considering leaving pathology

[toby2]

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Hi everyone,

I have always enjoyed this forum. I'm a long-time lurker and infrequent poster. It seems I only post when I'm in trouble or trying to make some huge career decision. OK, so right now is another one of those times.

You read the title correctly- I am considering leaving path. Why? It's not that I don't think path is a good specialty (and I don't want to discourage anyone going into it). I could try to list all my reasons, but more than anything it is just a gut feeling that this is not where I belong. Back in 4th year med school, I thought I was pretty sure of my choice. I found the material interesting and felt it was something I could keep always learning more of and never get bored of. Now, looking back I think I chose path almost purely for selfish reasons, which now seem pretty empty and meaningless. Obviously the lifestyle is good, and compared to other specialties you are reimbursed pretty well for your time, and you have quite a bit more free time compared to almost every other specialty out there- etc... Time is one of the most valuable commodities in my life and this was one of the biggest factors for me... Like I said, all selfish reasons.

Now, 1.6 years into residency, I'm just not getting the juice out of it that I thought I would. I'm finally waking up and facing this personal reality: I feel I sold out going into path, for the wrong reasons. I realize there are a lot of people who really enjoy being at the scope for hours every day. I'm not one of them! It's not that I don't think I could do it, I just don't want to anymore! If I'm this bored now how will I feel 10 years from now? I also feel patients deserve to have their slides read by someone who really DOES have a passion for the work and who truly enjoys being a pathologist. My conscience is getting the better of me, because I know that's not me!

The one single rotation where I felt more at home was TM. I actually enjoyed seeing patients for plasma exchanges, apheresis, etc. I like the heat-of-the-moment decision making of a massive transfusion/ trauma case, etc. I like working with anesthesiologists and (most) surgeons. I like antibody workups and solving other TM issues that come up. I am one of the few people who doesn't mind taking overnight TM call every now and then.

I guess I didn't realize how much I would miss working with people face-to-face. Prior to med school I worked with athletes as a trainer and coach (I know, far cry from path- are you starting to see why I feel I don't belong?) So why didn't I go into ortho you say? I considered it, until I realized what HELL any surgery residency is. No thanks - like I said, I value my time too much. I have thought (and still think) about Family Medicine or Emergency Med, with a sports med fellowship. Family Medicine was my favorite rotation in med school. I unfortunately never got the lucky draw to do a primary care sports med elective rotation. I shadowed one guy a few times who did it "on the side" in addition to his normal FM practice. He liked it a lot but I didn't want to do it only part time, if I did it. I guess I wasn't sure there would be a job for me if I went that route (although now I'm realizing there are jobs out there, and you can always "create" your own job in the right area with enough demand- something you don't find in path).

So what options do I have now? I could stick it out in AP/CP, but it would feel like torture and I would almost feel obligated to work at a job I know I don't want to do, just to pay back the loans, make the education worthwhile etc. I just don't want to do it!

I could quit medicine altogether and do something completely different (this thought has crossed my mind many times). But then there's the student loan issue, and I did have some genuine reasons for going into medicine to begin with. Have I wasted the last 2 years of my life? Or the last 6 years, including med school?

I could try to get an EM/ FM position outside of the match for July 2007, and go this route since I know I have an interest there, but I have no idea how to apply outside of ERAS and I think most programs use only ERAS. Talk about bad timing for me to be making this decision- interview season is almost over and the application deadline for the majority of programs was 2 months ago.

I could switch to CP only to shorten my track, then do a TM fellowship. I've already brought this up with my PD but this program is hard-core AP and I feel like it would be tough to get approval to do this. Also, from what I've seen on this board, there are far less TM jobs available compared to surg path/AP jobs, and they're limited to academics/ donor centers. Not sure if I would enjoy the research side of academics since I've had very little experience there. But like I said, TM is the one subspecialty that I could see myself enjoying long-term.

If anyone has any advice or suggestions, or knows anyone in a similiar situation, please share!


(P.S. anyone want a PGY-2 AP/CP spot if I end up quitting?)

 

[LADoc00]

I was on the verge of quitting every year I was in residency until my last. During my first 2 years I applied and interviewed with McKinsey, Bain, BCG etc. I applied to biopharma as well. I had my completed application in at Harvard B-school before I backed out. Even during my fellowship AFTER I had a job offer in a cush oceanside town, I called the head of the American Society of Radiology to ask advice on switching to rads. I even explored doing a 1-year surgical internship and then going pure cosmetics. I had been MDPhD at one point (and had all the bells and whistles, NIH, NSF AND Howard Hughes support), and was such a gunner that I actually applied to postdocs along with residency. But everytime I backed away.

I cant tell you what to do other than I have been, there are many that have, are and will be in your situation.

 

[CameronFrye]

Hi everyone,

I have always enjoyed this forum. I'm a long-time lurker and infrequent poster. It seems I only post when I'm in trouble or trying to make some huge career decision. OK, so right now is another one of those times.

You read the title correctly- I am considering leaving path. Why? It's not that I don't think path is a good specialty (and I don't want to discourage anyone going into it). I could try to list all my reasons, but more than anything it is just a gut feeling that this is not where I belong. Back in 4th year med school, I thought I was pretty sure of my choice. I found the material interesting and felt it was something I could keep always learning more of and never get bored of. Now, looking back I think I chose path almost purely for selfish reasons, which now seem pretty empty and meaningless. Obviously the lifestyle is good, and compared to other specialties you are reimbursed pretty well for your time, and you have quite a bit more free time compared to almost every other specialty out there- etc... Time is one of the most valuable commodities in my life and this was one of the biggest factors for me... Like I said, all selfish reasons.

Now, 1.6 years into residency, I'm just not getting the juice out of it that I thought I would. I'm finally waking up and facing this personal reality: I feel I sold out going into path, for the wrong reasons. I realize there are a lot of people who really enjoy being at the scope for hours every day. I'm not one of them! It's not that I don't think I could do it, I just don't want to anymore! If I'm this bored now how will I feel 10 years from now? I also feel patients deserve to have their slides read by someone who really DOES have a passion for the work and who truly enjoys being a pathologist. My conscience is getting the better of me, because I know that's not me!

The one single rotation where I felt more at home was TM. I actually enjoyed seeing patients for plasma exchanges, apheresis, etc. I like the heat-of-the-moment decision making of a massive transfusion/ trauma case, etc. I like working with anesthesiologists and (most) surgeons. I like antibody workups and solving other TM issues that come up. I am one of the few people who doesn't mind taking overnight TM call every now and then.

I guess I didn't realize how much I would miss working with people face-to-face. Prior to med school I worked with athletes as a trainer and coach (I know, far cry from path- are you starting to see why I feel I don't belong?) So why didn't I go into ortho you say? I considered it, until I realized what HELL any surgery residency is. No thanks - like I said, I value my time too much. I have thought (and still think) about Family Medicine or Emergency Med, with a sports med fellowship. Family Medicine was my favorite rotation in med school. I unfortunately never got the lucky draw to do a primary care sports med elective rotation. I shadowed one guy a few times who did it "on the side" in addition to his normal FM practice. He liked it a lot but I didn't want to do it only part time, if I did it. I guess I wasn't sure there would be a job for me if I went that route (although now I'm realizing there are jobs out there, and you can always "create" your own job in the right area with enough demand- something you don't find in path).

So what options do I have now? I could stick it out in AP/CP, but it would feel like torture and I would almost feel obligated to work at a job I know I don't want to do, just to pay back the loans, make the education worthwhile etc. I just don't want to do it!

I could quit medicine altogether and do something completely different (this thought has crossed my mind many times). But then there's the student loan issue, and I did have some genuine reasons for going into medicine to begin with. Have I wasted the last 2 years of my life? Or the last 6 years, including med school?

I could try to get an EM/ FM position outside of the match for July 2007, and go this route since I know I have an interest there, but I have no idea how to apply outside of ERAS and I think most programs use only ERAS. Talk about bad timing for me to be making this decision- interview season is almost over and the application deadline for the majority of programs was 2 months ago.

I could switch to CP only to shorten my track, then do a TM fellowship. I've already brought this up with my PD but this program is hard-core AP and I feel like it would be tough to get approval to do this. Also, from what I've seen on this board, there are far less TM jobs available compared to surg path/AP jobs, and they're limited to academics/ donor centers. Not sure if I would enjoy the research side of academics since I've had very little experience there. But like I said, TM is the one subspecialty that I could see myself enjoying long-term.

If anyone has any advice or suggestions, or knows anyone in a similiar situation, please share!


(P.S. anyone want a PGY-2 AP/CP spot if I end up quitting?)

I try to keep my ear to the ground when it comes to jobs and I've been surprised to hear of several private groups/hospitals looking to hire CP-only people. Obviously, there are a lot more AP/CP positions out there, but I was kind of surprised to hear about any CP-only jobs that weren't solely research positions at academic institutions. Going CP-only would almost certainly make things more difficult for you, but it doesn't look impossible.

 

[b&ierstiefel]

I was on the verge of quitting every year I was in residency until my last. During my first 2 years I applied and interviewed with McKinsey, Bain, BCG etc. I applied to biopharma as well. I had my completed application in at Harvard B-school before I backed out. Even during my fellowship AFTER I had a job offer in a cush oceanside town, I called the head of the American Society of Radiology to ask advice on switching to rads. I even explored doing a 1-year surgical internship and then going pure cosmetics. I had been MDPhD at one point (and had all the bells and whistles, NIH, NSF AND Howard Hughes support), and was such a gunner that I actually applied to postdocs along with residency. But everytime I backed away.

Um...you didn't complete the PhD. You applied to postdocs?

 

[Selectin-Man]

Um...you didn't complete the PhD. You applied to postdocs?

You can do a post-doc without a PhD. Lots of MDs do residencies and fellowships first, and then later do a post-doc and make a transition into basic sciences.

 

[DarksideAllstar]

You can do a post-doc without a PhD. Lots of MDs do residencies and fellowships first, and then later do a post-doc and make a transition into basic sciences.

Yeah, I thought about (and continue to think about) this as a segway into biopharma.

 

[dwil75]

I've just decided to do the opposite... I recently left a program in family medicine and am hoping to go into path... thought I wanted to be a primary care doc and really did not find clinic work rewarding, but I loved 4th year pathology and continue to regret I didn't have the guts to do it.

Wanna trade programs? 😉

Good luck with the change... I've found the best thing is to call PDs and explain your circumstances. Some of the ones I've talked to have really gone out of their way to be helpful to me in this transition, and they're the one who is the key to getting into what you really want.

 

[toby2]

Glad to know there are others in similiar situations. I'm sure this happens in every specialty. If you don't get enough experience to fully evaluate a specialty during med school, you get to learn by trial and error. Unfortunately, I liked path enough going into residency that I had no real thoughts of quitting or switching up until a few months ago. I actually know a guy who did a transitional year, then started rads, then partway through first year realized he couldn't stand looking at black and white the rest of his life. He then grabbed a path spot outside of the match at a program with an unexpected opening and stuck with it, eventually switched to CP only, finished a TM fellowship and is quite happy with his current job.

LADoc, it's funny you mentioned applying for an MBA program... over the past 2 months I've been looking into that as well. It would definitely give a lot of flexibility for almost anything. The problem is the tuition. I just don't want to pile any more onto the loan pile right now, plus essentially stop working for a couple of years to finish it... not sure if it would be worth it. I've looked at some online programs (Kaplan and U of Phoenix) with more reasonable tuition, but ? quality. My B-school friends have convinced me there's some value in getting an MBA from a school with a great reputation. But any decent MBA opens up more doors. I suppose online it could be done in evenings and on weekends, but would be tough to do during residency and would be a huge distraction (as if I need any more) from residency training.

I actually wrote some PDs in a few family medicine programs today, just to see if they would consider an application outside of the match.

 

[yaah]

If you don't like it, you need to get out. Don't torture yourself, you have to do something you love as a career. If it involves realizing you made a mistake and having to sort of start over, then so be it. Better to make the change than to stick with it out of spite or a sense of obligation. You don't want to make your life a "what if" situation. Don't just do a TM fellowship because it's the only thing you can stand, you probably won't end up getting the patient contact you want that way.

 

[mcfaddens]

Seems to me that your ready to do something and get out and work. If you were a coach and still love sports do FM and then a sports med fellowship. A couple of yrs and your out vs MBA weekend + Fam med and increased call time. You can work on your biz skills while in practice and still be involved insomething (sports) that you like with out adding more debt to the equation. Is there a fam med program at you hospital. Get to know them or a couple of residents and work your way in. If you want to transfer go to a program with a sports fellowship.

 

[b&ierstiefel]

You can do a post-doc without a PhD. Lots of MDs do residencies and fellowships first, and then later do a post-doc and make a transition into basic sciences.

I fully realize that...but for someone who basically quit a PhD program (i.e., they were wise enough to realize that research was not for them), why would the person apply for a postdoc?

I agree quite a few MDs go onto do postdocs...but it is relatively rare for MD/PhDs who quit the PhD part and became straight MDs to do postdocs after their medical training.

 

[gungho]

Did the opposite as well-practiced FM, then came to Path. No regrets, either. FM is great, for some people, just as Path or every other specialty is great for some people. The trick is finding who you are. Agree with Yaah, go where you want to be, or, at least as importantly, don't stay where you don't want to be.
Did the MBA thing-U of Phoenix (though none of it was online).Sure, MBA from name place is "more valuable" than lesser name (same as any other training), but I compared curriculum to other name places nearby and thought it was very comparable-the weakness, I believe, was in the caliber of student, since so much of your graduate business education is spent in group/collaborative work. Getting an MBA is basically learning the vocabulary and being able to communicate with the bean counters,etc.
Wish you well-enjoy the journey.

 

[LADoc00]

You can do a post-doc without a PhD. Lots of MDs do residencies and fellowships first, and then later do a post-doc and make a transition into basic sciences.

yep. Similar KO8/HH route. Originally I was scheduled for just 2 years of residency then a departmental funded 2 year post doc.

 

[LADoc00]

I fully realize that...but for someone who basically quit a PhD program (i.e., they were wise enough to realize that research was not for them), why would the person apply for a postdoc?

I agree quite a few MDs go onto do postdocs...but it is relatively rare for MD/PhDs who quit the PhD part and became straight MDs to do postdocs after their medical training.

lots of reasons, but a big one was my lab sucked and didnt really want to work with anyone else in division, the short time I was in it was more than enough.

 

[Aubrey]

I try to keep my ear to the ground when it comes to jobs and I've been surprised to hear of several private groups/hospitals looking to hire CP-only people. Obviously, there are a lot more AP/CP positions out there, but I was kind of surprised to hear about any CP-only jobs that weren't solely research positions at academic institutions. Going CP-only would almost certainly make things more difficult for you, but it doesn't look impossible.

"Looking for CP-only" is probably code for "$50k salary and free cookies at seminars."

 

[djmd]

"Looking for CP-only" is probably code ...and free cookies at seminars."

I think that needs to be documented as an benefit for academics!

 

[EUA]

Getting an MBA is basically learning the vocabulary and being able to communicate with the bean counters,etc.

Tend to agree with gungho here. A big-name B-school may be crucial if you're the Wall Street type, but for the majority of medical folks I really don't think it matters. After all, it's always secondary to your MD/DO.

Anyway, the online way is very managable. The material is not difficult. My biggest challenges are, like gungho said, learning their language. It's actually analogous to medicine -- lots of multiple terms that all mean the same thing and really could have been said in a lot simpler way in the first place.

You can do it!

Good luck.

 

[toby2]

Wanna trade programs? 😉

Yeah! Does your program have a sports med fellowship by chance? Or even if not, is there one within a couple hours?

You guys are right- it's all about living with no regrets. My timing couldn't be worse- it's past the application deadline and I would be stuck with scrambling or finding a spot after the match is over. I'm e-mailing PD's but no word back yet. If I don't find a decent EM or FM spot, then what? I could take a year completely off of medicine, but I've got a family to feed. I'm sure I could find some other job for a year but what's the point of that?

If I don't get into FM or EM this year, I may just stick it out and switch to CP only as it would only be one more year. At least I'd be boarded and have the option to do a TM fellowship. Will I need more patient contact than that? Possibly, but I really think the satisfaction of helping someone in critical need makes up for the lower numbers of patients you work with. I think the reason I like massive transfusions and being able to utilize recombinant Factor VII, etc, is it's the only time in path where I've felt the satisfaction of actually helping to save a life.

Yeah, I know what you guys do on AP is important, and technically you are helping to save some lives (hopefully) but I never really felt the same type of satisfaction in diagnosing cancers and esoteric tumors that others do. On the other hand, I kinda liked doing frozen sections (sometimes). If only I could just do frozens and TM, I'd be perfectly happy in path. Most of my colleagues are the complete opposite. They'd rather be at the scope.

At our institution we probably have more patient contact in TM compared to other places. We see at least a couple patients everyday, and sometimes 5 or more. It really depends on the preference of the attending. Two of our TM docs round on all the patients with critical transfusion issues, do formal consults, etc. Another one is very hands-on with the OR and goes in there frequently. Two others are more research-oriented and prefer to let the fellows and residents do the consults, and just be there as back-up.

I have no idea where I will be 5 months from now. One door is closing, and hopefully another one will open soon. But on the other hand, I may be in a long hallway for quite some time.

 

[toby2]

Here's my latest idea if I can't switch this year: going into a business which will allow me to be involved part-time in sports and fitness again. I've already talked with a fitness center franchiser in this city and it will cost about 225K plus a 15K franchise fee to get started, with an already-negotiated lease that includes 6 months with no lease payments. The 225K is all for equipment. The franchise is successful and already has 9 locations in the metro area. Later on, I will set up a sports med clinic within it. Since I won't be boarded and couldn't practice yet I will instead hire an orthopod, a primary care doc, and a PT to run it, each with partial ownership from the start. Average total overhead at the other locations is 25K/ month (including franchise royalties of 4%), with gross monthly sales ranging between 50-60K. Ramp-up time to those levels is averaging 9-12 months. Since I will only be able to work there on evenings and weekends, I'm currently looking for a partner. I have a friend who organizes adventure races and triathlons who would be the ideal partner. Problem is he lives in another state and can't relocate because that's where the events are. I've talked to a couple other local people with some desire to get into something like this, but no definite plans yet.

Of course all this will take time and a lot of work, but on the positive side once it is up and running that will free up my time and provide the flexibility to later go back and finish my sports medicine training if I still wanted to then. Where does a path residency fit into this? I'm definitely switching to CP only. My main question right now is whether this could it become a conflict of interest/ conflict of time issue? There's no way I could do it myself and stay in residency, hence the need for a partner. But I have a highly-respected AP attending who runs a ranch on the side, who has been doing it for 20+ years in addition to practicing surg path. So I know that people have done and are doing things like this.

 

[yaah]

Where does a path residency fit into this?

It doesn't, unless you can't find another way to make $40,000 a year and work 50-60 hours a week over the next few years. Why on earth would you be doing a path residency? Just drop out. This is just like that post I just replied to about applying to pedes and path at the same time. Study hard and get a CPA, that won't take you that long, then you can make more money to seed your facility.

 

[toby2]

Study hard and get a CPA, that won't take you that long, then you can make more money to seed your facility.

Although the accounting knowledge would help with any business, being a CPA would be one of the last things I'd want to do as a career. And I wouldn't be staying in path just to pay the bills either.

yaah, I know you want me out, but there is something keeping me from completely dropping out of path and that is the reality that I genuinely like transfusion medicine. The more I've worked in TM, the more times I've been on call, thought about it and talk to other TM fellows and attendings, the more interested I have become, so I know that it is a real interest.

 

[Circumflex]

yaah, I know you want me out, but there is something keeping me from completely dropping out of path and that is the reality that I genuinely like transfusion medicine. The more I've worked in TM, the more times I've been on call, thought about it and talk to other TM fellows and attendings, the more interested I have become, so I know that it is a real interest.

I think we are just confused. You stated in a previous post that you wanted to set up your business, then do sports medicine. Do you plan to do TM, then do a residency/fellowship for sports medicine? It just sounds odd.

 

[LADoc00]

Funny, now that Ive almost made it, I sometimes wonder what life would be like back in a lab, strolling in at 9 each day, pipeting a bit between lattes, chatting up the college crowd and playing World of Warcraft or some other game on a LAN at work....even if you were dirt poor forever doing academic research, it has a real appeal. I can now see why people do it.

Maybe Ive just pushed too much glass today, but basic science research doesnt seem that bad right now.

 

[yaah]

yaah, I know you want me out, but there is something keeping me from completely dropping out of path and that is the reality that I genuinely like transfusion medicine. The more I've worked in TM, the more times I've been on call, thought about it and talk to other TM fellows and attendings, the more interested I have become, so I know that it is a real interest.

It makes no difference to me whether you stay in or not, but you need to make up your mind. If you do transfusion medicine then do transfusion medicine. But your sports medicine startup is going to have no use for transfusion medicine, and anything you learn or do during a path residency will be completely wasted (virtually).

If I were in your residency class or your residency program, I would also not want you there, nor would I if I were your program director. Because you don't even know if you want to do path and you might bail out at any time.

I have other real interests too. I find american history fascinating. But I'm not going to finish my path residency and go be an american history teacher. Just like if I wanted to be a pathologist I wouldn't go to history grad school and write a thesis on the role of the water rights in the development of the american west first.

Ultimately you have to decide what you want to do for your career, and you should do it sooner rather than later. Many people go into residency not knowing if they want to be in academics or private, which is fine, because you have time to decide and also time to learn more about what the fields entail. But ultimately they all will be pathologists. I don't know of anyone who is going into pathology residency so they can open up a gym and treat ankle sprains.

 

[toby2]

I think we are just confused. You stated in a previous post that you wanted to set up your business, then do sports medicine. Do you plan to do TM, then do a residency/fellowship for sports medicine? It just sounds odd.

Right now the plan is to do TM and finish a couple years from now. As far as doing another residency and sports med fellowship goes, the possibility of starting this year at a decent program is looking dim. I am assuming that I will not get into a program for July 2007. So if I started that in 2008, I would finish over 5 years from now. Right now that seems too long, or maybe I really don't want to do it bad enough to wait that long. It's still a possibility. I refuse to feel pressured into making a decision faster than I am truly ready for. Right now I am keeping an open mind to many possibilities.

Obviously the TM career and the fitness center are totally unrelated. I do, however, think that I could do both, just like my attending who also runs a ranch in his spare time. For those with similiar outside interests, don't ever feel that you are stuck with only doing medicine as your entire life's work. If there's something else in the back of your mind that you've thought about doing, give it some more thought. For me, co-owning the fitness center would at least let me be involved in something else that I enjoy again, even if it was very part-time. The satisfaction would be in helping to create something, and doing something to promote health and wellness. So much of what we do in medicine is more like damage control.

 

[beary]

Funny, now that Ive almost made it, I sometimes wonder what life would be like back in a lab, strolling in at 9 each day, pipeting a bit between lattes, chatting up the college crowd and playing World of Warcraft or some other game on a LAN at work....even if you were dirt poor forever doing academic research, it has a real appeal. I can now see why people do it.

Maybe Ive just pushed too much glass today, but basic science research doesnt seem that bad right now.

This is NOT what my life was like in grad school. If you lived like this in academic basic science I think your funding would last about a week.

 

[ResDame]

To be honest Toby2, you really have no idea of what floats your boat. Sorry to sound harsh, but you're looking for a needle in a haystack but jumping from haystack to haystack.

Running a fitness business is work. You may as well be on call 24/7 as that's how it will be. Just because you may have hot shots working for you doesn't give you license to 'jump in when you want'. As for giving them partnerships from the beginning that's just insane as you'll be booted off the island quicker that you can say quad stretch! Just because there's successful franchises in your particular metro area, how you do know yet another will work. You need to research this, and come up with a business plan.

You've got a long way to go baby!

 

[toby2]

And you know what you're talking about because you've run a business before?

I know it won't be easy because I've done it before. Prior to med school I was co-owner or another fitness center for 5 years. We started from scratch rather than a franchise and I had 2 different partners. It was rough starting out. However, once it was up and running I was able to devote time to other things. I sold out to one of my partners to go back to school. As far as bringing on others partners into this venture goes, I am very selective in who I do business with. The sports med clinic would just be a small part of it and they would not have ownership of the entire operation. I do not wish to build another facility from the ground up again, which is why I'm looking into the franchise. It's not perfect, but there are definite advantages to group advertising and the business model itself. I'm definitely not rushing into it without doing due diligence first.

 

[path15]

So, you are going to start a sports med clinical after doing TM? With what credentials? Wouldn't you have to be board certified in FM and sports medicine to open a sports medicine clinic?
If you plan on being a TM physcian, and opening a sports medicine clinic and hiring sports medicine board certified physcians to work for you - why wouldn't the sports medicine physcians just open their own practice, without you, the TM physcian?
I don't see where TM fits into the sports medicine practice - I don't think sports medicine physcians would want to partner with someone who cannot offer any professional medical skills to their practice.

Have you thought about partnering with clincians to open up an outpatient lab so that the practice could bill for all services - both patient care and routine lab tests? Here, the clinicians benefit b/c the practice can bill for the test - Just a thought -

 

[yaah]

If I understand right, the two aren't related at all. It's like being a lawyer and having a part time job owning and running a restaurant. But that's the problem. It makes no sense to want to do both, as both are full time jobs. And if you aren't going to do both, then why continue to act as though you are? Eh, I've had enough.

 

[toby2]

I don't see where TM fits into the sports medicine practice - I don't think sports medicine physcians would want to partner with someone who cannot offer any professional medical skills to their practice.

They're completely unrelated. Basically it would just be providing a location and good client base for the sports medicine clinic to operate out of. With a membership base of even a few thousand, one ortho and one PC sports med doc could find plenty of patients which is why they may prefer to partner with us rather than opening up a brand new facility and paying all the overhead themselves. I would not need to be credentialed since I would just be a limited partner in that entity.

 

[toby2]

If I understand right, the two aren't related at all. It's like being a lawyer and having a part time job owning and running a restaurant. But that's the problem. It makes no sense to want to do both, as both are full time jobs. And if you aren't going to do both, then why continue to act as though you are? Eh, I've had enough.

They are not necessarily both fulltime jobs. There are people who work part-time in TM. The fitness center I co-owned before was never a fulltime job, except at the beginning, setting it up. In fact I was still a college student at the time. I was still involved very part-time during the first year and a half of med school until my partner and I finished the buyout agreement. It was more of a process of creating something, rather than a job I worked at.

 

[djmd]

Toby2,
Look you want to do this thing, it has nothing to do with pathology, except for the part about what you should do now...

You want to know about doing CP only and TM.

Stop this tread. Start a new thread, ask

Can anyone give me information about changing to CP only and TM. I really like TM, and want do that exclusively, how is the job market for full time and part time TM? Thanks for any info...

Your life plan is do pathology and X. The X part doesn't really matter and is just stopping anyone from answering your question.

 

[toby2]

Have you thought about partnering with clincians to open up an outpatient lab so that the practice could bill for all services - both patient care and routine lab tests? Here, the clinicians benefit b/c the practice can bill for the test - Just a thought -

That is a good thought and I have thought about the possibility- although I'm not sure how many things would be allowed under the possible POD lab legislation in the works (or if it would be considered a POD lab, I'm not sure). I don't know enough right now about the current rules and possible future legislation involved in something like that. If it looks like too much of a hassle I would probably choose to avoid it completely.

 

[thewebthsp]

That is a good thought and I have thought about the possibility- although I'm not sure how many things would be allowed under the possible POD lab legislation in the works (or if it would be considered a POD lab, I'm not sure). I don't know enough right now about the current rules and possible future legislation involved in something like that. If it looks like too much of a hassle I would probably choose to avoid it completely.

Why don't you sit down with your PD and ask him to help you transfer to a FM program? Then do a 1-2? year sports medicine fellowship, open your sports rehab clinic, partner, etc ...?

It really sounds like that's what you want to do from what you're saying in your posts. FM isn;t that bad of a residency and as an AMG you should be fine with transferring, no? I knew one woman on one rotation who did nursing, then path and now family practice -- she was really happy even though it took her a while to find what she really loved.

Me on the other hand, I think I want a research career/academic path career
and then claim patents and then found a biotech startup... But we'll see.

 

[docbiohazard]

I'm guessing theweb didn't realize this thread was about a year old, but I'm wondering what happened to the original poster... where he's at now...

BH

 

[Pangu]

Hi everyone,

I have always enjoyed this forum. I'm a long-time lurker and infrequent poster. It seems I only post when I'm in trouble or trying to make some huge career decision. OK, so right now is another one of those times.

If I read your post correctly, you are just bored of sitting around a microscope and probably yearn for people contact. You may enjoy seeing people helped by you DIRECTLY. Why quit medicine alltogether then? Have you thought about Physical Medicine and Rehabilitation? I used to know a guy who's doing that and it appears to be a cush specialty. Not really sure about the job market though, you need to do your own research. Like any other specialties, someone may drop out in the middle of their training. You just need to be well informed when a spot opens up. One way to do this is to inform the PDs and let them keep you in mind. Another resource is residentswap.org.

 

[yaah]

It is kind of weird that the thread is almost exactly 1 year old. Eerie.

 

[docbiohazard]

It is kind of weird that the thread is almost exactly 1 year old. Eerie.

I'm assuming that thewebsp was doing some sort of a search (on SDN or Google) and came across the thread, saw the date and misread it, assuming it was a current thread, and replied...

I still wonder whatever happened to the guy..

BH

 

[Pangu]

I'm assuming that thewebsp was doing some sort of a search (on SDN or Google) and came across the thread, saw the date and misread it, assuming it was a current thread, and replied...

I still wonder whatever happened to the guy..

BH

I even read the date and still thought it was a current thread. I guess it took a bit too long for me to realize it's 2008 now.

 

[ABC789]

Hi Toby2,

Does your program have any PGY2 AP/CP vacancies for 2008? I never feared for my education until I started started surgical pathology at this institution. We maybe preview 10% or less of what we gross and, at that rate, I do not believe I will be competent in three more years. Thanks!

 

[CaymanIslander]

Hi everyone,

I have always enjoyed this forum. I'm a long-time lurker and infrequent poster. It seems I only post when I'm in trouble or trying to make some huge career decision. OK, so right now is another one of those times.

You read the title correctly- I am considering leaving path. Why? It's not that I don't think path is a good specialty (and I don't want to discourage anyone going into it). I could try to list all my reasons, but more than anything it is just a gut feeling that this is not where I belong. Back in 4th year med school, I thought I was pretty sure of my choice. I found the material interesting and felt it was something I could keep always learning more of and never get bored of. Now, looking back I think I chose path almost purely for selfish reasons, which now seem pretty empty and meaningless. Obviously the lifestyle is good, and compared to other specialties you are reimbursed pretty well for your time, and you have quite a bit more free time compared to almost every other specialty out there- etc... Time is one of the most valuable commodities in my life and this was one of the biggest factors for me... Like I said, all selfish reasons.

Now, 1.6 years into residency, I'm just not getting the juice out of it that I thought I would. I'm finally waking up and facing this personal reality: I feel I sold out going into path, for the wrong reasons. I realize there are a lot of people who really enjoy being at the scope for hours every day. I'm not one of them! It's not that I don't think I could do it, I just don't want to anymore! If I'm this bored now how will I feel 10 years from now? I also feel patients deserve to have their slides read by someone who really DOES have a passion for the work and who truly enjoys being a pathologist. My conscience is getting the better of me, because I know that's not me!

The one single rotation where I felt more at home was TM. I actually enjoyed seeing patients for plasma exchanges, apheresis, etc. I like the heat-of-the-moment decision making of a massive transfusion/ trauma case, etc. I like working with anesthesiologists and (most) surgeons. I like antibody workups and solving other TM issues that come up. I am one of the few people who doesn't mind taking overnight TM call every now and then.

I guess I didn't realize how much I would miss working with people face-to-face. Prior to med school I worked with athletes as a trainer and coach (I know, far cry from path- are you starting to see why I feel I don't belong?) So why didn't I go into ortho you say? I considered it, until I realized what HELL any surgery residency is. No thanks - like I said, I value my time too much. I have thought (and still think) about Family Medicine or Emergency Med, with a sports med fellowship. Family Medicine was my favorite rotation in med school. I unfortunately never got the lucky draw to do a primary care sports med elective rotation. I shadowed one guy a few times who did it "on the side" in addition to his normal FM practice. He liked it a lot but I didn't want to do it only part time, if I did it. I guess I wasn't sure there would be a job for me if I went that route (although now I'm realizing there are jobs out there, and you can always "create" your own job in the right area with enough demand- something you don't find in path).

So what options do I have now? I could stick it out in AP/CP, but it would feel like torture and I would almost feel obligated to work at a job I know I don't want to do, just to pay back the loans, make the education worthwhile etc. I just don't want to do it!

I could quit medicine altogether and do something completely different (this thought has crossed my mind many times). But then there's the student loan issue, and I did have some genuine reasons for going into medicine to begin with. Have I wasted the last 2 years of my life? Or the last 6 years, including med school?

I could try to get an EM/ FM position outside of the match for July 2007, and go this route since I know I have an interest there, but I have no idea how to apply outside of ERAS and I think most programs use only ERAS. Talk about bad timing for me to be making this decision- interview season is almost over and the application deadline for the majority of programs was 2 months ago.

I could switch to CP only to shorten my track, then do a TM fellowship. I've already brought this up with my PD but this program is hard-core AP and I feel like it would be tough to get approval to do this. Also, from what I've seen on this board, there are far less TM jobs available compared to surg path/AP jobs, and they're limited to academics/ donor centers. Not sure if I would enjoy the research side of academics since I've had very little experience there. But like I said, TM is the one subspecialty that I could see myself enjoying long-term.

If anyone has any advice or suggestions, or knows anyone in a similiar situation, please share!


(P.S. anyone want a PGY-2 AP/CP spot if I end up quitting?)

Dont do it. Finish residency, get a job, work minimally, and volunteer. Not even the "people" jobs in medicine are all their cut out to be. Lets face it, its a tough career. In path you can work a little, make enough, learn to invest really well and quit in 10 yrs.

Working sucks, but you gotta do it.

 

[djmd]

Dont do it. Finish residency, get a job, work minimally, and volunteer. Not even the "people" jobs in medicine are all their cut out to be. Lets face it, its a tough career. In path you can work a little, make enough, learn to invest really well and quit in 10 yrs.

Working sucks, but you gotta do it.

Man you know nothing about pathology or medicine in general do you.

 

[DarksideAllstar]

Man you know nothing about pathology or medicine in general do you.

Not to mention that the OP posted this over a year ago and people are still posting advice (some of it ******ed at that).

 

[b&ierstiefel]

Not to mention that the OP posted this over a year ago and people are still posting advice (some of it ******ed at that).

Man you know nothing about pathology or medicine in general do you.

Well, this guy already admitted that he isn't the brightest kid on the block.

He should just go away now and not have the door hit his *** on the way out.

 

[LADoc00]

Not to mention that the OP posted this over a year ago and people are still posting advice (some of it ******ed at that).

I LOL'd in RL on that.

 

[dientamin]

I LOL'd in RL on that.

We call that an "AL" where I come from.

(audible laughter)

 

[djmd]

We call that an "AL" where I come from.

(audible laughter)

What do you call reviving a three week old thread?

for a joke?

 

[HRantz]

I know the below quote was posted over a year ago, but LADoc, how do you define "almost made it"? Are you almost a millionaire...almost retired...almost your own man...almost living the dream? Just curious.

Funny, now that Ive almost made it, I sometimes wonder what life would be like back in a lab, strolling in at 9 each day, pipeting a bit between lattes, chatting up the college crowd and playing World of Warcraft or some other game on a LAN at work....even if you were dirt poor forever doing academic research, it has a real appeal. I can now see why people do it.

Maybe Ive just pushed too much glass today, but basic science research doesnt seem that bad right now.

 

[mcfaddens]

I know the below quote was posted over a year ago, but LADoc, how do you define "almost made it"? Are you almost a millionaire...almost retired...almost your own man...almost living the dream? Just curious.

Uh Oh! Looks like weve got ourselves a stalker here. First using one of LADOC's pics as your avatar now pulling up his posts from over a year ago