Advice on path potential

[midwestern]

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I'm a former derm wannabe who did not match and ended up doing a prelim year in surgery which I finished last summer (thought I might want to do surgery). I was going to spend this year doing derm research but that fell through. Now I'm trying to decide between doing path or doing IM and going on to specialize. I have not done a path rotation but really enjoyed my derm path experiences. I do have some misgivings about path though and was hoping the board could provide some clarity.

First is about job opportunities. I have seen a varying degree of comments on this issue but the general sense is that job opportunites are not strong. However, its hard for me to tell if jobs really are lacking or if really high paying jobs are lacking (>200K). Also, once you have been in the workforce for 3+ years what are the realistic numbers for salary expectations? Also, what type of work arrangements are offered in path as far as call, weekends, hours worked, etc. I've seen the median salary listed on "salary.com" as approx 150K. But the following website lists salaries much higher than that: http://www.allied-physicians.com/salary_surveys/physician-salaries.htm
Ideally, I'd like to be able to chose where my family and I live.

Next, how likely is it that given my lack of path experience I could find a spot? I have average Step scores, average grades, etc. Left my surgery program with good recs.

Finally, what do you guys see as the potential future for path in terms of innovations that will keep the field interesting and in demand?

 

[sandyworks]

Being only a 4th year medstudent, I don't think I have an answer to all your concerns, but in finding a spot, what has come up the most is how interested in path I really was. I believe there is a big concern among path programs everywhere that they're just the backup for another specialty and that the applicant isn't going to be happy when they end up in path. To that regard, they're going to look for at least some experience (i.e. one elective month or something) in path and probably at least one letter from a pathologist. So, if you truly have misgivings, for your own sake, don't apply; but if you're going to apply, don't tell them you have misgivings. <obvious, right?> 😀
In terms of what's great about path, in my three months of elective time, is that there are so many different aspects to it. If you're into patient care, blood banking and hemepath, even cytopath are great media by which you can get to know the people you're diagnosing through pheresis, bone marrow biopsies and FNAs. But even intellectually, transfusion medicine and microbio are so different from surg path and autopsy. It's great for someone (no bragging here, really) whose mind is versatile and needs a lot of stimulation. However, you should be someone who is okay with never knowing everything about it all, because that's just not pathology. It's a continuous learning process, and there's so much information, you're going to forget some basics about aspects you're not involved in. There's a reason path specialty boards are considered by many to be the most difficult.
In terms of future directions, it's really an exciting time to be in pathology, because of all the molecular techniques that have been coming out, enabling pathologists to make better and more accurate diagnoses. Also, there are constantly more immunostains (tumor markers etc) that are coming out. All of this equals lots of opportunity in research, if that's what you're interested in.
Lastly, if you're into derm, I'm sure you know you can get into dermpath via dermatology or pathology residency. Most dermpathologists I've met just do derm anyway, so if you can "put up" with four years of path residency, you can always just practice derm path later (although you'd be missing out on a lot of other cool stuff). Good luck to you; hope you find what you're looking for!

 

[LADoc00]

Just a thought: think outside the box, surgery skills are nice, even if you only did a prelim year, I wouldnt want that to go to waste. Also you might want to consider EM, ENT, Derm with a focus on MOHS if you cant hang with the surgery lifestyle. I realize Im totally diverting this thread but I just dont think people should be completely hanging their hat on path at the current time.

 

[yaah]

First is about job opportunities. I have seen a varying degree of comments on this issue but the general sense is that job opportunites are not strong. However, its hard for me to tell if jobs really are lacking or if really high paying jobs are lacking (>200K).

This is not the general sense. The general sense is that job opportunities are good. Most graduating residents (particularly those with fellowships) find jobs without difficulty. The opinion of a minority is that job opportunities are not strong, and generally this has to do with comparing the job situation now to what it was a few years ago when salaries were quite high and you could name your location and you only had to work 3 weeks per year (approximately). IN general, it is probably hard to find a job paying >200k right out of residency. A few years later, however, probably not. So you can't finish residency and get paid 400k with use of a private plane and a vacation home in Maui.

OK - we have had lots of talks about most of these questions previously - about future innovations, etc. I recommend looking through our old posts - lots of interesting stuff.

In regards to not having experience - the majority of med students who match into path have very little experience in it as well. Generally, most have done at least one rotation. It clearly helps to have a recommendation letter from a pathologist. I would question a residency application without a letter from the field you are applying to. But people switch fields all the time - especially after one year of training.


You have to do what interests you. If that is dermatology, then go for the research. Don't just do path (or IM) because it is available, because you'll probably end up switching out of that too.

 

[Doctor B.]

I can't say much more than what Yaah said. Don't worry about lack of path experience; no one expects you to have it. Path will continue to evolve and remain interesting, especially when the splitters decide to reclassify every single lymphoma again 🙂.

If you really like derm, re-apply. You can do dermpath from that if you like the path aspect of things.