crunch time

[tennik]

I'm coming to the end of my third year and I'm feeling the heat to make my 100% specialty choice. I have been thinking path for quite some time, but I have loved my third year. My problem is that every fricken path resident I talk to comments on how pathologists all hated their clinical years and would never consider any clinical specialties. So what's the deal?

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[b&ierstiefel]

I'm coming to the end of my third year and I'm feeling the heat to make my 100% specialty choice. I have been thinking path for quite some time, but I have loved my third year. My problem is that every fricken path resident I talk to comments on how pathologists all hated their clinical years and would never consider any clinical specialties. So what's the deal?

Well, I don't think hating 3rd year of med school is a prerequisite for going into pathology. Some of us did hate 3rd year and some of us liked 3rd year.

I know that I have been quite vocal about how the clinical clerkships suck ass. But let me clarify. Although most of the time, I felt that I was everyone's bitch, my work didn't matter in the long run, I was dispensible, and nobody cared about me...I didn't think the actual work done by the residents and attendings was all that bad. The part of 3rd year that I absolutely hated was the fact that I was a 3rd year student. That's it.

I think a lot of us don't hate the work per se but I believe that we have come to a realization that we can do without it. Think about it...there seems to be a lot of obstacles we aspiring pathologists need to overcome: the fact that we will not be "real" doctors anymore, we will be seen as a bunch of freaks that work with dead bodies in basements, we will not get the same recognition as the clinicians when it comes down to disease diagnosis. Pathologists really seem to work in the background, most of the work which does go unnoticed. Irregardless of all of these "cons", many of us have chosen to go into pathology because we think it's interesting and the thought processes and work is more consistent with our inner being and how we think.

It's great that you loved your 3rd year. And if there's a field apart from pathology that you've fell in love with during this year, then definitely consider it. Granted, it is crunch time as you noted so you'll have to make your decision relatively quickly

 

[beary]

Do you get to do a path rotation early in your fourth year? That might help you make your choice - to see if you liked that better than you liked your clinical rotations. Maybe you are just a happy person and like lots of things.

For me personally, I hate medicine and totally dreaded the thought of doing an internship. I haven't done surgery yet but think I will hate that too. I really seriously considered doing rad onc and got to explore the clinical side of that quite a bit while I was in grad school and I really liked it. So I don't hate everything clinical.

 

[tennik]

I would be lying if the "not a real doctor" thing didn't bug me, but in the end I will decide want I want to do, not what will get me respect in the dentist's office. One of my relatives asked me the other day what a pathologist does and I responded simply that they explain the tough cases to the real doctors.

The crux of my concern is this. I am a people person that likes pathology. As a pathologist, will I be a freak in the basement or will I be looking at disease, learning about disease process, and discussing.

I am doing path in July - I am counting on making a decision during this rotation. When do you think you need to decide by? I am thinking like August 15.

 

[bananaface]

Dentists get the "not a real doctor" thing too. We can all join the "not a real doctor" club and be buddies. (future PharmD speaking)

Is the issue really that you feel pathologists aren't "real doctors", or that people don't recognize what pathologists do without you having to explain it to them?

 

[b&ierstiefel]

I would be lying if the "not a real doctor" thing didn't bug me, but in the end I will decide want I want to do, not what will get me respect in the dentist's office. One of my relatives asked me the other day what a pathologist does and I responded simply that they explain the tough cases to the real doctors.

The crux of my concern is this. I am a people person that likes pathology. As a pathologist, will I be a freak in the basement or will I be looking at disease, learning about disease process, and discussing.

I am doing path in July - I am counting on making a decision during this rotation. When do you think you need to decide by? I am thinking like August 15.

Yes, pathologists are branded with the stereotype of not being "people-persons". Pathologists are probably perceived as anti-social, schizoid freaks. Which is unfortunate because many of the pathologists I've met are real cool, down-to-earth people. But of course, for every "normal" pathologist you will meet a pathologist who is socially a bit "off." Anyways, just because you're a people person and don't fit the stereotype doesn't mean you should shy away from pathology. In fact, pathologists should be people-persons because they have to associate with other clinicians who are consulting them for their services.

Much of pathology isn't done in a basement. But at many hospitals, autopsies are being done in basement morgues in the bowels and dungeons of the hospital. At a few hospitals that I've visited though, the morgue wasn't in the basement. For instance, at UNC the morgue is analogous to a penthouse suite in that it's at the top floor of the hospital. In fact, there are windows and you can look out and see Chapel Hill...quite cool.

A lot of pathology involves sitting at the scope during signouts where you diagnose cases. Much of this is not done in a basement. Some of this may be done in an office setting and other signouts are done in a cozy room with a big table that houses a multiheaded scope. Some of the work in pathology involves teaching. Here, your work environment is a lecture hall or a pathology lab/classroom. Of course this is if you go into academics...if you go into private practice, you likely will not be teaching medical students.

Anyways, when do you need to decide? Well, I remember submitting my ERAS application shortly after Labor Day so I would say that you need to decide by September. I'll tell you my experience just to serve as a point of reference. My fourth year of med school started in July. I did my two sub-I's during July and August. I knew I was applying for pathology anyways but my path rotation wasn't until September. I applied anyway. The only issue I ran into was getting my letters of recommendations submitted in a timely manner. Fortunately, I lucked out and got all my pathology letters by the end of September (3 weeks after submission of my ERAS application). On a related note, some programs will offer interviews without any letters. They will just look at your ERAS and say, "hey, let's invite this guy for an interview!" I think my first three interview invites were from Vanderbilt, BIDMC, and Brigham...and this was like a few days after I submitted my ERAS (no letters in by this point). My point is this, given that you'll do your pathology rotation in July, you will have plenty of time to reflect and decide. I wouldn't sweat it if I were you.

 

[tennik]

Just a note, I sweat like a pig. Seriously, I can play like two sets of tennis and go through three shirts. I know this paints a fairly repulsive picture, but what am I supposed to do. I guess on the other had I'm pretty good with the bowstaff, so I have that going for me.

Response to earlier, I don't mind having to explain what a pathologist does, it is more that after telling people (family and other students), they are comment that they thought my strength was talking to people. To be honest, I have a bit of a dilemma on this. I feel like pathology is the best specialty for me (it matches my pre medschool goals very well - learn about disease process, help people, make important decisions), but I think I may be best for some field like psych where your job is to talk to people. I can't really assess my skills at reading a slide sinse I haven't had much experience.

Sounds like you decided fairly late, what else were you considering.

Thanks for discussing.

 

[b&ierstiefel]

Response to earlier, I don't mind having to explain what a pathologist does, it is more that after telling people (family and other students), they are comment that they thought my strength was talking to people. To be honest, I have a bit of a dilemma on this. I feel like pathology is the best specialty for me (it matches my pre medschool goals very well - learn about disease process, help people, make important decisions), but I think I may be best for some field like psych where your job is to talk to people. I can't really assess my skills at reading a slide sinse I haven't had much experience.

Sounds like you decided fairly late, what else were you considering.

Thanks for discussing.

Slide reading skillz comes with time. I can't read slides worth jack right now but I suspect that I'll be working hard this upcoming year and ascend up the steep learning curve.

I like talking to people too...in fact during clinics and ward work, I was criticized for talking to and spending too much time with the families. But see here's the thing...I can talk to friends and peers who are not patients and I'll be just fine with that. I like to go to social events...so I'll talk and shoot the **** with people there. I felt that "talking to patients" was therefore not a prerequisite for my job.

What else was I considering at this point last year? Post-doctoral research. I decided that if I hated my pathology rotation, I would drop out of the match right away and apply to labs in Boston and the Bay Area.

 

[bananaface]

Just a comment. When we are referring to pathologists as not being "real doctors", I at least am joking. Every physician specialty is a unique and valuble application of the med school experience. If we look at all the reasons that people would cite for pathologists not being "real doctors", are any of them really unique to pathology? Last time I checked there were plenty of ways to minimize patient contact.

 

[tennik]

I like talking to people too...in fact during clinics and ward work, I was criticized for talking to and spending too much time with the families. But see here's the thing...I can talk to friends and peers who are not patients and I'll be just fine with that. I like to go to social events...so I'll talk and shoot the **** with people there. I felt that "talking to patients" was therefore not a prerequisite for my job.

Good to hear. Makes sense, be social at home and work at work.

 

[yaah]

OK - in regards to pathologists being "anti social" this is the biggest bunch of bull**** I have ever heard in my life. There is no higher percentage of social misfits in path than there are in any other branch of medicine. There are butthead surgeons, arrogant pediatricians, stupid radiologists, anti-social psychiatrists, etc etc. Of COURSE there are some anti social pathologists.

Path departments when hiring new people, it turns out, look for interpersonal skills and communication ability as a definite important factor (on a scale of 0-100, where 100 is the highest, these skills were given a 98 in terms of importance). To make this relevant - where you did residency comes in in the 70s somewhere. Research comes in much lower. These are numbers that the USCAP secretary/treasurer showed us today.

I am a people person, for the most part. I found out I like pathology much more than dealing with clinical medicine. It doesn't mean I hated clinical medicine and would have quit the field of medicine before doing an IM residency. I think it's important to realize that most people who go into pathology do so because they like the field, not because it is their only option. Going into a field for other reasons is a bad idea.

 

[tennik]

First, that is impressive. Do you know where I can find this survey?
Second, how much would you say the average path dude uses these interpersonal skills?

 

[geddy]

First, that is impressive. Do you know where I can find this survey?
Second, how much would you say the average path dude uses these interpersonal skills?

From my limited exposure to path, it seems that interpersonal skills are used all the time in path. The big difference is that it's on a professional level, not a doctor-patient level. You'll talk to other pathologists a lot about cases, structural issues for the department, etc. You talk to surgeons on frozens or with clinicians if they have questions about diagnoses - you can have as much interaction with clinical people as you like. I've seen one pathologist who include lots of refences in her reports and has a lot of interactions with clinicians as a result. Of course, you interact with administrative staff, but that's like every other kind of physician. Pathologists also interact a lot with lab staff, from PAs to blood center techs, flow technologists, whatever. This is unique to pathology. Lot's of professional interactions, which I generally prefer over interactions with patients.

 

[yaah]

First, that is impressive. Do you know where I can find this survey?
Second, how much would you say the average path dude uses these interpersonal skills?

It might be somewhere on the USCAP page. I haven't gone to look yet. He did add that there is a pathologist named Horowitz (first initial R) at Southern Cal or somewhere who has published a lot of interesting survey info, specifically in the journal Human Pathology.

Path people use interpersonal skills all the time. You can get away with being a poor communicator a lot of the time, either because you have someone else doing your bidding or because the person you are talking to is an equally poor communicator. But having good skills and being friendly, IMHO, actually saves you a lot of time and hassle. Because you can anticipate questions, help people out, and work with them to get them the information they need, saving you 50 phone calls about "what does this mean?" etc etc.

Path is like any other career - it's a business too. So, dealing with other people is part of your job. It behooves anyone to do the best they can in this regard. People will tend to want you around more this way.

 

[gungho]

It might be somewhere on the USCAP page. I haven't gone to look yet. He did add that there is a pathologist named Horowitz (first initial R) at Southern Cal or somewhere who has published a lot of interesting survey info, specifically in the journal Human Pathology.

Path people use interpersonal skills all the time. You can get away with being a poor communicator a lot of the time, either because you have someone else doing your bidding or because the person you are talking to is an equally poor communicator. But having good skills and being friendly, IMHO, actually saves you a lot of time and hassle. Because you can anticipate questions, help people out, and work with them to get them the information they need, saving you 50 phone calls about "what does this mean?" etc etc.

Path is like any other career - it's a business too. So, dealing with other people is part of your job. It behooves anyone to do the best they can in this regard. People will tend to want you around more this way.

We have a 1st year in our program from another country who has been doing research in the U.S for the last 12 years or so, yet his English is barely intelligible. He seems intelligent enough, picks up on things quickly, etc., yet it is a real burden to try to communicate with him. He is always asking questions about what different English words mean, how to word something in English,etc. It's to the point where the staff is requiring him to take some English classes to improve or he's down the road. So, no matter how smart he is, if he can't communicate his findings or recommendations to clinicians in a reasonable manner, how valuable is he in this country? I like him, he is personable and friendly, but ...

 

[Pookies]

I enjoyed my clinical rotations (all except FP). In fact I had a hard time deciting between path and Peds. Do some rotations in 4th year. Dont let anyone push you into something. If you choose a specialty that you dont like, you can always change. I know many path residents that started in Peds, FP, IM, etc.

Good Luck

 

[yaah]

We have a 1st year in our program from another country who has been doing research in the U.S for the last 12 years or so, yet his English is barely intelligible. He seems intelligent enough, picks up on things quickly, etc., yet it is a real burden to try to communicate with him. He is always asking questions about what different English words mean, how to word something in English,etc. It's to the point where the staff is requiring him to take some English classes to improve or he's down the road. So, no matter how smart he is, if he can't communicate his findings or recommendations to clinicians in a reasonable manner, how valuable is he in this country? I like him, he is personable and friendly, but ...

Yeah - we have a resident from another country who used to be a neurosurgeon. He initially was AP/CP, but ran into trouble in some of his CP rotations because 1) he has a quiet voice and 2) is hard to understand. So he is put on AP only rotations for the entire year. I agree with your statement - it's hard to know what to do, because even if this guy is smart (he is), is he going to be an effective pathologist? I think he probably would because he's nice enough and can relate to people, but it would present a challenge in dealing with some people, particularly over the phone. How much responsibility do training programs have in these circumstances? You can't really decide NOT to train someone because their english speaking isn't the greatest - or can you? Does it fit in with "technical standards?" Is it discrimination? Strange area. This resident is also the only IMG non-fellow in the entire program, and this may be part of the reason this program is not very IMG friendly. Many IMGs may interview well and perform well in non-clinical situations - but when it gets to clinical situations some of the trouble comes out.

 

[b&ierstiefel]

Yeah - we have a resident from another country who used to be a neurosurgeon. He initially was AP/CP, but ran into trouble in some of his CP rotations because 1) he has a quiet voice and 2) is hard to understand. So he is put on AP only rotations for the entire year. I agree with your statement - it's hard to know what to do, because even if this guy is smart (he is), is he going to be an effective pathologist? I think he probably would because he's nice enough and can relate to people, but it would present a challenge in dealing with some people, particularly over the phone. How much responsibility do training programs have in these circumstances? You can't really decide NOT to train someone because their english speaking isn't the greatest - or can you? Does it fit in with "technical standards?" Is it discrimination? Strange area. This resident is also the only IMG non-fellow in the entire program, and this may be part of the reason this program is not very IMG friendly. Many IMGs may interview well and perform well in non-clinical situations - but when it gets to clinical situations some of the trouble comes out.

Is this guy an MD/PhD? I have a hard time understanding him too.

 

[yaah]

Is this guy an MD/PhD? I have a hard time understanding him too.

Yeah - there is another one from the same country who is a fellow. I am not sure which one you are thinking of but both can be tough to understand.

 

[b&ierstiefel]

Yeah - there is another one from the same country who is a fellow. I am not sure which one you are thinking of but both can be tough to understand.

WTF. There are TWO of them? I'm talking about the pissed-off looking chinese guy.

 

[yaah]

WTF. There are TWO of them? I'm talking about the pissed-off looking chinese guy.

Yeah - there is a 5th year guy too - a surg path fellow this year. He's kind of shorter and has glasses (first name starts with W). The 2nd year guy doesn't wear glasses and always wears scrubs (first name starts with B).

 

[b&ierstiefel]

Yeah - there is a 5th year guy too - a surg path fellow this year. He's kind of shorter and has glasses (first name starts with W). The 2nd year guy doesn't wear glasses and always wears scrubs (first name starts with B).

yeah, it was the 5th year guy. actually, pissed off looking is the wrong descriptive phrase...i take that back. he kind of has this surprised look on his face all the time.

 

[deschutes]

You can't really decide NOT to train someone because their english speaking isn't the greatest - or can you? Does it fit in with "technical standards?" Is it discrimination? Strange area... Many IMGs may interview well and perform well in non-clinical situations - but when it gets to clinical situations some of the trouble comes out.

(with all due respect to tennik...)

I think one can, and it does. Before Step 2 CS there was the CSA, which all IMGs had to pass. That is already a "technical standard" - and I think it is certainly reasonable.

It is probably for this reason that the Royal College of Physicians and Surgeons of Canada has oral exams as part of their fellowship certifications.