think the first option is easier to do than the second), they're going to continue to bark up the wrong tree. Medical students don't care about "jobs". They want "careers" with as much control over as they can have in terms of salary and place. Pathology offers neither presently.

I'm a partnership tracked pathologist making good money at this point, so I have nothing to personally gain from saying any of this. Yaah, whether you agree with any of this or not if you have someone's ear in these committees please make them understand that. It's like I tell all the vendors who show up at my door: I don't care if you think you have a good product, it only matters if I think you have a good product. And I'm annoyed deeply to see obliviously wasted effort spent chasing down red herrings when all they need to do is pull in a couple of successfully matched derm, ortho, anesthesia, and radiology med students (the target demographic they appear to be chasing) into a room and talk to them. These students will be honest because they have nothing to lose by saying what's on their mind and CAP will learn more in 20 minutes than the months it takes them to aggregate the data in a vacuum.

 

[KeratinPearls]

I sat through the entire presentation and I seriously hope this isn't a recent presentation (edit: is just noticed it's from this year 😱). While I'll give him credit for recognizing there's a serious problem, he's either in total denial or completely ignorant of why pathology is unattractive. You can bring a horse to water, but you'll never get them to drink if the water is fetid. Low starting salary and limited geographic choice are almost universal deal breakers. Either the starting salaries are going to have to double so that you really won't care where you live until you find a place that you want to be or job openings are going to have to open up much more frequently and be much more accessible to new graduates. Since neither are likely to happen under the current leadership (although I think the first option is easier to do than the second), they're going to continue to bark up the wrong tree. Medical students don't care about "jobs". They want "careers" with as much control over as they can have in terms of salary and place. Pathology offers neither presently.

I'm a partnership tracked pathologist making good money at this point, so I have nothing to personally gain from saying any of this. Yaah, whether you agree with any of this or not if you have someone's ear in these committees please make them understand that. It's like I tell all the vendors who show up at my door: I don't care if you think you have a good product, it only matters if I think you have a good product. And I'm annoyed deeply to see obliviously wasted effort spent chasing down red herrings when all they need to do is pull in a couple of successfully matched derm, ortho, anesthesia, and radiology med students (the target demographic they appear to be chasing) into a room and talk to them. These students will be honest because they have nothing to lose by saying what's on their mind and CAP will learn more in 20 minutes than the months it takes them to aggregate the data in a vacuum.

Agree with all of this.

Salarywise:

Starting salaries are low from talking to my friends and the jobs I interviewed for.

Starting salaries ranged from 180-220,000, with the 220 being in a rural non desirable area. Yeah there are jobs that start higher but that wasn’t what I experienced.

Partnerships were mostly 4-6 years until partner. I saw one job in Arizona for 3 years until partner.

Is that the norm (4-6 years) in other fields or even competitive fields?

Location wise:

I only found 3 jobs within 1 hour of my hometown. One of the three was from online cold messaging a physician in a group. Had I not did that I would have been down to two. One job was for hemepath which I’m not hemepath trained. So really I was qualified for only two jobs in a one hour radius from my hometown.

Another job opened up recently but they postponed hiring due to covid when I contacted them.

The jobs had other candidates interviewing for the position. So with the few positions I interviewed at, there were others Competing for the spot.

 

[Med Director New England]

I just listened to the pipeline presentation. i had heard of this but was good to listen to this.

I could not agree more with the comments of alteran after hearing the presentation. At this point to not even consider the possibility that the issues raised by many on SDN, usually discussed in a civil way, usually by credible sources might be true and are simply malicious lies by a few malcontents is shortsighted. Most of the negative talk here is not along the lines of flee now, thrombus mantra...

 

[HeyDalaron]

The long standing downward spiral of domestic interest in pathology is the result of many factors, the largest of which is the very low standards for resident selection. The job market would organically improve if the incentives to blindly accept any applicant to a residency were removed. One could also consider program directors raising the standards by which people are recruited, but as that does not seem to be a concern, I doubt PDs would be on board.

I cannot envision any way to do this realistically besides empowering other fields with true shortages to convince ACGME to redirect funding from pathology programs to theirs.

 

[path19]

...I cannot envision any way to do this realistically besides empowering other fields with true shortages to convince ACGME to redirect funding from pathology programs to theirs.

I think this is the only hope. There are specialties where patients in need cannot see a doctor because there aren't any nearby or without a months-long waiting period. I have never heard of a patient waiting for a path report because there is no pathologist available to interpret it. It seems clear that path isn't going to give up the ACGME funding willingly, but I bet this is the right angle to take.

 

[yaah]

And I'm annoyed deeply to see obliviously wasted effort spent chasing down red herrings when all they need to do is pull in a couple of successfully matched derm, ortho, anesthesia, and radiology med students (the target demographic they appear to be chasing) into a room and talk to them. These students will be honest because they have nothing to lose by saying what's on their mind and CAP will learn more in 20 minutes than the months it takes them to aggregate the data in a vacuum.

I think this is a great idea/thought. It is always worth talking to the people who "considered it, but passed" - kind of like an exit interview.

 

[yaah]

At this point to not even consider the possibility that the issues raised by many on SDN, usually discussed in a civil way, usually by credible sources might be true and are simply malicious lies by a few malcontents is shortsighted. Most of the negative talk here is not along the lines of flee now, thrombus mantra...

I agree! Most discussion quite civil. The outliers tend to be noticed more though. For those of us here, we trust that most of the people who post here are credible sources. But to people not familiar with it, that is not as obvious.

 

[Alteran]

The long standing downward spiral of domestic interest in pathology is the result of many factors, the largest of which is the very low standards for resident selection. The job market would organically improve if the incentives to blindly accept any applicant to a residency were removed. One could also consider program directors raising the standards by which people are recruited, but as that does not seem to be a concern, I doubt PDs would be on board.

I cannot envision any way to do this realistically besides empowering other fields with true shortages to convince ACGME to redirect funding from pathology programs to theirs.

This is the other thing that our field's academic and practice leadership don't understand because its obviously going to be a touchy subject, but we in private practice who've hired, and fired, understand. The fact that the ideal candidate that most surveyed groups want is a pathologist with 2-3 years experience, as seen in the recently published paper, is a rejection of the kind of residents that are being matriculated into practice. I frankly don't see any other field's job postings say "we want a surgeon of 2-3 year experience" or "IM hospitalist of 2-3 years", etc. - but I'm open to someone telling me otherwise.

So you are right in that no one wants to tell PDs "your program needs to go away for the betterment of the specialty". I do feel there are going to be some very unpleasant and hard conversations to be had here in the near future on this issue too.

 

[deleted314957]

There literally needs to be only 50% of the number of present pathologists and training programs. If you turn this into a shortage field, things will change 180 degrees. AND, y’all need to get your asses OUT of hospitals. Makes us too much like the “in house” help who are ALWAYS there to be used. Have an office across the street or something. Make them come to you.


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[D1b()4]

They should just ban recruitment of FMGs who do not reside in the United States into pathology.

 

[gbwillner]

The long standing downward spiral of domestic interest in pathology is the result of many factors, the largest of which is the very low standards for resident selection. The job market would organically improve if the incentives to blindly accept any applicant to a residency were removed. One could also consider program directors raising the standards by which people are recruited, but as that does not seem to be a concern, I doubt PDs would be on board...

This is the other thing that our field's academic and practice leadership don't understand because its obviously going to be a touchy subject, but we in private practice who've hired, and fired, understand. The fact that the ideal candidate that most surveyed groups want is a pathologist with 2-3 years experience, as seen in the recently published paper, is a rejection of the kind of residents that are being matriculated into practice. I frankly don't see any other field's job postings say "we want a surgeon of 2-3 year experience" or "IM hospitalist of 2-3 years", etc. - but I'm open to someone telling me otherwise...

I think this is a chicken and egg problem. Standards of entry of new residents are low, outputting low quality pathologists. Pathology is not a desirable filed, meaning lower-quality students apply for positions. Raising the bar for applicants can't me done because higher-caliber applicants to to other fields.

To fix this you need to make pathology groovy.

 

[gbwillner]

I sat through the entire presentation and I seriously hope this isn't a recent presentation (edit: is just noticed it's from this year 😱). While I'll give him credit for recognizing there's a serious problem, he's either in total denial or completely ignorant of why pathology is unattractive. You can bring a horse to water, but you'll never get them to drink if the water is fetid. Low starting salary and limited geographic choice are almost universal deal breakers. Either the starting salaries are going to have to double so that you really won't care where you live until you find a place that you want to be or job openings are going to have to open up much more frequently and be much more accessible to new graduates. Since neither are likely to happen under the current leadership (although I think the first option is easier to do than the second), they're going to continue to bark up the wrong tree. Medical students don't care about "jobs". They want "careers" with as much control over as they can have in terms of salary and place. Pathology offers neither presently.
...

I think you are painting a false dichotomy here. I agree these are negative aspects that are seen in other desirable specialties that can be overcome with other attributes (specifically money), but there are definitely other variables at play that contribute to the popularity of a specialty. One of the biggest drawbacks IMO is that you are not a clinician and are removed from the patient. Most people go into med school wanting to see patients. Some realize they despise it and go into DX specialties, but not all. This is unlikely to be seen as an attractive characterization just like having to relocate. I also think a lack of exposure in med school leads to students not really being aware of what pathologists do outside of autopsy. When I finished basic science and started clinical rotations, when I heard that a classmate was doing a pathology rotation I automatically assumed that he had failed his basic science qualifying exam, as path is lumped in with the basic science curriculum (and at my med school was not taught by an actual pathologist). Personally, I never cared for a minute about having to relocate- probably because I knew it would happen from day one and I'd moved for every stage of my training anyway.

I think we often also operate in a vacuum. Other specialties have ups and downs and desirable and undesirable characteristics . I knew when I started with path the job market would not be like FM, but that doesn't make FM a better job. When comparing jobs with your colleagues, do you ever talk about quality of life? Or work-life balance? Or call???? One of my good friends where i live is in FM, and he's driving 200 miles a day between 3 remote locations, putting in weekend call every other week for less salary than I made 1 year out of fellowship. Occasionally he sleeps on the couch of his office. My Peds friend started at an annual salary of $85K (this was about 15 years ago now).

I guess what I'm saying here is that we are a biased group of people who were already OK with not seeing patients and other obvious things but to most med students that's a deal breaker from the start.

 

[D1b()4]

One of the biggest drawbacks IMO is that you are not a clinician and are removed from the patient. Most people go into med school wanting to see patients. Some realize they despise it and go into DX specialties, but not all.

Why doesn't diagnostic radiology have issues recruiting good AMGs? I think everything has a price, and every specialty has its advantages and disadvantages; if compensation/lifestyle is good, medical students will do it. If FM paid 600k, I would have chosen it over pathology with minimal reservations.

 

[Dro133]

There is something that I fundamentally do not understand when it comes to the discussion of the pathology job market. Over and over again I've heard the statement that 50% of pathology programs need to be shut down in order to reduce the oversupply and the recruitment of sub-par trainees into the field. This leads me to the following questions:

- If it is widely known that there are programs training subpar pathologists, would hiring managers not avoid hiring pathologists trained at these programs?
- If the above is true, then would it not also be true that pathologists trained at more "reputable" programs do not face the same challenges in the job market as the trainees of "subpar" programs?
- If the above two are true, then could one make the leap that those who complain the loudest about the poor pathology job market are ones who trained at one of those "subpar" programs? And if that is true, wouldn't the obvious conclusion for a prospective trainee to draw be that your best shot at shielding yourself from the difficult job market would be to go to a "good" program, and if you can't get into one, don't go into pathology?

Basically my question boils down to, does it even matter that the job market is poor for, say, half of all pathology trainees if the half who go to "good" programs do not face the same difficulties in the job market? Or does the overall surplus of trainees make it difficult for even those graduating from strong programs to find a good job?

 

[D1b()4]

There is something that I fundamentally do not understand when it comes to the discussion of the pathology job market. Over and over again I've heard the statement that 50% of pathology programs need to be shut down in order to reduce the oversupply and the recruitment of sub-par trainees into the field. This leads me to the following questions:

- If it is widely known that there are programs training subpar pathologists, would hiring managers not avoid hiring pathologists trained at these programs?
- If the above is true, then would it not also be true that pathologists trained at more "reputable" programs do not face the same challenges in the job market as the trainees of "subpar" programs?
- If the above two are true, then could one make the leap that those who complain the loudest about the poor pathology job market are ones who trained at one of those "subpar" programs? And if that is true, wouldn't the obvious conclusion for a prospective trainee to draw be that your best shot at shielding yourself from the difficult job market would be to go to a "good" program, and if you can't get into one, don't go into pathology?

Basically my question boils down to, does it even matter that the job market is poor for, say, half of all pathology trainees if the half who go to "good" programs do not face the same difficulties in the job market? Or does the overall surplus of trainees make it difficult for even those graduating from strong programs to find a good job?

I trained at a pretty solid program (not top 10 whatever that means) but pretty solid. I am doing a pretty competitive fellowship at a good program. Job search was still difficult. There were not that many jobs to even apply for unless you want to go into academics.

I am not sure what subpar trainees do. They might do additional fellowships or have great networking skills and find a job anyway. Honestly, getting your first job, unless you are staying at your home institution, probably depends more on luck and networking skills rather than your skills as a pathologist unless you totally suck and everyone knows it.

In the end, everyone seems to find a job. But it is definitely a stressful experience and might be suboptimal job. Pathology seems to be the only field in medicine where finding a job, just any job, is a challenge.

 

[gbwillner]

There is something that I fundamentally do not understand when it comes to the discussion of the pathology job market. Over and over again I've heard the statement that 50% of pathology programs need to be shut down in order to reduce the oversupply and the recruitment of sub-par trainees into the field. This leads me to the following questions:

- If it is widely known that there are programs training subpar pathologists, would hiring managers not avoid hiring pathologists trained at these programs?
- If the above is true, then would it not also be true that pathologists trained at more "reputable" programs do not face the same challenges in the job market as the trainees of "subpar" programs?
- If the above two are true, then could one make the leap that those who complain the loudest about the poor pathology job market are ones who trained at one of those "subpar" programs? And if that is true, wouldn't the obvious conclusion for a prospective trainee to draw be that your best shot at shielding yourself from the difficult job market would be to go to a "good" program, and if you can't get into one, don't go into pathology?

Basically my question boils down to, does it even matter that the job market is poor for, say, half of all pathology trainees if the half who go to "good" programs do not face the same difficulties in the job market? Or does the overall surplus of trainees make it difficult for even those graduating from strong programs to find a good job?

I think for the most part this is exactly it. I went to a top program. All my co-residents got good jobs. The only people that did more than one fellowship were the people that wanted to for some reason. I don't know a single unemployed pathologist. I've never met a pathologist from my training program that didn't have a job. I understand it can be variable, even from mid-tier programs. I think the lack of quality of applicants hurts all programs, but those at the top I think are basically immune. If you go to a top program and have problems it's probably on you- you either need to work on networking or selling yourself.

I was not the typical resident, and did an instructorship, at my home institution where I did both residency and fellowship. When I decided to leave I have multiple offers (at least 5 I think). I had offers from academia for a higher salary almost a decade ago then I've seen posted here for PP. When I left academia I made considerably more than the numbers thrown around here. I've been out in the wild now, and before COVID-19 I was getting unsolicited job offers on almost a weekly basis.

 

[D1b()4]

I was not the typical resident, and did an instructorship, at my home institution where I did both residency and fellowship.

Exactly, you did an instructorship to get work experience. We are talking about job search straight after fellowship without experience. I have heard from multiple practicing pathologists that they regularly get unsolicited job offers weekly, so it is not unusual.

In the end, I had two offers without instructorship, both paying 300k+ (I also cancelled one PP interview invitation), but I feel I was lucky. The only help I could get from the faculty was for academic jobs. I did not apply for any academic positions due to low salaries.

 

[gbwillner]

Exactly, you did an instructorship to get work experience. We are talking about job search straight after fellowship without experience. I have heard from multiple practicing pathologists that they regularly get unsolicited job offers weekly, so it is not unusual.

I said it was not typical, but you can't dismiss it. Either I had a lot of offers when I left, or the instructorship is the first job, and it was secured during residency and was guaranteed.

In any case, I did not struggle to get a job and I think other folks from top programs are likely to have similar experience.

 

[D1b()4]

I said it was not typical, but you can't dismiss it. Either I had a lot of offers when I left, or the instructorship is the first job, and it was secured during residency and was guaranteed.

In any case, I did not struggle to get a job and I think other folks from top programs are likely to have similar experience.

Were you paid as a fellow during your instructorship? I also qualified my statement that there are not that many jobs unless you want to go into academics.

I am not sure what the exact definition of a top program is. I suspect you trained at WashU based on your prior posts. I am doing my fellowship at a better program than WashU (based on the prominent faculty members in my field), so I guess at least my fellowship is from a top program.

Maybe my definition of a challenge/struggle is somewhat loose. I did not do any cold calling or extensive networking during the job search, but at times I felt that I might need a plan B.

 

[gbwillner]

Were you paid as a fellow during your instructorship? I also qualified my statement that there are not that many jobs unless you want to go into academics.

No, I was paid as an instructor, and the salary was somewhere between fellow and Asst. Professor. I agree that it is for those who want to go into academics- that was my intent (until it was not). I actually did very little service work and focused almost entirely on research.