Coming Back to Pathology

[Back2Pathology]

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I completed one year of Pathology Residency before starting a year in General Surgery. My experience in Pathology was mixed- although I enjoyed the material I was very concerned about two main issues in my program: the poor board passage rate of my program and the lack of jobs in pathology.

As an American Medical Graduate (MD) I wanted to make sure that I would have a job at the end of my training. However, after months of experience in General Surgery, I miss the thought and nuance of a good pathological diagnosis. My added training is a net benefit, both in general surgery and pathology. I was wondering if any residents or attendings reading this forum may be able to give me any advice.

I am applying for the match, and have a few interviews, but if any of your programs is experiencing any attrition or interested in an applicant with additional training, I would appreciate it.

Your thoughts are appreciated

-Back2Pathology

 

[deleted314957]

I completed one year of Pathology Residency before starting a year in General Surgery. My experience in Pathology was mixed- although I enjoyed the material I was very concerned about two main issues in my program: the poor board passage rate of my program and the lack of jobs in pathology.

As an American Medical Graduate (MD) I wanted to make sure that I would have a job at the end of my training. However, after months of experience in General Surgery, I miss the thought and nuance of a good pathological diagnosis. My added training is a net benefit, both in general surgery and pathology. I was wondering if any residents or attendings reading this forum may be able to give me any advice.

I am applying for the match, and have a few interviews, but if any of your programs is experiencing any attrition or interested in an applicant with additional training, I would appreciate it.

Your thoughts are appreciated

-Back2Pathology

would strongly recommend you stay in surgery. this is from someone with a 36 year perspective as a (now retired) physician who has experienced military, private practice partner and megalab employee.

 

[Inez2000]

Can you imagine four years of medical school, four years of residency, and 2 fellowships, and after all that training, not being able to find a job? That is the situation I face right now. I recommend avoiding pathology.

 

[path24]

Can you imagine four years of medical school, four years of residency, and 2 fellowships, and after all that training, not being able to find a job? That is the situation I face right now. I recommend avoiding pathology.

You should contact Barbara McKenna to see if you can join the 2014 USCAP panel.

 

[Inez2000]

You should contact Barbara McKenna to see if you can join the 2014 USCAP panel.

What is the 2014 USCAP panel?

 

[path19]

Have you considered sending in a CV for the USCAP exec VP position that's available?

 

[WEBB PINKERTON]

Have you considered sending in a CV for the USCAP exec VP position that's available?

Ha ha.

 

[Thrombus]

Can you imagine four years of medical school, four years of residency, and 2 fellowships, and after all that training, not being able to find a job? That is the situation I face right now. I recommend avoiding pathology.

You need to ask the following for a job. They all claim there is a looming shortage.
Stanley J. Robboy, Sally Weintraub, Andrew E. Horvath, Bradden W. Jensen, C. Bruce Alexander, Edward P. Fody, James M. Crawford, Jimmy R. Clark, Julie Cantor-Weinberg, Megha G. Joshi, Michael B. Cohen, Michael B. Prystowsky, Sarah M. Bean, Saurabh Gupta, Suzanne Z. Powell, V. O. Speights Jr, David J. Gross, W. Stephen Black-Schaffer and additional members of the Workforce Project Work Group

Lets see if they put their money where their mouths are and hire poster "Inez2000"🤣🤣🤣

 

[Thrombus]

I completed one year of Pathology Residency before starting a year in General Surgery. My experience in Pathology was mixed- although I enjoyed the material I was very concerned about two main issues in my program: the poor board passage rate of my program and the lack of jobs in pathology.

As an American Medical Graduate (MD) I wanted to make sure that I would have a job at the end of my training. However, after months of experience in General Surgery, I miss the thought and nuance of a good pathological diagnosis. My added training is a net benefit, both in general surgery and pathology. I was wondering if any residents or attendings reading this forum may be able to give me any advice.

I am applying for the match, and have a few interviews, but if any of your programs is experiencing any attrition or interested in an applicant with additional training, I would appreciate it.

Your thoughts are appreciated

-Back2Pathology

Silly resident, stay in surgery! If you go back to pathology you may still "miss the thought and nuance of a good pathological diagnosis" as there will likely be no work for you!

I have asked many a time if there is anyone who has too much work to do, and never have received the opportunity to do their extra work! That says all you need about pathology!!!!

 

[yaah]

You need to ask the following for a job. They all claim there is a looming shortage.
Stanley J. Robboy, Sally Weintraub, Andrew E. Horvath, Bradden W. Jensen, C. Bruce Alexander, Edward P. Fody, James M. Crawford, Jimmy R. Clark, Julie Cantor-Weinberg, Megha G. Joshi, Michael B. Cohen, Michael B. Prystowsky, Sarah M. Bean, Saurabh Gupta, Suzanne Z. Powell, V. O. Speights Jr, David J. Gross, W. Stephen Black-Schaffer and additional members of the Workforce Project Work Group

Lets see if they put their money where their mouths are and hire poster "Inez2000"🤣🤣🤣

They claim there will be a looming shortage in many years, not imminently. It really doesn't help to conflate the present with the future, this is a MAJOR part of the problem with getting to the root of the current problem. If you focus all of your attention on future projections and how way off they are because of what current conditions are, then you are not going to be able to successfully argue with anyone that you listed above.

Do you see what the problem is? They are saying something like "in 10 years there is a projected shortage of pathologists" and you are saying "you're terrible wrong, right now there are too many pathologists". But they aren't really talking about right now. I have little doubt that their views of the current market differ from yours, but you're still talking about different things.

 

[2121115]

I completed one year of Pathology Residency before starting a year in General Surgery. My experience in Pathology was mixed- although I enjoyed the material I was very concerned about two main issues in my program: the poor board passage rate of my program and the lack of jobs in pathology.

As an American Medical Graduate (MD) I wanted to make sure that I would have a job at the end of my training. However, after months of experience in General Surgery, I miss the thought and nuance of a good pathological diagnosis. My added training is a net benefit, both in general surgery and pathology. I was wondering if any residents or attendings reading this forum may be able to give me any advice.

I am applying for the match, and have a few interviews, but if any of your programs is experiencing any attrition or interested in an applicant with additional training, I would appreciate it.

Your thoughts are appreciated

-Back2Pathology

This post must be a joke. Surely you are not serious.

 

[Glass Pusher]

They claim there will be a looming shortage in many years, not imminently. It really doesn't help to conflate the present with the future, this is a MAJOR part of the problem with getting to the root of the current problem. If you focus all of your attention on future projections and how way off they are because of what current conditions are, then you are not going to be able to successfully argue with anyone that you listed above.

Do you see what the problem is? They are saying something like "in 10 years there is a projected shortage of pathologists" and you are saying "you're terrible wrong, right now there are too many pathologists". But they aren't really talking about right now. I have little doubt that their views of the current market differ from yours, but you're still talking about different things.

You can't honestly deny defending this article this time, can you? I hope you've at least read it by now. Because if you have, you should realize my points from the other thread that the current market DOES matter in this study. If you base all of your supply/demand projections off of it, it is actually quite important--probably the most important variable. The main finding of the study actually predicts a shortfall in pathologist supply compared to CURRENT levels. The authors conveniently equate this to a workforce shortage--two different things. If CAP simply wanted to write an article on predicting the number of future pathologists, they did a great job, but what good does that do anyone?

 

[Back2Pathology]

It is actually a very honest post. I really enjoyed Pathology when I was a resident, but the low board passage of our program was an issue. I didn't want to finish a residency unable to pass boards. We had very few formal lectures or didactic sessions. I simply wish I would have matched in a larger academic center.

Thanks

-Back2Pathology

 

[mlw03]

You're going to have a hard sell going back to a pathology program. If I were a PD I'd be asking if you know what you want to do with your life, and figuring you're not worth the risk of leaving pathology... again. Unless you hate surgery, I'd suggest sticking with it.

 

[gbwillner]

It is actually a very honest post. I really enjoyed Pathology when I was a resident, but the low board passage of our program was an issue. I didn't want to finish a residency unable to pass boards. We had very few formal lectures or didactic sessions. I simply wish I would have matched in a larger academic center.

Thanks

-Back2Pathology

Good luck on your quest. Pathology can still be a rewarding career. Medicine is ever-changing and the payscales across the board are changing now against our favor. It does not mean the end of the world is coming, only that we need to change with the times.

 

[Inez2000]

Maybe by the time you finish residency and two fellowships, there will be a pathologist shortage. In all seriousness, the only way to any success in pathology is to train at a top ten program especially as a fellow.

 

[deleted314957]

Maybe by the time you finish residency and two fellowships, there will be a pathologist shortage. In all seriousness, the only way to any success in pathology is to train at a top ten program especially as a fellow.

??? That may get the attention of some academics ( if you consider that "success") but it won't do Jack Shi_ as far as private practice or corporate pathology is concerned. There are too damned many of you.

 

[yaah]

You can't honestly deny defending this article this time, can you? I hope you've at least read it by now. Because if you have, you should realize my points from the other thread that the current market DOES matter in this study. If you base all of your supply/demand projections off of it, it is actually quite important--probably the most important variable. The main finding of the study actually predicts a shortfall in pathologist supply compared to CURRENT levels. The authors conveniently equate this to a workforce shortage--two different things. If CAP simply wanted to write an article on predicting the number of future pathologists, they did a great job, but what good does that do anyone?

We're talking about somewhat different things now. I'm not really disagreeing with you. Moving on.

 

[Torsed]

I'd stay in surgery. You've already bounced from a program, forever the scarlet letter of P with a dash through it will be on your C.V. Wouldn't recommend pathology to anyone.

 

[Glass Pusher]

To the OP, I agree with most here and recommend staying in surgery if at all feasible. Having switched once before, it's unlikely you are going to be looked at favorably at the most competitive/best pathlogy programs (but I could be wrong not knowing your whole story). With that in mind, your original reasons for transferring out haven't really changed. The job market still sucks and there's a good chance you'll end up in a mediocre program again.

 

[mlw03]

Maybe by the time you finish residency and two fellowships, there will be a pathologist shortage. In all seriousness, the only way to any success in pathology is to train at a top ten program especially as a fellow.

I'd venture this is written by a resident or fellow from a "name" program, and I don't buy it. I agree with Mike - name will get the attention of folks in academia, not so much in the private sector world. Success in private practice pathology requires the same things as in any field - 1) competence 2) work ethic and 3) not being a d-bag. Your paper on yet another brown stain isn't going to put bread on the table. Perhaps #4 would be board certification, but that probably goes under #1.

For the OP, the concern will be work ethic, which includes sticking with made commitments.

 

[yaah]

That's true to a point, but if you are considering hiring a new graduate the name can make an impact. The name also can help, to be honest, because a lot of private groups will have someone who knows someone at the name place, and then it is easier to talk to someone about the candidate. It is extremely difficult to assess competency and work ethic for new hires. A name program is something of a proxy for this, although everyone has likely been burned by relying too much on this so it doesn't mean THAT much. But it does have an impact.

 

[mlw03]

That's true to a point, but if you are considering hiring a new graduate the name can make an impact. The name also can help, to be honest, because a lot of private groups will have someone who knows someone at the name place, and then it is easier to talk to someone about the candidate. It is extremely difficult to assess competency and work ethic for new hires. A name program is something of a proxy for this, although everyone has likely been burned by relying too much on this so it doesn't mean THAT much. But it does have an impact.

Fair enough - I've not been involved in hiring in private practice. In FP, it's such a small world you're likely to know someone who knows your applicant, so you just pick up the phone or write an email. We both know name program is no guarantee of competence or work ethic, just like really solid pathologists can come from no-name residency programs. I guess it's something akin to step I scores - it ain't a perfect measure, but it's better than nothing.

 

[2121115]

Do not buy into the notion that "name" means nothing in private practice. That has not been my experience. If you come from a "non-name" program, people may wonder if you have seen complex cases and gotten a broad experience. And, never discount the fact that the clinicians referring specimens like to hear that the new person in the practice is from [insert name program here].

 

[deleted314957]

Do not buy into the notion that "name" means nothing in private practice. That has not been my experience. If you come from a "non-name" program, people may wonder if you have seen complex cases and gotten a broad experience. And, never discount the fact that the clinicians referring specimens like to hear that the new person in the practice is from [insert name program here].

One who is fresh out of residency/fellowship does not have "broad experience"--they have NO experience as an independently performing pathologist. They have never had to bottom-line even a weeks worth of cases without the "net". Real experience will count for much more than a "name"

 

[pathstudent]

One who is fresh out of residency/fellowship does not have "broad experience"--they have NO experience as an independently performing pathologist. They have never had to bottom-line even a weeks worth of cases without the "net". Real experience will count for much more than a "name"

Right. And people who think that complex cases are limited to a handful of "name" programs in general don't have a clue about the real world.

The biggest lie I was told by academics about going into community practice is that I "will be bored and not see anything interesting". I work up more crazy **** on a day to day basis than I ever had when studying surg path via subspecialty rotations.

 

[pathstudent]

But to the OP.

I would recommend doing a parody video to "going back to Cali" by ll cool j called "going back to pathology". It might genereate a lot of buzz in the buzzospehre for your application.

 

[deleted314957]

Right. And people who think that complex cases are limited to a handful of "name" programs in general don't have a clue about the real world.

The biggest lie I was told by academics about going into community practice is that I "will be bored and not see anything interesting". I work up more crazy **** on a day to day basis than I ever had when studying surg path via subspecialty rotations.

That was exactly my experience for 25 solo years at a 175 bed community hospital

 

[2121115]

One who is fresh out of residency/fellowship does not have "broad experience"--they have NO experience as an independently performing pathologist. They have never had to bottom-line even a weeks worth of cases without the "net". Real experience will count for much more than a "name"

But we are not talking about "real experience" - few would disagree with what you posted. Rather, we are talking about a newbie out of training from a "name" program versus a newbie out of training from a "non-name" program.

The truth is, residency experiences differ. And some programs are just not very good.

And marketing/perception matters with clinicians. Maybe not so much in a smaller market/small town where you can go tell the local docs that your kids play with that the new person coming in is good and they believe you. But in larger markets where everyone barely knows each other, sometimes your CV is all you got.

JMO.

 

[pathstudent]

But we are not talking about "real experience" - few would disagree with what you posted. Rather, we are talking about a newbie out of training from a "name" program versus a newbie out of training from a "non-name" program.

The truth is, residency experiences differ. And some programs are just not very good.

And marketing/perception matters with clinicians. Maybe not so much in a smaller market/small town where you can go tell the local docs that your kids play with that the new person coming in is good and they believe you. But in larger markets where everyone barely knows each other, sometimes your CV is all you got.

JMO.

Again, totally disagree. My group has a policy that we won't take anyone directly out of training. It has worked out in some instances but some people, no matter, where they trained, couldn't hack the volume and velocity of the practice, or they were just kind of weird.

 

[yaah]

Again, totally disagree. My group has a policy that we won't take anyone directly out of training. It has worked out in some instances but some people, no matter, where they trained, couldn't hack the volume and velocity of the practice, or they were just kind of weird.

If you don't take anyone right out of training then you're not really talking about the same thing. Both he and I were giving examples of when the name matters to some extent. This doesn't apply to your group, so you can't really totally disagree. Everyone in practice knows of people who came from "unknown" programs who are stellar and people who came from excellent programs who are lacking.

 

[pathstudent]

No. our current policy being driven by the partners is that we will no longer take people directly out of training as 4 of the last 5 have not worked out because they couldn't handle the work load or they were weird.

What I disagree with him is his belief that you need to go a brand name program to have had experienced complex cases.

If you don't take anyone right out of training then you're not really talking about the same thing. Both he and I were giving examples of when the name matters to some extent. This doesn't apply to your group, so you can't really totally disagree. Everyone in practice knows of people . from "unknown" programs who are stellar and people who came from excellent programs who are lacking.

 

[deleted314957]

No. our current policy being driven by the partners is that we will no longer take people directly out of training as 4 of the last 5 have not worked out because they couldn't handle the work load or they were weird.

What I disagree with him is his belief that you need to go a brand name program to have had experienced complex cases.

Again, I have to agree with Pathstudent wholehartedly, having "been there, done that" in a number of partnership years in P.P. with hiring decisions.
The "name" is nice but there is just too much at stake in the hiring business. As per the "3-A's of pathology", ability comes in third place after
"affability" and "availability". Ability was kind of assumed when we made hiring decisions.

 

[BU Pathology]

I like those 3 As, and agree with ability being in third place. Residency programs do train residents well, so that there is usually plenty of ability.

 

[2121115]

No. our current policy being driven by the partners is that we will no longer take people directly out of training as 4 of the last 5 have not worked out because they couldn't handle the work load or they were weird.

What I disagree with him is his belief that you need to go a brand name program to have had experienced complex cases.

Maybe you should work on the reading comprehension thing. I did not say that, nor do I think that.

But it is a fact that some programs are better than others. That cannot be denied.

 

[Inez2000]

So, if practices don't hire people right out of 'training', does that mean their training is generally insufficient ? Yes (or there are too many pathologists, and thus private practices have the luxury of choosing only experienced pathologists rather than developing them).

Does becoming a practicing pathologist really need to take 4 years of residency, year(s) of fellowship, and then years of 'experience' in the real world to become ready to practice pathology? Who in there right mind would undertake such a process to get a job, if they knew the truth about the current process of pathology training?

When one is in medical school, these issues are not discussed with potential pathology applicants. And when they are, applicants typically say "not me, I am different"

 

[yaah]

So, if practices don't hire people right out of 'training', does that mean their training is generally insufficient ? Yes (or there are too many pathologists, and thus private practices have the luxury of choosing only experienced pathologists rather than developing them).

Does becoming a practicing pathologist really need to take 4 years of residency, year(s) of fellowship, and then years of 'experience' in the real world to become ready to practice pathology? Who in there right mind would undertake such a process to get a job, if they knew the truth about the current process of pathology training?

When one is in medical school, these issues are not discussed with potential pathology applicants. And when they are, applicants typically say "not me, I am different"

This is variable. Part of the problem is that many (most) programs don't really prepare residents for the admin and CP work that comes into play in private practice. A lot of it is hard to teach which is part of the problem, but there are other issues also.

Most residents come out of training with a good grasp of AP, the main issue is usually confidence and common sense - like thinking you have to order 10 immunos to sign out certain types of cases, or knowing when to call something atypical or suspicious or positive, or having a good understanding of the clinical problems and questions. A lot of that takes signout experience which some programs do a decent job with but many don't. But some of this is also individual dependent - some people come out of training and are just confident and ready and you don't really worry about them. Others are nervous and overly cautious. Usually that resolves after a few weeks or months, so a lot of groups won't really hesitate to hire new people if they are hiring them for the long hall. Groups that want more temporary workers or those that don't offer parternship track or whatever will hesitate more to hire fresh grads because by the time they get comfortable they will want to leave.

So yeah, there are two types of groups that hire new grads - groups that want to exploit the new grad and groups that want to nurture the new grad and have them move into a full role in the group. It is usually reasonably easy to tell which one you are dealing with but it can be tricky.

Most training is not insufficient - but many people come out of training insufficiently trained. Many residents need to do a better job of maximizing their training time - this is definitely possible. But others just want to do "what is required" and get out of there as soon as possible, not take risks, etc, and end up the kind of new grad that people don't want to hire.

Our group hired an out of training grad (first job) in the past 3-4 years - not a problem at all. But this individual is confident, clinically knowledgable, and intelligent. And clearly used their training appropriately.