Academic Pathology

[big al]

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Hello,

Long time lurker, first time poster. I am interested in an academic career i.e. signing out surgical cases, doing basic science research and lecturing to medical students. I know that the academic salary is considerably lower than that in the private sector. What options are there, once in an academic job, for increased income i.e. are there ways to supplement this income? I'm not talking about selling tupperware or Mary Kay. I was thinking about, for example, testifying in court cases/expert testimony/reviewing cases, lecturing for Osler and other review courses, etc. Would this be prohibited by a contract? Any additional thoughts would be appreciated.

 

[yaah]

I don't think it's prohibited as long as it's not over the top in some fashion. Lots of people do this although I'm sure many have the department paid as the beneficiary (instead of personally). Academics refer to "stipends" to participate in conferences/review courses/etc but I have never actually asked what that refers to or how much of a stipend they are talking about.

 

[KCShaw]

To make "significant" money outside of your regular academic salary generally requires a lot of work to build a reputation, but it's certainly possible to accomplish. Things some people have done within the field to supplement their income (whether through departmental bonuses or other deals) include:

* Writing/contributing to books
* Giving lectures (other than at their own institution, which is usually required in the local contract)
* Getting involved in regional or national teaching conferences
* Consultation on legal cases
* Other consult services (some institutions divvy up all incoming consults, others direct them by specialty and offer bonuses, and still others might allow you to moonlight doing other services; for example, I know some who privately handle autopsies for outside institutions independent of their regular work)
* Some research opportunities also pay for service

It would be important to clarify these things in your academic contract, of course, as in some cases the department may get a cut or otherwise have requirements of you when offers come your way.

 

[pathstudent]

Hello,

Long time lurker, first time poster. I am interested in an academic career i.e. signing out surgical cases, doing basic science research and lecturing to medical students. I know that the academic salary is considerably lower than that in the private sector. What options are there, once in an academic job, for increased income i.e. are there ways to supplement this income? I'm not talking about selling tupperware or Mary Kay. I was thinking about, for example, testifying in court cases/expert testimony/reviewing cases, lecturing for Osler and other review courses, etc. Would this be prohibited by a contract? Any additional thoughts would be appreciated.

i think you can still make good money in academics. it just takes a bit longer. docs working at MGH get reimbursed the same amount by medicare and insurance companies as docs working at top private hospitals. However, academic departments typically aren't as lean as private practice groups. They have slack to give people time to do research and teach. In academics, where the pathologists are subspecialized you only sign-out for a 2-3 hours a day and are only on the scheduel 2-3 weeks out of the month. The rest of your time is devoted to teaching and research and so that explains the average slightly lower salary. However there are certainly a few people in academics that make much more than the average private pathologist. It just takes time to become one of those people.

I'm dedicated to being an academic pathologist because I love the university environment, I'll love teaching residents and medical students, and I love doing studies and research and advancing the frontier of pathology. Plus I have no desire to work from 7am-7pm just signing out cases in order to maximize $$$. I want to have a life outside of pathology.

 

[abefromann]

Since we're on salary: I would like to do academics as well, but don't have family money and have loans. I think the draw to pathology is being able to diagnose but also teach and be involved in the academic community, and perhaps eventually be part of the administration.

So, what's a ballpark percentage that an academic pulls in versus a privateer (w/in same specialty). Like, eventually I'd do dermpath and academics. I know private derms can easily make 300-500, so an academic derm would pull in what, 150-250?

 

[yaah]

I think that's a reasonable estimate. Academic derms might start out lower at many places, higher than 150 at some. The upper end of academic salaries is generally capped around 200k-250k (a semi-educated guess there) for pathology, but of course many make more depending on their personal situation (e.g. the two at UCSF).

Don't forget though, many academic programs give you more perks and extras than some private places. There are academic programs who will pay your childrens' college tuition, free health care, pensions, etc. It's hard to know how much is reserved for full professors (who generally get excellent perks) as opposed to "lowly" assistant profs

 

[LADoc00]

dont have the link, if you are interested do a google on SFGATE in regards to california state employee salaries, you get a massive 1000+ person list of the top paid people by the state of CA. The No.1 and 2 in the entire state are dermatopathologists, no.3 is usually the UCLA football coach. If you take that 1000+ person list and cross reference it to all UC pathology faculty, the standard deviation is huge obviously, I would guess the mean is ROUGHLY between 250-300 for full seasoned professors.

The idiocy of the fact someone like Noel Wiedner is only worth 1/5 Phil Leboit shouldnt be lost on anyone. The system is patently broke.

 

[yaah]

The myth that Noel Weidner is worth 1/4 the UCLA football coach is even more disturbing. Just think where that salary would be if UCLA ever won a meaningful football game.

The UMich salaries are also public knowledge (I don't know how many perks are not included though). The highest salary in the university system is the clinical VP of the hospital system. Second is university president, then hospital CEO, athletic director, football coach. Highest paid practicing MD is an opthalmologist, then the chair of neurosurg. Pathology is further down the line, but full profs range from ~$180-240. They say the head football coach makes $380k or so per year. I highly doubt that. That probably doesn't include endorsements, etc.

 

[big al]

Thanks for the ideas. How do you find out more specific information on writing book chapters, giving lectures at other institutions and consultation? Do you make it known to the legal community you are interested in this type of work? Also our institution is interested in increasing our pediatric autopsy services to practitioners in the community. Would it be possible to have something built in to the contract stating you would be compensated more for doing this type of service? I know you would need to be pediatric fellowship trained and I'm fine with that.

 

[Neddy]

The UMich salaries are also public knowledge (I don't know how many perks are not included though). The highest salary in the university system is the clinical VP of the hospital system. Second is university president, then hospital CEO, athletic director, football coach. Highest paid practicing MD is an opthalmologist, then the chair of neurosurg. Pathology is further down the line, but full profs range from ~$180-240. They say the head football coach makes $380k or so per year. I highly doubt that. That probably doesn't include endorsements, etc.

Does that include the consult services of the big names? I would think they would rake it in.

 

[DarksideAllstar]

The coach is from UC Berkeley (Tedford). Here is the salary link:
http://sfgate.com/c/a/2006/11/09/UCchart.html

 

[yaah]

Does that include the consult services of the big names? I would think they would rake it in.

No that is base salary, I think. But not every institution has consult revenue that is distributed to the individual like at UCSF. A lot of times it is shared within the department.

 

[Anna Plastic]

Thanks for the ideas. How do you find out more specific information on writing book chapters, giving lectures at other institutions and consultation? Do you make it known to the legal community you are interested in this type of work? Also our institution is interested in increasing our pediatric autopsy services to practitioners in the community. Would it be possible to have something built in to the contract stating you would be compensated more for doing this type of service? I know you would need to be pediatric fellowship trained and I'm fine with that.

The only academic pathologist I know that actually did medicolegal consultations enough to make it worth his while (i.e. the compensation was greater than the pain-in-the-ass factor) was an international expert in an area where there was a lot of lawsuits for exposure to a particular carcinogen. But he had worked incredibly hard and was amazingly prolific in his research/writing in this area.

As for being invited to lectures, write chapters, etc.--this generally comes after establishing yourself in the field. You start off with local recognition, then regional, and finally national/international. These requests usually take a while before you start receiving them without having a mentor/higher up toss them your way. Generally it takes at least 10+ years of productive work in a field (i.e. publishing) before you will be approached for this sort of work.

My advice: unless you are absolutely passionate about academics, unless you can't imagine doing anything else, I'd seriously give it a second thought before going into this. If you are thinking you will have time for "moonlighting" in academics to boost your salary, you will be undermining the work you need to do to succeed in academics. Funding is drying up faster than Lake Lanier. Academic success depends on one thing only: publication--and any serious publication will be dependent on funding to do any work of merit. Your time will be primarily spent writing grants which, even if they are stellar, most likely will not be funded. If you think your department head or the promotions committe will give a crap about teaching or service work, think again. You would need to be in a clinician-educator path to have that count for anything, and clinician educators generally have less salary, and less departmental respect, than their research track colleagues.

To give you some perspective: I've been working 70+ hours/week in academics, and am making a five digit salary as a junior attending at a highly ranked academic institution. Once I am brought on as an assistant prof in two years, I will probably be earling in the very low six figures. If all goes well, I will be looking at associate prof in no sooner than eight years. I've been invited to speak at national conferences, but haven't been compensated for that. I am looking at years and years of work before catching up to my private practice peers' starting salaries. 'Course, I'm in a CP field, but I have friends who are in hematology, peds heme/onc, etc. who are at the same academic level as I am and are paid less.

So don't be under the delusion that academics may pay you a little less, but you have more time than private practice (pathstudent, I *wish* my workweek was 7-7 M-F). Do academics because you would be heartbroken doing anything else.

 

[big al]

Anna,

Thanks for the reply. Do you have extensive experience in basic science research? I have some but I would be unable to write a grant without taking a workshop and/or considerable help from a mentor. Do you have a mentor? How are you going about doing research? I'm not trying to steal your ideas just looking for general advice. Also, can you elaborate on your responsibilities as a junior faculty member? Thanks

 

[cluecells]

I'm dedicated to being an academic pathologist because I love the university environment, I'll love teaching residents and medical students, and I love doing studies and research and advancing the frontier of pathology. Plus I have no desire to work from 7am-7pm just signing out cases in order to maximize $$$. I want to have a life outside of pathology.

You must be kidding. 😱

In which academic department do you have a life outside of pathology ?
Please let me know, would be interested in applying there.

 

[pathstudent]

You must be kidding. 😱

In which academic department do you have a life outside of pathology ?
Please let me know, would be interested in applying there.

I'm not quite sure what you are getting at.

 

[pathstudent]

So don't be under the delusion that academics may pay you a little less, but you have more time than private practice (pathstudent, I *wish* my workweek was 7-7 M-F). Do academics because you would be heartbroken doing anything else.

You work over 12 hours a day M-F every week of the month? The t-med attendings at my "highly ranked academic medical center" roll in about 9-10 and are out of there by 5-6 on their worst days. Plus they are only on service 1-2 weeks/month.

Residents on surgical pathology are in by 7 and go home about 9ish. Attendings on surg path show up at 8-9 and go home 6ish, and that is when they are on service. No attending works longer hours than the residents at my program. And I have heard from a few residents that they work longer hours in private practice than they did in residency. But that depends, some private practice jobs are a little more slack with a 4 day work week. But if that is the case, then they don't make as much. Remember that medicare/insurace companies reimburse more or less the same no matter where you work. So if you work a lot, you should make a lot of money. If you work a little less, you should make less. It's pretty simple.

But like I said, I am interested in being an attending because I love residents and unknown sessions at the scope and sign-out and showing people how to gross and doing research projects, so I'm going to academics. Also I am looking forward to only being on service 2-3 weeks/month rather than 4 weeks/month like the schleps in private practice.

 

[Anna Plastic]

Anna,

Thanks for the reply. Do you have extensive experience in basic science research? I have some but I would be unable to write a grant without taking a workshop and/or considerable help from a mentor. Do you have a mentor? How are you going about doing research? I'm not trying to steal your ideas just looking for general advice. Also, can you elaborate on your responsibilities as a junior faculty member? Thanks

Hi Al--

It isn't stealing ideas at all. I think it is a really good idea to ask as many people as possible about their experience. And, of course, I'm doing translational research in a CP field, so I can't speak authoritatively on anatomic pathology--getting a lot of perspective from AP junior faculty will be important for that.

I have 4+ years experience in basic science research prior to med school, with another year or so of clinical research work. I did a research fellowship following my TM/BB clinical fellowship, during which I established mentorship with someone who helped me focus my research goals. If you are serious about basic science research, a good research fellowship will be a big help in getting started.

I have a K grant for doing clinical/translational research, so my time is spent 25% service work (on call coverage for transfusion service and apheresis service, associate director for a regional reference lab, teaching, administrative duties) and 75% research. Having K grants are very helpful, because it gives you much needed protected time. Of course the challenge is even getting a K grant in the first place. My mentor was instrumental in helping find these opportunities; actually, a very good way to get experience in grant writing is helping your mentor by writing a first draft for an R01 (and then have him/her show you everything you got wrong 😳).

You can become an excellent physician-scientist without a PhD, but in order to do that you really need a foundation of some structured research time, like a research fellowship. If you are doing basic science with the intention of being a P.I. and having a lab, you need data, you need publications in core journals, and you need to constantly be submitting for grants. Hard work and luck will play a part in this too, but I can't emphasize enough the importance of a good mentoring relationship.

Needless to say, this doesn't leave a lot of time for moonlighting to earn extra money--and if you do, you're probably robbing yourself of time needed to advance your research goals. A good article to read: "NIH budget: Boom or Bust" in Science, April 20 2007. If you are trying to do science, you need money, and the NIH money as I said previously is quite dry now, with little hope for improvement due to government money diverted to other areas (coughs *Iraq*).

 

[Anna Plastic]

You work over 12 hours a day M-F every week of the month? The t-med attendings at my "highly ranked academic medical center" roll in about 9-10 and are out of there by 5-6 on their worst days. Plus they are only on service 1-2 weeks/month.

Residents on surgical pathology are in by 7 and go home about 9ish. Attendings on surg path show up at 8-9 and go home 6ish, and that is when they are on service. No attending works longer hours than the residents at my program. And I have heard from a few residents that they work longer hours in private practice than they did in residency. But that depends, some private practice jobs are a little more slack with a 4 day work week. But if that is the case, then they don't make as much. Remember that medicare/insurace companies reimburse more or less the same no matter where you work. So if you work a lot, you should make a lot of money. If you work a little less, you should make less. It's pretty simple.

But like I said, I am interested in being an attending because I love residents and unknown sessions at the scope and sign-out and showing people how to gross and doing research projects, so I'm going to academics. Also I am looking forward to only being on service 2-3 weeks/month rather than 4 weeks/month like the schleps in private practice.

No. I work anywhere from 8-16 hour days M-F. Then I work 2-6 hours Saturday. Then I work 5-12 hours Sunday. Lather. Rinse. Repeat. Some weeks I may work only 50 hours. Others, I may work 90 hours. It averages out to 70-75 hours/week. There is always a paper that needs writing, an experiment to do, a presentation due, reports that need to be signed out--and this isn't even considering on call duties.

I'm not at your institution, so I can't comment on what your TM/BB attendings do. At my institution, the only TM docs who put in those kinds of hours are clinician-educators. The research track TM docs are putting in even more hours than I am.

I think the point you highlight here is that there is a very wide definition used here of what "academic" means. To some, this means working as a pathologist in a university setting, teaching residents, publishing a case series here and there in a clinician-educator track. To others, that means that you are competing for NIH grant money and generating scientifically significant original work in a basic science/clinical research track. Both are important, but I assure you that in this day and age, the latter is working many more hours than the former. Anything less than that, and you will be creamed by the competition.

But it sounds like you have everything figured out. Good luck to you.

 

[Sean2tall]

I think the point you highlight here is that there is a very wide definition used here of what "academic" means. To some, this means working as a pathologist in a university setting, teaching residents, publishing a case series here and there in a clinician-educator track. To others, that means that you are competing for NIH grant money and generating scientifically significant original work in a basic science/clinical research track.

This is a good point, which I only realized after one of my interviews. Depending what you are more exposed to in school/residency, your picture of "academics" is colored a certain way. I had been saying on interviews that I was interested in teaching/research, but after interviewing with one CP attending who writes grants, etc., he easily gleaned out that I was interested in occasionally having my name on a paper and working with residents/students, rather than fighting it out for my own grants and having research be my primary task.

I guess I should have realized this, as programs will sometimes say they are not big on research, while so far every program I've seen has more than enough research for what I want to do. So, I should be more specific on the rest on my interviews, I think, although I don't think any of them have gotten the wrong impression.

 

[big al]

Anna,

That's an interesting article. I've received advice from attendings here about doing a research fellowship year. Like yourself, I'm soon to be a slave to SallieMae. I will have to start paying back my loans in about 2 years. The fact I have such a large student loan is going to probably determine if I am able to have an academic career.
I have one additional question. If an individual becomes junior faculty/assistant professor and then pursues an MBA/MHA or a similar degree, would this help in the promotion process? i.e. would this help in achieving a high level of professorship faster?

 

[LADoc00]

The nice thing about academics is that you can work your 80 hrs/wk whenever you want.

Just realized last week I *maybe* worked 25 hours last week (no special vacations, regular work week) when I went through my CMS timecard today.

 

[Anna Plastic]

Just realized last week I *maybe* worked 25 hours last week (no special vacations, regular work week) when I went through my CMS timecard today.

I hate you, Kenny. 😛

If money had been the goal, clearly I am working hard, not working smart. Let this be a warning to all the impressionable young budding academics out there.

 

[Anna Plastic]

Anna,

That's an interesting article. I've received advice from attendings here about doing a research fellowship year. Like yourself, I'm soon to be a slave to SallieMae. I will have to start paying back my loans in about 2 years. The fact I have such a large student loan is going to probably determine if I am able to have an academic career.
I have one additional question. If an individual becomes junior faculty/assistant professor and then pursues an MBA/MHA or a similar degree, would this help in the promotion process? i.e. would this help in achieving a high level of professorship faster?

Oy. This is tough to advise on, because you are the only one who can say whether a career path is right for you. It depends on a lot of intangibles I have no understanding of, so please...caveat emptor. Don't believe anything I'm saying, but look into it for yourself.

Having said that, here's my opinion for things to consider in making this decision:

1) Going into private practice, then trying to go back into academics: very tough. Going into private practice *from* academics: easier, but not without its own hurdles. Your decision here won't be easily reversible.

2) Academics is a bit of a Ponzi scheme. The senior guys like getting junior guys in for several reasons: they can list them as people they have mentored on their CV, they do work in their labs to generate data they needs for publications, grants, etc. So realize that someone in academics trying to sell you on academics may not be entirely looking out for your best interests only. If they are a decent person, they will put your interests before theirs. I’ve been in a position where that wasn’t true. Your mentors by and large won't particularly care about your level of personal financial hardship, and they may not have any decent grasp on the economy at large.

3) Speaking of which, the economy is looking to take a bad turn for the worse. One of the best pieces of financial advice I can give trainees now is to ruthlessly minimize/eliminate debt. An academic junior attending’s salary will seriously put you behind in dealing with your student loans.

4) An MBA will not help you much in academics, at least in the academic settings I’ve been in (and I’ve been in about five different academic settings in my career now). Business is looked upon with a certain amount of suspicion in academics, and there is a fair amount of distain for administration. It won’t hurt you, but again, I think pursuing that degree would distract you from the things you really need to get promotion (publications, grants, good teaching evaluations, publications, service work, publications…). An MBA won’t help you get to full professorship faster. Thirty first author publications in core journals will.

Hope this helps.

 

[BU Pathology]

The NIH has a loan repayment program that can help with your student loans. http://www.lrp.nih.gov/

You need to be in academics to qualify for the program, but you do not need to be working at NIH.

I feel compelled to comment on the differences between community practice and academic pathology. First, most people in academics work more than 40 hours a week. Second, people who work in community settings are just as intelligent and work just as hard as pathologists in academic settings. The significant difference is that academics teach and publish.

If you wish to be involved in research and teaching, do not let the differences in salaries push you towards one area of the other. You will still have a pretty good salary and be more than comfortable even in academics.

Dan Remick
Chair, Boston University Department of Pathology and Laboratory Medicine

 

[LADoc00]

Oy. This is tough to advise on, because you are the only one who can say whether a career path is right for you. It depends on a lot of intangibles I have no understanding of, so please...caveat emptor. Don't believe anything I'm saying, but look into it for yourself.

Having said that, here's my opinion for things to consider in making this decision:

1) Going into private practice, then trying to go back into academics: very tough. Going into private practice *from* academics: easier, but not without its own hurdles. Your decision here won't be easily reversible.

2) Academics is a bit of a Ponzi scheme. The senior guys like getting junior guys in for several reasons: they can list them as people they have mentored on their CV, they do work in their labs to generate data they needs for publications, grants, etc. So realize that someone in academics trying to sell you on academics may not be entirely looking out for your best interests only. If they are a decent person, they will put your interests before theirs. I’ve been in a position where that wasn’t true. Your mentors by and large won't particularly care about your level of personal financial hardship, and they may not have any decent grasp on the economy at large.

3) Speaking of which, the economy is looking to take a bad turn for the worse. One of the best pieces of financial advice I can give trainees now is to ruthlessly minimize/eliminate debt. An academic junior attending’s salary will seriously put you behind in dealing with your student loans.

4) An MBA will not help you much in academics, at least in the academic settings I’ve been in (and I’ve been in about five different academic settings in my career now). Business is looked upon with a certain amount of suspicion in academics, and there is a fair amount of distain for administration. It won’t hurt you, but again, I think pursuing that degree would distract you from the things you really need to get promotion (publications, grants, good teaching evaluations, publications, service work, publications…). An MBA won’t help you get to full professorship faster. Thirty first author publications in core journals will.

Hope this helps.

Interesting point in bold. You would be shocked at some practices in Europe where chairmen must be put on all departmental publications regardless of their contribution. You can imagine they eventually become CV beasts with hundreds and hundreds of publications and sit like mini-warlords over their realm...good gig if you can get it.

 

[raspberry009]

In particular, teaching doesn't count. Many students have the mistaken impression that teaching is a big part of academics. It sometimes is -- but only for the foolish. I had a friend who won a "best professor" award. Afterwards, his department chair told him this was a real shame because now he would be viewed as a teacher rather than a researcher and, as a consequence of winning the award, he would have difficulty getting tenure. He wasn't kidding.

Poor guy. But on the other hand. Why should he/she take the chair seriously? From my experience some of the best teachers are the best people people. It is because of this they network easily and are great assets to the department. Am I wrong?

 

[PathProspect]

Having said that, here's my opinion for things to consider in making this decision:

1) Going into private practice, then trying to go back into academics: very tough. Going into private practice *from* academics: easier, but not without its own hurdles. Your decision here won't be easily reversible.


--------------
Anna, Very interesting comments --

what do you see as the hurdles of going into private practice from academics?
Have you considered makeing this jump?

Thanks --

 

[pathstudent]

Having said that, here's my opinion for things to consider in making this decision:

1) Going into private practice, then trying to go back into academics: very tough. Going into private practice *from* academics: easier, but not without its own hurdles. Your decision here won't be easily reversible.


--------------
Anna, Very interesting comments --

what do you see as the hurdles of going into private practice from academics?
Have you considered makeing this jump?

Thanks --

THere aren't any really. Spending a few years in academics only makes one more desirable, even if you are subspecialized. We have "lost" a few of our young academically oriented faculty to private practice groups. They have no problems getting the best private jobs with the cachet of the elite medical center name behind them. All pathology residents would be wise to spend 2-3 years in academics honing their skills before going into private practice. The added cachet of being an academic attending is worth ten fellowships.

Going from private to academics is harder but can be successfully done too.

 

[yaah]

There are a lot of people who go from academics to private. It includes both junior people and, more recently, lots of senior people. I have heard some academics say it can be hard if you are not boarded in both AP/CP, but that probably depends on the individual situation.

 

[Anna Plastic]

Having said that, here's my opinion for things to consider in making this decision:

1) Going into private practice, then trying to go back into academics: very tough. Going into private practice *from* academics: easier, but not without its own hurdles. Your decision here won't be easily reversible.


--------------
Anna, Very interesting comments --

what do you see as the hurdles of going into private practice from academics?
Have you considered makeing this jump?

Thanks --

Actually, I have been considering making this jump, and have been looking at different jobs, both academic, private practice, and not-for-profits. And I can say that my being so strong in academics caused private practices to look at me with suspicion. All of my interviews had at least 15-20 minutes of discussion on "hey, you have a K grant, all these publications, etc, etc. You're clearly academic--why are you wanting to do private practice? You're going to be really bored." I think it was such a leap for most that they automatically thought I had some difficulties that I wasn't forthcoming with. I suspect someone who is in a clinician educator path probably wouldn't be looked at with such suspicion.

To touch on yaah's point--I think it would be incredibly limiting to try and go from academics to private practice with only AP. These groups were very happy at the idea that they could hand over BB/TM/CP to someone with a solid skill set in that. If anyone has even a teeny tiny bit of doubt at to what they will be doing in the future, just go ahead and do AP/CP.

And to also mention the NIH loan repayment program--it can certainly help out if you are really dedicated to academics. But keep in mind that this, too, is a grant competition. Many of the applications for that program are cut and pasted from someone's K grant application. The competition for this has been getting stiffer--check out the stats of received applications versus awards on the website. Also be aware that they are more interested in clinical research than basic science, but if you could tie in your interests to peds, they have a separate group of awards just for that, and it seems the competition for those awards is less stiff.

 

[l&usibari]

This thread has been very valuable to me, someone currently debating whether to go academics or private. Thanks to all who are contributing, particularly Anna Plastic.

 

[SLUsagar]

I think a lot of good ideas have been brought out on this thread, but the main thing is that it's all institution-dependent. Yes, some academia folks work a ton of hours (likely ALL newbie attendings do...here they've told me they often stay late to re-review each twice before the final click to sign it out, nervous about missing a carcinoid in an appi tip etc. b/c for the 1st time, it's THEIR name on the bottom line). But again, many private folks bust their balls as well. It all depends. I've assessed that academics has the potential for flexibility, which sometimes isn't the case with PP. Your service/timeoff/research ratios will depend on the institution (AND salary), but I do like the flexibility. Even when you're on service, say you've got to leave emergently for something (or even for something non-urgent), you've got other attendings on service that cover your frozens for a few hours, etc. (that's how it is here, but unsure if other places have such a collegial environment). I'm sure in the private sector you might be able to do the same, but it's dependent on the # of partners/people in the group obviously. Flip side, sometimes in academics you're a paper pusher, whereas in PP, it's often like a high school telemarketing job where your $ is often based on your volume/#s.

Final thing I'd add is that there are also pseudo-academic places (i'm sure there are more, 1 for example is Beaumont hosp in Detroit) where it's not an official academic-type-university-tied place, but you have the opps for research and often get paid like PP (somtimes even have residents rotate through....so you get to teach & get some help w/workload). Important to remember it's not all benign/malig...there are some places that fall under UMP/LMP.

 

[PathProspect]

This thread has been very valuable to me, someone currently debating whether to go academics or private. Thanks to all who are contributing, particularly Anna Plastic.

Yes, thank you Yaah and Anna

 

[pathstudent]

Actually, I have been considering making this jump, and have been looking at different jobs, both academic, private practice, and not-for-profits. And I can say that my being so strong in academics caused private practices to look at me with suspicion. All of my interviews had at least 15-20 minutes of discussion on "hey, you have a K grant, all these publications, etc, etc. You're clearly academic--why are you wanting to do private practice? You're going to be really bored." I think it was such a leap for most that they automatically thought I had some difficulties that I wasn't forthcoming with. I suspect someone who is in a clinician educator path probably wouldn't be looked at with such suspicion.

.

Someone in private described their job as boring? Definitely stay away from that group. Most people I have talked to that went private said the cases are no different than what they see in residency except there is a lot less transplant, a lot less bone tumors and a lot less peds. But if you go into academics and specialize in breast/head and neck, you won't see any of that stuff either, and you won't see GI/neuro/heme/gu/gyn/liver and cytology.

Personally I am OK with only signing out 1-2 organs for the rest of my life.

 

[l&usibari]

You're only going to be able to limit yourself to your specialty area (within surgpath) in academics if you go to an institution with specialized sign-out. At my academic institution, surgical pathologists have their areas of specialization but still have to sign out everything. They don't have to do heme/neuro/cyto though.

 

[pathstudent]

You're only going to be able to limit yourself to your specialty area (within surgpath) in academics if you go to an institution with specialized sign-out. At my academic institution, surgical pathologists have their areas of specialization but still have to sign out everything. They don't have to do heme/neuro/cyto though.

I definitely won't take a job anywhere where they do general sign-out. I only want subspecialized sign-out. How can a place be subspecialized if you sign-out organs out of your subspecialty and others are signing them out?

That's like having people specialized in cardiology, gastroenterology, neprhology, and hepatology but they all see all kinds of patients no matter the disease.

If I do ENT, I want to be somewhere I only see ENT. How can I become an expert in ENT if I am having waste my time signing-out placentas and whipples?

Also generalist sign-out is worse for patient care.

The only draw back is that a place has to have a large enough volume to be completely dedicated to subspecialty sign-out. You can't have someone on salary to sign-out one fibrous tumor or 1 sarcoma a day. You need to be at a huge referral center where they have sarcoma surgeons and orthopedic oncology to have a person subspecialized in bone and soft tissue. So there are a limited number of institutions that can fully committ to subspecialty sign-out.

 

[yaah]

I think that is wishful thinking in part - there are few places that have the volume and staffing to allow for total subspecialty signout. We have subspecialty signout, but some attendings rotate through multiple services and there is a general "catch all" rotation which includes head and neck, soft tissue, lung. You will generally have to cover something outside of your area of interest, I would suspect.

 

[b&ierstiefel]

I think subspecialty signout is the way to go. As yaah said though, many places do general signout due to clear specimen volume and staffing issues. And I'm thinking that the job market isn't all that great where we can be in the position to be too choosy. I think one can get away with a pure subspecialized career in a setting where the volume in that subspecialty is high and there aren't too many people do what you do. Head and neck path may be a bit tough in that regard if you compare it to other subspecialties...let's say Derm perhaps?

 

[SLUsagar]

for training purposes though, i think general s/o may be better especially in the beginning b/c on your signout day you'll have a lil' bit o'everything from a 1yr old with an infantile fibrosarc to an 88-yr-old with the worst case of reflux associated dysplasia. For a fellowship/senior level training, i could see how subspecializing lets you fine tune your skills and see the spectrum of cases within that field. But all in all, for those of you thinking that this makes a whole lotta difference in choosing a residency program, think twice. In the end it doesn't really matter that much (~ to whether the program splits up AP/CP or is intergrated), you'll come out a good pathologist...assuming the program is of a decent caliber. Use the many other criteria that you (and others here on the forum) have mentioned, and, in my opinion, don't let the s/o method be the deciphering factor.

 

[DarksideAllstar]

I completely agree with SLUsagar.

I definitely won't take a job anywhere where they do general sign-out. I only want subspecialized sign-out. How can a place be subspecialized if you sign-out organs out of your subspecialty and others are signing them out?

Not really sure what you mean--I guess you are defining "subspecialized" as a place that only does subspec s/o, but a place can have general s/o with people focusing on a particular organ system (presumptively possessing additional training or extensive experience in that area). Many times we are asked to show it to X attending who is the in house expert in Y. In addition, if you ever decide to leave academia for community practice, you will probably be a lot weaker if all you ever look at is skin, gi, etc-- which is one of the reasons why I would prefer to work in a place that has general s/o-- gotta keep your skill set sharp in case your circumstances change.

Also generalist sign-out is worse for patient care.

Sometimes I think you post on here just to annoy people. This is completely contradictory to what you and I have had a few PMs about private practice vs academics, where you argue vehemently that private pathologists are AS GOOD if not BETTER than pathologists in academia who do subspec s/o--make up your mind. Show me the data where there is a clinically significant change in diagnoses in an academic center that does general s/o compared to an academic institution that does subspecialty s/o. It has been my experience at a center that has general s/o that if they have any doubts, they will show it to someone who has expertise in that area. We usually hear on these boards, you don't have to be a subspecialist to sign out most cases, don't we?

 

[Gut Shot]

That's like having people specialized in cardiology, gastroenterology, neprhology, and hepatology but they all see all kinds of patients no matter the disease.

If I do ENT, I want to be somewhere I only see ENT. How can I become an expert in ENT if I am having waste my time signing-out placentas and whipples?

Also generalist sign-out is worse for patient care.

Nah, general sign out is just fine. The majority of cases really aren't that hard, and it's not that difficult to get a second opinion for the exceptions.

 

[pathstudent]

Nah, general sign out is just fine. The majority of cases really aren't that hard, and it's not that difficult to get a second opinion for the exceptions.

That's true but if you want to be a bone and soft tissue expert, what's the point of looking at breast lumpectomies. Likewise, if you are a breast expert, why look at gallbladders, ever, unless they have metastatic breast cancer?

But like it has been pointed out, some medical centers may not have enough volume to maintain their own dedicated pathologists in every area of specialty. Also, for others, it might be too much of a hassle to make the switch when what they have been doing has worked fine for so long as it would involve a major overhaul of the schedule.

 

[yaah]

There becomes a risk in becoming too subspecialized though. Being unable to recognize or just being unfamiliar with standard difficult cases in other areas harms you diagnostically. There are plenty of cases I have seen that get shuttled from one subspecialty to another because they "belong" there. But why? Sometimes the service they are sent to is inappropriate. There are also cases that overlap different areas, what do you do with these cases? Complete subspecialization can only work if the volume is high enough to warrant it, which is actually rare. It may be becoming LESS rare, though.

The converse is that subspecialists are familiar with the intricacies, subtleties, and all of the updates to diagnosis that make for a complete diagnosis. Somehow you have to balance these areas.

 

[Gut Shot]

That's true but if you want to be a bone and soft tissue expert, what's the point of looking at breast lumpectomies. Likewise, if you are a breast expert, why look at gallbladders, ever, unless they have metastatic breast cancer?

But like it has been pointed out, some medical centers may not have enough volume to maintain their own dedicated pathologists in every area of specialty.

This characterizes not some hospitals/medical centers, but the vast majority of them. If you want to be an expert in some particular subspecialty, fine, practice in an academic center that generates enough volume to keep you busy. Otherwise you're either going to have to shoulder some of the gallbladder burden, or earn the ire of your partners.

 

[seniorpath]

I admire anyone who has the courage to pursue the academic track circa 2007.

I've seen many young brilliant minds begin their career hoping to make ground-breaking discoveries. What ends up happening, unfortunately, is that the pressure to ascend the academic ladder supersedes the desire and hampers their capacity to do meaningful research. These people become puppets of their institution and/or chairman and they end up studying one protein for 30+ years. Although they may publish ad nauseum on their beloved protein (to which they eventually ascribe undeserving, sometimes divine, importance, as is all too common these days), their publications rarely amount to anything. All their hard work ends up having no impact on the practice of medicine. Of course, there are a handful who get lucky with their protein and end up saving lives (Gleevec, etc.).

Anyone, this day in age, with insight would choose private practice over academic medicine simply realizing that medicine (although seemingly complex) is still in its infancy. Just imagine the pathologists 300 years from now laughing at your ignorance--thinking that "your" protein was somehow more important than the other 25,000 or so.

 

[malchik]

Anyone, this day in age, with insight would choose private practice over academic medicine simply realizing that medicine (although seemingly complex) is still in its infancy. Just imagine the pathologists 300 years from now laughing at your ignorance--thinking that "your" protein was somehow more important than the other 25,000 or so.

Without academics, pathologists in 300 years will know no more than we do now.

 

[big al]

At my institution, the academic salary is lower than that of private practice. We have lost faculty to the private sector based on the substantial increase in income in the private world. When one talks about "private practice" does this also include entities such as AmeriPath? What I'm really asking is if the salary at AmeriPath is the same as private practice, academia or somewhere in between. The way I understand it is that you will be somewhat of an employee and so therefore I am wondering if this means a reduction is salary compared to those who may have a hospital based "private practice"? Also, when speaking with these type employers what are some general questions to consider in the initial phase of the process?