Clinical vs Anatomic Pathology

[cait.vet]

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I will be a third-year veterinary student in the fall. I have always been interested in pathology and knew that I wanted to pursue that route going into vet school. It's about that time where we need to start applying to externships and thinking more about future plans. I am currently torn between pursuing CP vs AP. I love microscopy, so the idea of histopathology and cytology/hematology both appeal to me. I am not a fan of necropsy, but I would be able to do it during residency. My career goals would either be to work for a corporate lab (Antech/IDEXX) or in academia.

For AP, I love that you get a more definitive diagnosis than CP most of the time. You're able to see how disease affects the tissues and relate that to the patient's clinical signs. The architecture of histology is so beautiful to me and there are so many different things to see. For CP, I love that you get to be more involved in patient care. I know that APs still get to view slides from patients that are alive, but a lot of the time the patients are dead. In CP, I feel like you get to speak with clinicians more and be a part of the patient's diagnostic plan. I'd prefer to help animals and clients from the antemortem side. Something that I fear with CP is getting bored. I don't have a lot of experience shadowing CPs but I know that in labs such as IDEXX or Antech, you mainly look at cytologies and hematologies. Does it ever get boring looking at the "same thing" all day?

I'd love to hear if any of you were in the same boat and what ultimately helped you decide. If you're a current AP or CP, what do you love most about your job? What do you dislike the most? Is there anything you wish you would have known before applying for residency?

Thank you!!

 

[JaynaAli]

There’s several old posts in this forum where we have discussed both you may find interesting to read.

I work for one of the major diagnostic labs as a clinical pathologist. I always knew I wanted to do clin path though, I didn’t really consider anatomic. You’re correct that our workload is almost all cytology and hematology every day. My company does have some specialty reading teams you can opt in to participating in, such as SPE, ICC, flow cytometry, exotics, marrow cores, etc. We also do projects whether that’s in lab quality, rounds, resident training, outreach, etc. We don’t do nearly the chemistry interpretations I did as a resident but I don’t really miss it. I have always enjoyed cyto/heme the most so I don’t mind that being the vast majority of my work. Yes, a lot of the cases are things you get all the time (lymphoma, mast cell tumors, lipomas…common things occur commonly) but there’s usually at least a few weird things every day to keep things interesting. I make the same money whether a case is easy and takes two minutes or if it’s awful and takes 30+ to evaluate and write up. But every field has their “bread and butter” cases they see day in and day out. CPs get tons of MCTs and lipomas, but anatomics will too. GP vets do a ton of wellness cases and allergies. Surgeons do tons of TPLOs, neurologists see lots of IVDD, and cardio sees a ton of mitral valve disease. You just gotta pick what “flavor” of normal you like best.

I do still talk to vets, but definitely less than when I was in residency. But I’d say I get at least one email or phone call to discuss a case daily, though they tend to come in waves and I may go a couple days without any then get three in one day.

What I think the best part of being in a diagnostic lab is the work life balance. I have my list of cases for the day, I can choose when to start (my lab’s only rule is that all have to be signed out by midnight) and when those are done, I log off, walk out of my home office, and don’t think about work until the next morning. I never have more than my set daily case quota unless I ask for more to make more money. When I’m off, I don’t check emails because there are other people working to handle questions in my absence. And the pay is higher than in academia. My residentmate is in academia and loves it, but they easily work nearly double the hours I do for significantly less pay, especially when you factor in the lecture prep, projects, etc. they do outside of case reading.

What do I dislike? Not much, honestly. Being an employee of a corporation has some challenges (decision makers way up the chain are not always pathologists, price increases are frustrating for our clients but we have no control) but overall the benefits outweigh that for me. Academia has different bureaucracy but it’s very much present there too. AI encroachment on jobs/changing the field is a big concern but not a lot we can do to prevent that, we’ll just have to adapt and hope they still need a real human to read at least some samples in the future.

 

[cait.vet]

There’s several old posts in this forum where we have discussed both you may find interesting to read.

I work for one of the major diagnostic labs as a clinical pathologist. I always knew I wanted to do clin path though, I didn’t really consider anatomic. You’re correct that our workload is almost all cytology and hematology every day. My company does have some specialty reading teams you can opt in to participating in, such as SPE, ICC, flow cytometry, exotics, marrow cores, etc. We also do projects whether that’s in lab quality, rounds, resident training, outreach, etc. We don’t do nearly the chemistry interpretations I did as a resident but I don’t really miss it. I have always enjoyed cyto/heme the most so I don’t mind that being the vast majority of my work. Yes, a lot of the cases are things you get all the time (lymphoma, mast cell tumors, lipomas…common things occur commonly) but there’s usually at least a few weird things every day to keep things interesting. I make the same money whether a case is easy and takes two minutes or if it’s awful and takes 30+ to evaluate and write up. But every field has their “bread and butter” cases they see day in and day out. CPs get tons of MCTs and lipomas, but anatomics will too. GP vets do a ton of wellness cases and allergies. Surgeons do tons of TPLOs, neurologists see lots of IVDD, and cardio sees a ton of mitral valve disease. You just gotta pick what “flavor” of normal you like best.

I do still talk to vets, but definitely less than when I was in residency. But I’d say I get at least one email or phone call to discuss a case daily, though they tend to come in waves and I may go a couple days without any then get three in one day.

What I think the best part of being in a diagnostic lab is the work life balance. I have my list of cases for the day, I can choose when to start (my lab’s only rule is that all have to be signed out by midnight) and when those are done, I log off, walk out of my home office, and don’t think about work until the next morning. I never have more than my set daily case quota unless I ask for more to make more money. When I’m off, I don’t check emails because there are other people working to handle questions in my absence. And the pay is higher than in academia. My residentmate is in academia and loves it, but they easily work nearly double the hours I do for significantly less pay, especially when you factor in the lecture prep, projects, etc. they do outside of case reading.

What do I dislike? Not much, honestly. Being an employee of a corporation has some challenges (decision makers way up the chain are not always pathologists, price increases are frustrating for our clients but we have no control) but overall the benefits outweigh that for me. Academia has different bureaucracy but it’s very much present there too. AI encroachment on jobs/changing the field is a big concern but not a lot we can do to prevent that, we’ll just have to adapt and hope they still need a real human to read at least some samples in the future.

Thank you so much! It's great to hear your experiences and that you love your job. Would you mind sharing where you attended residency and how you liked it? I'm trying to narrow down some programs and it's been daunting. I know that I don't want to pursue a PhD. I've heard that it's a good idea to reach out to the residents at programs I'm interested in to get their thoughts. Is there anything else I could do to help scope out programs?

 

[JaynaAli]

The place I went for residency has had a complete turnover in mentors and is under a whole different department and stuff, so my experiences probably aren’t applicable anymore. But definitely talk to current and former residents. Ask your current mentors what they know about programs. Ask about boards pass rate and how much time you spend on clinics and how much time’s spent in rounds and on research and stuff…some places have way more experience on clinics vs others.

 

[WhtsThFrequency]

I will be a third-year veterinary student in the fall. I have always been interested in pathology and knew that I wanted to pursue that route going into vet school. It's about that time where we need to start applying to externships and thinking more about future plans. I am currently torn between pursuing CP vs AP. I love microscopy, so the idea of histopathology and cytology/hematology both appeal to me. I am not a fan of necropsy, but I would be able to do it during residency. My career goals would either be to work for a corporate lab (Antech/IDEXX) or in academia.

For AP, I love that you get a more definitive diagnosis than CP most of the time. You're able to see how disease affects the tissues and relate that to the patient's clinical signs. The architecture of histology is so beautiful to me and there are so many different things to see. For CP, I love that you get to be more involved in patient care. I know that APs still get to view slides from patients that are alive, but a lot of the time the patients are dead. In CP, I feel like you get to speak with clinicians more and be a part of the patient's diagnostic plan. I'd prefer to help animals and clients from the antemortem side. Something that I fear with CP is getting bored. I don't have a lot of experience shadowing CPs but I know that in labs such as IDEXX or Antech, you mainly look at cytologies and hematologies. Does it ever get boring looking at the "same thing" all day?

I'd love to hear if any of you were in the same boat and what ultimately helped you decide. If you're a current AP or CP, what do you love most about your job? What do you dislike the most? Is there anything you wish you would have known before applying for residency?

Thank you!!

Academic AP here. If you're working as an AP in corporate, the vast majority of your patients are going to be alive. In academia, it's about half an half depending on your necropsy/biopsy service split, so there's that. If you're not a fan of necropsy, I would hesitate to go an academic path as an AP because you're likely going to have a decent chunk of it, particularly as a new faculty member. Also remember that academic positions also still (unfortunately) lean towards having their faculty members have a PhD in addition to board certification - so if that's not something you want to stomach, academia might not be the best option. I think it is slowly changing, but not at all places.

Quick aside on antemortem vs postmortem - from the AP side, even on necropsy cases, I still interact with other clinicians, referring vets, and even the owners or producers directly. My findings may not help that original animal, but I can help bring context, explanation, and closure to owners as well as help producers make their herds healthier and safer. I may not get to interact with owners as much as other vets, but I have gotten a lot of very heartfelt thank yous for helping people through their grief by providing explanations, context etc as to what happened. I always as tell them that lack of information makes grief even worse - so if I can provide some of that to help them in their process, I've done my job. So there's that.

I chose AP because I liked histology more than cytology (and was better at it). I like being left alone to do my work and mostly interacting with other clinicians and pathologists (as opposed to the general public - I have the greatest admiration for the patience of general practitioners, no way could I survive it on the daily). I'm mostly biopsy with only a smattering of necropsy due to my other service obligations and teaching. I love the flexibility and variety of what I get to do in an academic setting - I'm a jack of all trades. I do clinics, dabble in research, teach a bunch, participate in outreach and committees, etc. On the fip side, I hate the bureaucracy and how everything moves at a glacial pace. Overall though, I'm very happy with my choice. Once I get my 10 years of public service, I may try to move into corporate for the pay, however.

In terms of getting boring looking at the same thing every day - you're going to have that in every single specialty of medicine. Radiologists are going to get tired of looking at broken bones and pneumonia, cardiologists are going to get tired of seeing chronic mitral valve disease, dermatologists are going to get tired of flea bit dermatitis, APs and CPs are going to get tired of mast cell tumors. Not something you can really avoid.