Advice for an Incoming Medical Student Interested in Pathology?

[gasbait]

Hello all,

As the title says, I am an incoming medical student who is very interested in pathology.

Before getting accepted into medical school, I did two years of research in a cancer pathology laboratory and, while I am trying to enter med school with an open mind, I am fairly certain I would like to become a pathologist in the future.

I guess my question is what should my game plan be for making myself competitive for residencies once I graduate?

My current plan was simply to try and get the best grades and step scores I can and continue to do research throughout medical school. I have been published in two basic science papers during my tenure at the lab (second author in a review and research paper IF: ~5) and working on two other papers which I will hopefully be first author on.

I apologize if my post sounds premature/gunnerish. I am just extremely excited about getting in/attending medical school, and I want to start off on the right foot.

Thanks!

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[MedicalDoge]

Would also like to know this

 

[tensoranalysis]

good plan!

Residency committees heavily weight Step 1, Grades, and Letters of recommendation. Pathology is not currently a competitive residency.

With any residency application it helps to know people. When you approach a research lab - consider working for a with a pathologist if the fit is right for you. As you go through med school, try to gain exposure to pathology and envision(dream big) your future practice. It goes without saying and you'll hear this a lot but keep your mind open!

Lastly, when you are in your 3rd year you might see if you can fit in a visiting/away rotation to your favorite school. This is absolutely overkill for most applicants, but it may help you decide what program you want to go to, and it more than likely will help your case for being ranked to match at that school.

 

[LADoc00]

1. Max board scores
2. Do some research, perhaps get a pub or 2
3. Do away rotations at 2 places you think you are highly competitive at
4. Profit

 

[WillieTrill]

After finishing the interview season, research experience is definitely more important than I realized. My step scores were high and I had a solid class rank, but my lack of research was brought up in a lot of interviews. Also I believe it would have allowed for more interviews at top places. Just my thoughts.

 

[Dave CX]

I would focus on working your ass of in MS. This is not the time to think beyond your 3rd year. You will have enough on your plate.

 

[yaah]

The way pathology is going in US med schools, interest in the field from the strongest potential candidates is falling (because no one is exposed to it as much as they used to be). So just by being a great student and such, you will likely be a strong candidate. Strong scores, references, and such will likely get you into a great program.

The research you have been involved in (especially if you continue to participate in it) will definitely help. The idea of away rotations is also a good one, provided you take it seriously of course. One of my reference letters for residency application was from an away rotation I did.

 

[LADoc00]

The way pathology is going in US med schools, interest in the field from the strongest potential candidates is falling (because no one is exposed to it as much as they used to be). So just by being a great student and such, you will likely be a strong candidate. Strong scores, references, and such will likely get you into a great program.

The research you have been involved in (especially if you continue to participate in it) will definitely help. The idea of away rotations is also a good one, provided you take it seriously of course. One of my reference letters for residency application was from an away rotation I did.

Is this confirmed? Im curious. Falling from what benchmark? I thought things were bad back in the late 90s, are they actually worse now?

 

[Thrombus]

The way pathology is going in US med schools, interest in the field from the strongest potential candidates is falling (because no one is exposed to it as much as they used to be). So just by being a great student and such, you will likely be a strong candidate. Strong scores, references, and such will likely get you into a great program.

The research you have been involved in (especially if you continue to participate in it) will definitely help. The idea of away rotations is also a good one, provided you take it seriously of course. One of my reference letters for residency application was from an away rotation I did.

Interest is falling because the former profession has been commoditized and pathologists are treated increasingly as subordinates by our peers, hospital admin, and regulators/insurance negotiators. This being due to the massive oversupply created by Big Academia.

 

[kraskadva]

As an extension to this question (I'm a M1 also interested in path), how much weight would pre med school research have vs during med school research?
I did extensive bench research in UG and a Masters program before med school (genetics & biochem stuff, ran the lab for my PI as a Masters student, research thesis on RNA 2' structures, some posters/presentations, no pubs). I haven't gotten involved in research since I've been in med school because I was a little burnt on it coming in and wanted to focus on classes first. So I'm wondering if I need to do more research in MS or if the prior experiences are enough to show that I know what it's like to work in a lab.

 

[pianoguy05]

I think that the biggest disservice any medical student can do is limit their possibilities going in. Don’t go in with the mindset of “I want to be a pathologist.” You’ll be better served by giving each specialty you encounter a fair chance before you make a decision.

 

[kraskadva]

I think that the biggest disservice any medical student can do is limit their possibilities going in. Don’t go in with the mindset of “I want to be a pathologist.” You’ll be better served by giving each specialty you encounter a fair chance before you make a decision.

That's fair, and I'm open to other options, but I'm also not gunning for derm or competitive surgery.
And the question was really whether Masters research is = or < med school research for path (or other less competitive residencies). Not whether or not I should go into path.

 

[dukeresident]

Interest is falling because the former profession has been commoditized and pathologists are treated increasingly as subordinates by our peers, hospital admin, and regulators/insurance negotiators. This being due to the massive oversupply created by Big Academia.

Increasingly coming to exactly that conclusion. What other options are reasonable at this point? Currently a path resident.

 

[MrLogan13]

I’m an MS3 who also wants to go into pathology. I have an MS with some anatomical/paleontology research in that program, but no further research in medical school. How much does that hurt?


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[Pathman1000]

Anyone who applies will get accepted despite academic performance, personal red flags or English proficiency. This specialty has zero standards.

 

[cableguy555]

Hello all,

As the title says, I am an incoming medical student who is very interested in pathology.

Before getting accepted into medical school, I did two years of research in a cancer pathology laboratory and, while I am trying to enter med school with an open mind, I am fairly certain I would like to become a pathologist in the future.

I guess my question is what should my game plan be for making myself competitive for residencies once I graduate?

My current plan was simply to try and get the best grades and step scores I can and continue to do research throughout medical school. I have been published in two basic science papers during my tenure at the lab (second author in a review and research paper IF: ~5) and working on two other papers which I will hopefully be first author on.

I apologize if my post sounds premature/gunnerish. I am just extremely excited about getting in/attending medical school, and I want to start off on the right foot.

Thanks!

I hate be pessimistic but my neighbor is a pathologist who worked in Queens, NYC and his group recently filed for bankruptcy. He's been on the job hunt for nearly four months now and hasn't had much luck and is currently working part time as a lecturer at medical school. After bonuses, his salary used to be around $415k; and keep in mind this is after 30 years of experience. Most of the offers he's getting are below $225k and nearly all of them have minimum screening requirements per week. I asked him about starting his own practice but he says that nearly impossible to compete with academic hospitals and corporations who are rapidly substituting pathologists for cheaper alternatives. For example, genetic testing, which has a medicare reimbursement of $4000+ is rarely given to pathologists these days. And most examinations are now computer assisted and subject to drastic cuts by Medicare and private insurance.

He's roughly 65 years old so hes on the verge on retiring and he's convinced me to NOT purse pathology at any costs. He tells me that the future outlook for pathology is not great because computers are better able to identify unusual diagnostic markers than a human eye looking into a microscope. In addition, shadowing his practice was the worst experience I've ever had. The place was lifeless, no windows, people barely talk, and it smells like acetone. If you want to get in touch with him, send me a private message.

 

[cableguy555]

Anyone who applies will get accepted despite academic performance, personal red flags or English proficiency. This specialty has zero standards.

A bit too harsh, but not necessarily incorrect. Pathology has a step 1 score of 229, which is lower than most specialties. In 2014 it was 232 and its been consistently dropping. I would assume pathology is the profession that requires the LEAST amount of English proficiency due to lack of patient interaction. But again, I guess they do have to write reports...

 

[WEBB PINKERTON]

I hate be pessimistic but my neighbor is a pathologist who worked in Queens, NYC and his group recently filed for bankruptcy. He's been on the job hunt for nearly four months now and hasn't had much luck and is currently working part time as a lecturer at medical school. After bonuses, his salary used to be around $415k; and keep in mind this is after 30 years of experience. Most of the offers he's getting are below $225k and nearly all of them have minimum screening requirements per week. I asked him about starting his own practice but he says that nearly impossible to compete with academic hospitals and corporations who are rapidly substituting pathologists for cheaper alternatives. For example, genetic testing, which has a medicare reimbursement of $4000+ is rarely given to pathologists these days. And most biopsies are now computer assisted and subject to drastic cuts by Medicare and private insurance.

He's roughly 65 years old so hes on the verge on retiring and he's convinced me to NOT purse pathology at any costs. He tells me that the future outlook for pathology is not great because computers are better able to identify unusual diagnostic markers than a human eye looking into a microscope. In addition, shadowing his practice was the worst experience I've ever had. The place was lifeless, no windows, people barely talk, and it smells like acetone. If you want to get in touch with him, send me a private message.

That does sound like many pathology labs. I have yet to work in one with a window after all these years.

One thing that isn't talked about much is the danger of working with such harsh chemicals as formalin and xylene. If you aren't a scope monkey all day, you will be coming in contact with these chemicals. Histotech was labeled as the most dangerous profession in a publication I read a while back due to the chemical exposure mostly.

 

[tensoranalysis]

wow. There is an unreasonable amount of pessimism here. Are any of you that are complaining doing anything to help the field, i.e. solve the problems you have identified ? These !repetitive! negative comments are not constructive if not backed by action or plans. It hurts this and other professional communities, but maybe that is your intention?

To the med students: as mentioned, keep your options open and be excited for the fact that pathology (and other specialities) are rapidly changing due to incorporation of new technology. We do not yet know how tech, like AI, will impact the field, but those of us who do not want to become obsolete will take ownership in the implementation and validation of these technologies.

About research experience: Having any history of research is something you should talk about. The best bang for your buck moving forward would be to find a clinician that needs with publishing a clinical project. The best time to do this is in year 1, well before you need to study for boards. Honestly, for the amount of commitment on a clinical project, you should be able to balance this with board and school studies no problem. Don't get me wrong, your priority should be to do well in school - but as a general rule, I think you can find clinical research projects that wouldn't detract from your studies and probably help you go more in depth/teach you about a disease you only superficially understood. I would rule out trying to get involved in a basic science research project because the investment is too great, and payout is risky (potentially non-existent).

 

[cableguy555]

wow. There is an unreasonable amount of pessimism here. Are any of you that are complaining doing anything to help the field, i.e. solve the problems you have identified ? These !repetitive! negative comments are not constructive if not backed by action or plans. It hurts this and other professional communities, but maybe that is your intention?

To the med students: as mentioned, keep your options open and be excited for the fact that pathology (and other specialities) are rapidly changing due to incorporation of new technology. We do not yet know how tech, like AI, will impact the field, but those of us who do not want to become obsolete will take ownership in the implementation and validation of these technologies.

About research experience: Having any history of research is something you should talk about. The best bang for your buck moving forward would be to find a clinician that needs with publishing a clinical project. The best time to do this is in year 1, well before you need to study for boards. Honestly, for the amount of commitment on a clinical project, you should be able to balance this with board and school studies no problem. Don't get me wrong, your priority should be to do well in school - but as a general rule, I think you can find clinical research projects that wouldn't detract from your studies and probably help you go more in depth/teach you about a disease you only superficially understood. I would rule out trying to get involved in a basic science research project because the investment is too great, and payout is risky (potentially non-existent).

Med students do not bear the responsibility of keeping pathology alive. The decline in demand due to technology is inevitable in nearly any field. The best advice one can give is to try choose a field that will be least affected by advances in AI and other tech. In all honesty, it is quite unfair that pathologists need to undergo the same about of training as other medical specialties. Most of them rarely interact with patients making a lot med school rotations impractical. Pathology would be better served if there was a direct/focused program with straightforward requirement, similar to that of a "geneticist".

 

[Dro133]

Med students do not bear the responsibility of keeping pathology alive. The decline in demand due to technology is inevitable in nearly any field. The best advice one can give is to try choose a field that will be least affected by advances in AI and other tech. In all honesty, it is quite unfair that pathologists need to undergo the same about of training as other medical specialties. Most of them rarely interact with patients making a lot med school rotations impractical. Pathology would be better served if there was a direct/focused program with straightforward requirement, similar to that of a "geneticist".

Only a second year med student here so pardon my naivety, but why discourage students from entering pathology just because there are potential technological applications in the field? Shouldn't the potential to implement new technology be encouraged, as it could potentially arm pathologists with more data that can be be of value to the treatment of the patient? For example, if a validated machine learning technology could one day analyze a digital whole slide image, extract features that are invisible or too complex to detect by the human eye, and provide additional predictive or prognostic information that would otherwise be unknown to clinicians, isn't that a scenario in which a pathologist could provide tremendous value to patient care?

I don't claim to be an expert in AI by any means -- I only have a little bit of experience in applying machine learning to analyze digitized H&E images -- and as a second year med student I admittedly know essentially nothing about the practice of pathology; but from everything I've seen and read regarding AI, we are much closer to a point in time in which it will augment rather than overtake medical practice. Maybe I'm an optimist, but (supposed) job market woes aside, I think this is potentially a very exciting time to be a student with an interest in the field of pathology.

 

[cableguy555]

Only a second year med student here so pardon my naivety, but why discourage students from entering pathology just because there are potential technological applications in the field? Shouldn't the potential to implement new technology be encouraged, as it could potentially arm pathologists with more data that can be be of value to the treatment of the patient? For example, if a validated machine learning technology could one day analyze a digital whole slide image, extract features that are invisible or too complex to detect by the human eye, and provide additional predictive or prognostic information that would otherwise be unknown to clinicians, isn't that a scenario in which a pathologist could provide tremendous value to patient care?

I don't claim to be an expert in AI by any means -- I only have a little bit of experience in applying machine learning to analyze digitized H&E images -- and as a second year med student I admittedly know essentially nothing about the practice of pathology; but from everything I've seen and read regarding AI, we are much closer to a point in time in which it will augment rather than overtake medical practice. Maybe I'm an optimist, but (supposed) job market woes aside, I think this is potentially a very exciting time to be a student with an interest in the field of pathology.

Future advances in technology is great for medicine but necessarily so for physicians. For example, as little as 7 years ago liposuction was only possible by plastic surgery but technologies like SculpSure, often performed by dermatologists and IM’s, have reduced the demand for invasive procedures. Similarly nose jobs, a great money maker for plastic surgery, is being seen as a last resort given the increase injectable alternatives performed by IMs.

So what does mean? It’s not meant to discourage those interested in plastics or pathology, or whatever field that you prefer BUT rather assert the importance of considering future outlook in addition to genuine interest. As a med student, you’ll be sacrificing valuable time and resources and therefore it would be unwise to only take into account passion alone.

You are correct in that medical technology will augment instead of replace physicians but you fail to consider that the use of technology ALWAYS leads to lower wages for the person using the technology and increases wages for those who create it. This is because it diminishes the value of “skill” needed to perform such a procedure.

 

[tensoranalysis]

Med students do not bear the responsibility of keeping pathology alive. The decline in demand due to technology is inevitable in nearly any field. The best advice one can give is to try choose a field that will be least affected by advances in AI and other tech. In all honesty, it is quite unfair that pathologists need to undergo the same about of training as other medical specialties. Most of them rarely interact with patients making a lot med school rotations impractical. Pathology would be better served if there was a direct/focused program with straightforward requirement, similar to that of a "geneticist".

Fair enough. I agree that med students do not bear a responsibility here. I partially disagree on a few points. Demand for services is increasing, no telling how AI will impact demand or supply right now.

Specialized training is an interesting option but could be said about other specialties too. There are pros/cons to doing this. Some schools are already shortening the MD program to less than 4 years to provide more specialized education.

 

[Dro133]

Future advances in technology is great for medicine but necessarily so for physicians. For example, as little as 7 years ago liposuction was only possible by plastic surgery but technologies like SculpSure, often performed by dermatologists and IM’s, have reduced the demand for invasive procedures. Similarly nose jobs, a great money maker for plastic surgery, is being seen as a last resort given the increase injectable alternatives performed by IMs.

So what does mean? It’s not meant to discourage those interested in plastics or pathology, or whatever field that you prefer BUT rather assert the importance of considering future outlook in addition to genuine interest. As a med student, you’ll be sacrificing valuable time and resources and therefore it would be unwise to only take into account passion alone.

You are correct in that medical technology will augment instead of replace physicians but you fail to consider that the use of technology ALWAYS leads to lower wages for the person using the technology and increases wages for those who create it. This is because it diminishes the value of “skill” needed to perform such a procedure.

I agree with your assertion that it's important to consider future outlook when considering any given field, but I would challenge the statement in your third paragraph, that "the use of technology always leads to lower wages for the person using the technology". I agree with this statement partially, in that if a technology serves to automate a pre-existing workflow, then yes, it would likely reduce demand for pathologists -- but what about the case of a technology that adds a new dimension to the services that a pathologist currently provides? For example, and this is a genuine question because I'm not familiar with pathologist reimbursement, but I would imagine that the advent and clinical integration of IHC as a service that the pathologist provides led to increasing reimbursements for pathologists in general? Or is this not the case? If that is indeed the case, I could imagine a hypothetical (but maybe not completely unrealistic) scenario in which say, a computer algorithm that detects novel imaging biomarkers that adds to our predictive/prognostic capability could similarly be an additional service that pathologists could be reimbursed for. However, it would certainly require pathologists, and especially budding pathologists, to embrace, rather than fear the technology that is going to make its way into medical practice one way or another.

 

[dukeresident]

Future advances in technology is great for medicine but necessarily so for physicians. For example, as little as 7 years ago liposuction was only possible by plastic surgery but technologies like SculpSure, often performed by dermatologists and IM’s, have reduced the demand for invasive procedures. Similarly nose jobs, a great money maker for plastic surgery, is being seen as a last resort given the increase injectable alternatives performed by IMs.

So what does mean? It’s not meant to discourage those interested in plastics or pathology, or whatever field that you prefer BUT rather assert the importance of considering future outlook in addition to genuine interest. As a med student, you’ll be sacrificing valuable time and resources and therefore it would be unwise to only take into account passion alone.

You are correct in that medical technology will augment instead of replace physicians but you fail to consider that the use of technology ALWAYS leads to lower wages for the person using the technology and increases wages for those who create it. This is because it diminishes the value of “skill” needed to perform such a procedure.

At the least, the number of pathologists to handle the same workflow will be reduced.

 

[dukeresident]

I agree with your assertion that it's important to consider future outlook when considering any given field, but I would challenge the statement in your third paragraph, that "the use of technology always leads to lower wages for the person using the technology". I agree with this statement partially, in that if a technology serves to automate a pre-existing workflow, then yes, it would likely reduce demand for pathologists -- but what about the case of a technology that adds a new dimension to the services that a pathologist currently provides? For example, and this is a genuine question because I'm not familiar with pathologist reimbursement, but I would imagine that the advent and clinical integration of IHC as a service that the pathologist provides led to increasing reimbursements for pathologists in general? Or is this not the case? If that is indeed the case, I could imagine a hypothetical (but maybe not completely unrealistic) scenario in which say, a computer algorithm that detects novel imaging biomarkers that adds to our predictive/prognostic capability could similarly be an additional service that pathologists could be reimbursed for. However, it would certainly require pathologists, and especially budding pathologists, to embrace, rather than fear the technology that is going to make its way into medical practice one way or another.

I sincerely doubt that the added money would go to the pathologist. Expect the purveyor of the needed machinery/AI to do quite nicely though.

 

[MedicalDoge]

I do have a different experience than most of the pessimistic outlooks on here. I shadowed a brilliant pathologist at a hospital and he was extremely personable, humble, and happy with his lifestyle. Sure, he was a a partner in the corporation and also chief of staff of the hospital system, so he was probably making 500K+ (just a complete guess). This is probably an outlier case, but I think if you are very smart, love the field, and aren't an antisocial lab rat, you will have the opportunity for upward mobility in the field and possibly take on new roles in the hospital you work at. Maybe I am being naive, but just wanted to share this experience. He is a relatively young doctor as well.

 

[LoaLoa]

Pathology is a wonderful career. In general, we have a great lifestyle, are well-compensated and do interesting and meaningful work. Despite the soul-destroying pessimism and despair on these forums, pathology will continue to be a necessary medical specialty for the foreseeable future. That said, the field--especially the economics of private practice--are changing quickly. There is a strong tendency toward a culture of economic haves and have-nots among pathologists in that world, and I don't see that trend changing any time soon. You need to go into the field with your eyes open.

If you think you can end up near the top of the heap in training, i.e. a good residency with some name recognition, a good and economically viable subspecialty, good communication skills, leadership skills, personable, friendly etc. I'd say go for it. The market for excellent pathologists with good communication skills and strong credentials is NOT saturated and won't be during our careers. If others agree that you have these qualities, you will end up with a good job. If this is you, my advice would be to crush medical school, crush the USMLE, do a couple of research projects, and do your residency somewhere people have heard of.

If you think you might realistically end up in the middle or back of the pack, i.e. at an unknown training program with nothing to distinguish yourself from other new graduates, I'd consider a different specialty, unless you have total geographic flexibility or can't see yourself doing anything else. There is an ocean of technically qualified, but undesirable candidates for jobs that you'd be competing against. In that market, there is a race to the bottom. Unlike family medicine, for example, where the lowliest graduate from the lowliest training program is virtually guaranteed multiple job offers with strong compensation.

 

[Thrombus]

I do have a different experience than most of the pessimistic outlooks on here. I shadowed a brilliant pathologist at a hospital and he was extremely personable, humble, and happy with his lifestyle. Sure, he was a a partner in the corporation and also chief of staff of the hospital system, so he was probably making 500K+ (just a complete guess). This is probably an outlier case, but I think if you are very smart, love the field, and aren't an antisocial lab rat, you will have the opportunity for upward mobility in the field and possibly take on new roles in the hospital you work at. Maybe I am being naive, but just wanted to share this experience. He is a relatively young doctor as well.

Yes there are some that do quite well. I was not a big Mitt Romney fan, but one thing I liked that he said in a debate was "It doesn't have to be this way" (in reference to having every part of our life and work being regulated and taxed).

Similarly, in pathology it doesn't have to be this way!!! We should all be able to RECRUITED AGGRESSIVELY in addition to having OUR SERVICES RECRUITED AGGRESSIVELY, just like a dermatologist does! Then we can all work on our terms and tell the C average undergraduate suits to go fetch me another hot cup of coffee with a fresh scone or pastry of your choice as we watch him run after it in order to keep HIS (or her) job.

 

[AZpath]

Pathology is a wonderful career. In general, we have a great lifestyle, are well-compensated and do interesting and meaningful work. Despite the soul-destroying pessimism and despair on these forums, pathology will continue to be a necessary medical specialty for the foreseeable future. That said, the field--especially the economics of private practice--are changing quickly. There is a strong tendency toward a culture of economic haves and have-nots among pathologists in that world, and I don't see that trend changing any time soon. You need to go into the field with your eyes open.

If you think can end up near the top of the heap in training, i.e. a good residency with some name recognition, a good and economically viable subspecialty, good communication skills, leadership skills, personable, friendly etc. I'd say go for it. The market for excellent pathologists with good communication skills and strong credentials is NOT saturated and won't be during our careers. If others agree that you have these qualities, you will end up with a good job. If this is you, my advice would be to crush medical school, crush the USMLE, do a couple of research projects, and do your residency somewhere people have heard of.

If you think you might realistically end up in the middle or back of the pack, i.e. at an unknown training program with nothing to distinguish yourself from other new graduates, I'd consider a different specialty, unless you have total geographic flexibility or can't see yourself doing anything else. There is an ocean of technically qualified, but undesirable candidates for jobs that you'd be competing against. In that market, there is a race to the bottom. Unlike family medicine, for example, where the lowliest graduate from the lowliest training program is virtually guaranteed multiple job offers with strong compensation.

Your dead on. My concern is that we are due for a shake out due to the oversupply. I have seen labs are willing to accept contracts at 25% of MC in my area.
It only take a few changes in the insurance marketplace or a CMS cuts to force massive disruption and consolation.
I have been around long enough to see this happen twice. Once in the mid 80's due to the DRGs and then in the 90s as managed care caused consolidation.
Less productive members of even strong pathology groups are then let go. In the 90's, unemployment in pathology was reported as 10% by the WSJ as I recall.
That takes a while to repair. Even productive pathologists and younger members can be left out of work for a while.

 

[potato51]

If you think you can end up near the top of the heap in training, i.e. a good residency with some name recognition, a good and economically viable subspecialty, good communication skills, leadership skills, personable, friendly etc. I'd say go for it. The market for excellent pathologists with good communication skills and strong credentials is NOT saturated and won't be during our careers. If others agree that you have these qualities, you will end up with a good job. If this is you, my advice would be to crush medical school, crush the USMLE, do a couple of research projects, and do your residency somewhere people have heard of.

Having just participated in the recruitment process for a partnership track position in a private practice group, this really rings true to me. We had an overabundance of applications, all technically qualified, but it was still very easy to whittle the list down to a handful of strong contenders with the above qualifications. Some of the others may have been competent, but hard to tell from their application (couldn't follow their timeline from college to present, unknown program/references, poorly constructed cover letters/CVs, etc). Will have to google some of these applicants later this year to see where they ended up.

 

[cableguy555]

Yes there are some that do quite well. I was not a big Mitt Romney fan, but one thing I liked that he said in a debate was "It doesn't have to be this way" (in reference to having every part of our life and work being regulated and taxed).

Similarly, in pathology it doesn't have to be this way!!! We should all be able to RECRUITED AGGRESSIVELY in addition to having OUR SERVICES RECRUITED AGGRESSIVELY, just like a dermatologist does! Then we can all work on our terms and tell the C average undergraduate suits to go fetch me another hot cup of coffee with a fresh scone or pastry of your choice as we watch him run after it in order to keep HIS (or her) job.

You are quite delusional and have a great sense of entitlement. You, or anyone else for that matter, don’t deserve anything in life; you gotta earn it. Derms earn the lifestyle because they are among the most hardworking med students in America with **** load of research experience. Most derms could have easily matched to other competitive specialities because their average step 1 score is 250, while pathology has a step 1 of 229.


It’s quite funny to see pathologists demanding a certain lifestyle. It’s similiar to a teacher saying I have a masters in library studies and therefore I deserve a raise . Not all degrees are equal, and just because you’re a pathologist, it doesn’t mean that you are better or equivalent than your peers.

 

[Dro133]

I sincerely doubt that the added money would go to the pathologist. Expect the purveyor of the needed machinery/AI to do quite nicely though.

Could you explain why? The way I see it is that the AI would be bundled in some software that a pathology lab would purchase a license for, just like you or I would purchase a license for Photoshop. The pathology lab would still have to do the work to scan the slide. The lab would also have to run the computation, either on computer hardware that the lab would purchase or on a cloud platform such as Amazon Web Services.

The creator of the AI would make money from the license. A company such as Intel or Amazon would make money off the one-time sale of computer hardware or off of their cloud platform subscription, respectively. The day-to-day work of scanning the slides and running the computations would still fall on the lab, not on the purveyors of the hardware/AI.

I would certainly appreciate being corrected if there is naivety or inaccuracies in my view of how this would work.

 

[icpshootyz]

You are quite delusional and have a great sense of entitlement. You, or anyone else for that matter, don’t deserve anything in life; you gotta earn it. Derms earn the lifestyle because they are among the most hardworking med students in America with **** load of research experience. Most derms could have easily matched to other competitive specialities because their average step 1 score is 250, while pathology has a step 1 of 229.


It’s quite funny to see pathologists demanding a certain lifestyle. It’s similiar to a teacher saying I have a masters in library studies and therefore I deserve a raise . Not all degrees are equal, and just because you’re a pathologist, it doesn’t mean that you are better or equivalent than your peers.

BUT - the only reason dermatology pays so well and is so competitive is because the number of dermatologists is contained by limiting residency spots and the number trained per year, hence limiting competition and increasing demand for dermatologists and subsequently dermatologist pay. Of course the advent of cosmetic dermatology certainly helped, but really if derm opened the floodgates and trained more dermatologists each year their competitiveness would go down as well.

 

[Thrombus]

You are quite delusional and have a great sense of entitlement. You, or anyone else for that matter, don’t deserve anything in life; you gotta earn it. Derms earn the lifestyle because they are among the most hardworking med students in America with **** load of research experience. Most derms could have easily matched to other competitive specialities because their average step 1 score is 250, while pathology has a step 1 of 229.


It’s quite funny to see pathologists demanding a certain lifestyle. It’s similiar to a teacher saying I have a masters in library studies and therefore I deserve a raise . Not all degrees are equal, and just because you’re a pathologist, it doesn’t mean that you are better or equivalent than your peers.

YOU are quite delusional and have ZERO sense of basic economics. In a market driven world, pathologists would be training apprentices as demand is necessary. However, that market is SKEWED by lazy academics and the free lunch that CMS provides them via pathology trainees. There is a CANYON of disconnect between these academics and Joe Pathologist who would like to work as hard as he is able/willing and collect the fruits of his wages. DERM makes money because there is NO SUCH CANYON OF DISCONNECT and academics train apprentices as DEMAND "DEMANDS".

Your step 1 score follows the economic realities of both specialties. Additionally, YOU are the one with the sense of entitlement as if hard work memorizing mostly trivial (see Gross anatomy) facts in the information age in medical school has much to do with anything other than attaining a test score.

 

[cableguy555]

BUT - the only reason dermatology pays so well and is so competitive is because the number of dermatologists is contained by limiting residency spots and the number trained per year, hence limiting competition and increasing demand for dermatologists and subsequently dermatologist pay. Of course the advent of cosmetic dermatology certainly helped, but really if derm opened the floodgates and trained more dermatologists each year their competitiveness would go down as well.

Exactly! You are making my point. If dermatology ever opened the floodgates, it would be unwise to encourage med students to pursue dermatology. I don't think the "floodgates" were opened for pathology but rather technological advances and consolidation led to diminished pay. In all honesty, if Medicare wanted to cut costs, derm would definitely be a starting point because they take into account the time spent working towards the profession and most derm residencies are only 3 years.

 

[cableguy555]

YOU are quite delusional and have ZERO sense of basic economics. In a market driven world, pathologists would be training apprentices as demand is necessary. However, that market is SKEWED by lazy academics and the free lunch that CMS provides them via pathology trainees. DERM makes money because there is NO SUCH DISCONNECT and academics train apprentices as DEMAND "DEMANDS".

Your step 1 score follows the economic realities of both specialties. Additionally, YOU are the one with the sense of entitlement as if hard work memorizing mostly trivial (see Gross anatomy) facts in the information age in medical school has much to do with anything other than attaining a test score.

Hey I don't make the rules, if you're upset with the system, go change it. The "trival" facts that med students remember while studying for the step 1 define their career. People choose specialties like derm and opth because a little more hard work memorizing "trival" facts, hopefully, pays off well in the next stages of their career. I apologize if I upset you in any way...

 

[Thrombus]

Hey I don't make the rules, if you're upset with the system, go change it. The "trival" facts that med students remember while studying for the step 1 define their career. People choose specialties like derm and opth because a little more hard work memorizing "trival" facts, hopefully, pays off well in the next stages of their career. I apologize if I upset you in any way...

Exposing the disconnect between academics who feast on trainees' subsidies which harshly penalizes wannabe pathologist professionals trying to navigate the resulting commoditization is step #1 to changing the system.

 

[pianoguy05]

Oh Good. The medical student ventured over to tell us about practicing medicine and comparing specialties. So much in depth information about dermatology and step 1 scores...must be top of his class!

You are quite delusional and have a great sense of entitlement. You, or anyone else for that matter, don’t deserve anything in life; you gotta earn it. Derms earn the lifestyle because they are among the most hardworking med students in America with **** load of research experience. Most derms could have easily matched to other competitive specialities because their average step 1 score is 250, while pathology has a step 1 of 229.


It’s quite funny to see pathologists demanding a certain lifestyle. It’s similiar to a teacher saying I have a masters in library studies and therefore I deserve a raise . Not all degrees are equal, and just because you’re a pathologist, it doesn’t mean that you are better or equivalent than your peers.

 

[dukeresident]

Could you explain why? The way I see it is that the AI would be bundled in some software that a pathology lab would purchase a license for, just like you or I would purchase a license for Photoshop. The pathology lab would still have to do the work to scan the slide. The lab would also have to run the computation, either on computer hardware that the lab would purchase or on a cloud platform such as Amazon Web Services.

The creator of the AI would make money from the license. A company such as Intel or Amazon would make money off the one-time sale of computer hardware or off of their cloud platform subscription, respectively. The day-to-day work of scanning the slides and running the computations would still fall on the lab, not on the purveyors of the hardware/AI.

I would certainly appreciate being corrected if there is naivety or inaccuracies in my view of how this would work.

Looking at photography, photoshop and digital cameras have reduced the barriers to entry to be a professional photographer. It is much harder to make good money being a photographer these days than in the days of analog photography. Photoshop has been able to go to a licensing subscription fee model and generate higher revenue while professional photographers make less per capita. I had a very unhappy photographer for my wedding.

Expect AI to lower the prices that can be charged for pathology services but in order to compete you have to have the AI so the AI creator is not inclined to lower prices. Due to increased efficiency offered by using AI, less pathologists will be required to handle the same amount of workflow. What happens when you have an excess of something?

 

[dukeresident]

Could you explain why? The way I see it is that the AI would be bundled in some software that a pathology lab would purchase a license for, just like you or I would purchase a license for Photoshop. The pathology lab would still have to do the work to scan the slide. The lab would also have to run the computation, either on computer hardware that the lab would purchase or on a cloud platform such as Amazon Web Services.

The creator of the AI would make money from the license. A company such as Intel or Amazon would make money off the one-time sale of computer hardware or off of their cloud platform subscription, respectively. The day-to-day work of scanning the slides and running the computations would still fall on the lab, not on the purveyors of the hardware/AI.

I would certainly appreciate being corrected if there is naivety or inaccuracies in my view of how this would work.

Harvard can’t be wrong, right?

AI Will Change Radiology, but It Won’t Replace Radiologists

 

[Dro133]

Looking at photography, photoshop and digital cameras have reduced the barriers to entry to be a professional photographer. It is much harder to make good money being a photographer these days than in the days of analog photography. Photoshop has been able to go to a licensing subscription fee model and generate higher revenue while professional photographers make less per capita. I had a very unhappy photographer for my wedding.

Expect AI to lower the prices that can be charged for pathology services but in order to compete you have to have the AI so the AI creator is not inclined to lower prices. Due to increased efficiency offered by using AI, less pathologists will be required to handle the same amount of workflow. What happens when you have an excess of something?

I think that we're having two different conversations. I absolutely agree with you about an AI that increases the efficiency of the current standard pathology workflow; increased efficiency equals fewer pathologists needed to handle the same workflow. 100% agreement with you on that.

What I'm talking about is AI that adds additional services/value outside of what a pathologist can offer today. As I mentioned above, an example would be an algorithm can look at an image and not diagnose it, but rather use features of the image to add prognostic/predictive value. This type of research is certainly in its infancy and is likely a long ways away from becoming integrated clinically, but it is out there. For example, one study (Predicting non-small cell lung cancer prognosis by fully automated microscopic pathology image features) was able to train an AI algorithm to stratify patients with Stage 1 lung adenocarcinoma as "longer-term" or "shorter-term" survivors based on only the H&E image. Another study (https://www.biorxiv.org/content/biorxiv/early/2017/10/03/198010.full.pdf) performed a similar survival analysis for glioma using a combination of H&E images and genomics. There are many other examples out there.

My point is, we are probably a long, long time from AI replacing pathologists. That's the AI you're talking about. I'm talking about something completely different: AI that augments, but does not replace, pathologists. The article you posted illustrates my point:

"We’re confident, however, that the great majority of radiologists will continue to have jobs in the decades to come — jobs that will be altered and enhanced by AI. One of us (Keith) is a radiologist and artificial intelligence researcher, and the other (Thomas) has researched the impact of AI on jobs for several years. We see several reasons why radiologists won’t be disappearing from the labor force".

But that doesn't mean that AI can't be used by pathologists in their favor. I believe that pathologists might one day be able to provide AI as a (billable) service to improve patient care, similarly to how IHC is used today. As the article you posted writes:

"...the only radiologists whose jobs may be threatened are the ones who refuse to work with AI. There are substantial medical and productivity benefits to be gained from integrating AI with radiological practice."

And I believe the same can ring true for pathology, if it's embraced properly.

 

[LoaLoa]

Looking at photography, photoshop and digital cameras have reduced the barriers to entry to be a professional photographer. It is much harder to make good money being a photographer these days than in the days of analog photography. Photoshop has been able to go to a licensing subscription fee model and generate higher revenue while professional photographers make less per capita. I had a very unhappy photographer for my wedding.

Expect AI to lower the prices that can be charged for pathology services but in order to compete you have to have the AI so the AI creator is not inclined to lower prices. Due to increased efficiency offered by using AI, less pathologists will be required to handle the same amount of workflow. What happens when you have an excess of something?

This is probably true in the very long run, but it takes payers a long time to catch up. In the short run, anything that makes pathologists more efficient will increase profits. If you look at what has happened with other AI-like technological advancements, i.e. image analysis for biomarker interpretation, image-assisted pap screening, reimbursement is actually more, not less, for cases where those technologies are used. I think its far from clear how AI will shake out in our field. I think our bread and butter caseload will be "safe" for many years to come.

Parenthetically, one thing I've learned is that who gets paid in our field has very little to do with one's diagnostic skill or how many cases one can do. It has everything to do with the influence you have over your referral base and whether you own the case supply. If you want to get truly rich being a pathologist, land a big hospital contract or two and hire associates to churn cases while you chat up the decision makers. Alternatively, own an outpatient lab and build a referral base. Unless health care gets nationalized, both of these basic business techniques (both of which are much easier said than done) aren't going anywhere, even if AI takes over. You control the cases, you control the money.

 

[cableguy555]

Oh Good. The medical student ventured over to tell us about practicing medicine and comparing specialties. So much in depth information about dermatology and step 1 scores...must be top of his class!

I’m sorry if the post came out wrong. What you quoted was my reply to another member claiming that pathologists should be able to earn so much that premeds would bow down to them and bring them coffee. I just found that funny.

 

[Thrombus]

I’m sorry if the post came out wrong. What you quoted was my reply to another member claiming that pathologists should be able to earn so much that premeds would bow down to them and bring them coffee. I just found that funny.

No we should have enough leverage that the c average undergraduate business degree guy is asking to bring us coffee instead of vice versa. I suggest that you be seen more (or be reading more) and heard less from now on.

 

[cableguy555]

No we should have enough leverage that the c average undergraduate business degree guy is asking to bring us coffee instead of vice versa. I suggest that you be seen more (or be reading more) and heard less from now on.

Hey I’m sorry you don’t like bringing coffee to a “C” average business degree guy. I guess it shows that in the real world, things other than education matter. By the way, most people go to top business schools for the connections, and not to get an “A”. Because grades mean nothing in business school. Maybe the guy you are so upset about bringing coffee to is actually smarter than you think. After all he’s got a doctor working for him...

 

[dukeresident]

I think that we're having two different conversations. I absolutely agree with you about an AI that increases the efficiency of the current standard pathology workflow; increased efficiency equals fewer pathologists needed to handle the same workflow. 100% agreement with you on that.

What I'm talking about is AI that adds additional services/value outside of what a pathologist can offer today. As I mentioned above, an example would be an algorithm can look at an image and not diagnose it, but rather use features of the image to add prognostic/predictive value. This type of research is certainly in its infancy and is likely a long ways away from becoming integrated clinically, but it is out there. For example, one study (Predicting non-small cell lung cancer prognosis by fully automated microscopic pathology image features) was able to train an AI algorithm to stratify patients with Stage 1 lung adenocarcinoma as "longer-term" or "shorter-term" survivors based on only the H&E image. Another study (https://www.biorxiv.org/content/biorxiv/early/2017/10/03/198010.full.pdf) performed a similar survival analysis for glioma using a combination of H&E images and genomics. There are many other examples out there.

My point is, we are probably a long, long time from AI replacing pathologists. That's the AI you're talking about. I'm talking about something completely different: AI that augments, but does not replace, pathologists. The article you posted illustrates my point:

"We’re confident, however, that the great majority of radiologists will continue to have jobs in the decades to come — jobs that will be altered and enhanced by AI. One of us (Keith) is a radiologist and artificial intelligence researcher, and the other (Thomas) has researched the impact of AI on jobs for several years. We see several reasons why radiologists won’t be disappearing from the labor force".

But that doesn't mean that AI can't be used by pathologists in their favor. I believe that pathologists might one day be able to provide AI as a (billable) service to improve patient care, similarly to how IHC is used today. As the article you posted writes:

"...the only radiologists whose jobs may be threatened are the ones who refuse to work with AI. There are substantial medical and productivity benefits to be gained from integrating AI with radiological practice."

And I believe the same can ring true for pathology, if it's embraced properly.

I was being a bit facetious regarding the Harvard article. I’m not sure I buy their argument which I think applies to pathology as well as radiology. Certainly AI can enhance and alter the services offered. Will pathologists be the ones to offer them or will other specialists offer some of them? Will insurance cover these or will it be something only the wealthy patients can afford? There are certainly beneficial treatments/procedures today that are not available to most patients.

 

[Violetta80]

wow...reading just through parts of this I want to point out that:

1) it sounds very frustrating for an incoming path resident - guys, there are people that are (still) really passionate about this field for many reasons. Don't kill everything by comparing it with specialties like Derm - I think this just won't get us anywhere. (Also - arguments listing step scores never convinced me so far...there is a lot more to cleverness

2) poor "gasbait": as thread-opener asking a reasonable question - he never responded anymore/entirely disappeared. No wonder, this here is so intimidating.

#Pathology #rules

 

[dukeresident]

I think that we're having two different conversations. I absolutely agree with you about an AI that increases the efficiency of the current standard pathology workflow; increased efficiency equals fewer pathologists needed to handle the same workflow. 100% agreement with you on that.

What I'm talking about is AI that adds additional services/value outside of what a pathologist can offer today. As I mentioned above, an example would be an algorithm can look at an image and not diagnose it, but rather use features of the image to add prognostic/predictive value. This type of research is certainly in its infancy and is likely a long ways away from becoming integrated clinically, but it is out there. For example, one study (Predicting non-small cell lung cancer prognosis by fully automated microscopic pathology image features) was able to train an AI algorithm to stratify patients with Stage 1 lung adenocarcinoma as "longer-term" or "shorter-term" survivors based on only the H&E image. Another study (https://www.biorxiv.org/content/biorxiv/early/2017/10/03/198010.full.pdf) performed a similar survival analysis for glioma using a combination of H&E images and genomics. There are many other examples out there.

My point is, we are probably a long, long time from AI replacing pathologists. That's the AI you're talking about. I'm talking about something completely different: AI that augments, but does not replace, pathologists. The article you posted illustrates my point:

"We’re confident, however, that the great majority of radiologists will continue to have jobs in the decades to come — jobs that will be altered and enhanced by AI. One of us (Keith) is a radiologist and artificial intelligence researcher, and the other (Thomas) has researched the impact of AI on jobs for several years. We see several reasons why radiologists won’t be disappearing from the labor force".

But that doesn't mean that AI can't be used by pathologists in their favor. I believe that pathologists might one day be able to provide AI as a (billable) service to improve patient care, similarly to how IHC is used today. As the article you posted writes:

"...the only radiologists whose jobs may be threatened are the ones who refuse to work with AI. There are substantial medical and productivity benefits to be gained from integrating AI with radiological practice."

And I believe the same can ring true for pathology, if it's embraced properly.

My thought gets on the Harvard article:

Interventional radiology obviously will stay. Diagnostic radiology should go away, but medicine being a guild craft will probably manage to require human "overread" of images. VA and Kaiser, for example, have huge databases of images with associated readings. NLP software to parse the reading for an xray and ML to identify things should get around the claim of no repository of tagged images, etc. That approach will take longer to mature than using images with features tagged, though.

 

[chooks]

Having just participated in the recruitment process for a partnership track position in a private practice group, this really rings true to me. We had an overabundance of applications, all technically qualified, but it was still very easy to whittle the list down to a handful of strong contenders with the above qualifications. Some of the others may have been competent, but hard to tell from their application (couldn't follow their timeline from college to present, unknown program/references, poorly constructed cover letters/CVs, etc). Will have to google some of these applicants later this year to see where they ended up.

Our group had a similar experience. A recent job posting resulted in plenty of CV's, but really only a very small handful (3-4 maybe) of really viable candidates.