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Im a pathologist, my credentials are literally almost as good as you can get with recommendations from the most prominent people in the profession. Overall, Im very disappointed in the pathology job market and am learning things 5 years into the profession people should have told me day 1. So, let me rant, partly because I have had a bad week, partly because all the other pathologists around here have already heard my soap box orations.
Pathology in the 70s and early 80s was a golden era. The field was growing far faster than programs were producing newly boarded people, incomes were astronomical. It was a combination of supply/demand and the fee structure for the billing of lab tests. Every chem panel, every glucose had a professional fee attached and that made up a big part of a group's income. It was not uncommon for pathologists to have incomes in excess of a million a year in some areas.
Then mid 80s that changed, it was percieved (YET UNTRUE) that the restructuring of medicare had made this dubious practice illegal. Income dropped by 50% literally overnight. Then the billing for some surgical specimens was even rolled back, with more emphasis on the technical rather than the professional component. Many groups didnt own their histology labs so they were forced to buy them from hospitals to prevent even further erosion of their income. This sapped alot of capital and changed the way neophyte pathologists entered the system. Many people began taking on more cases to float income back to the 70s level. Towards the end of the 80s, groups almost stopped hiring new people completely (this meant more cash to split over less people). The unemployment among new pathologists was incredible. Think post cold war East Germany.
Where pathology had been the domain of AOA types and gunners, it became a clearing house for IMGs. The influx of IMGs created all sorts of new problems in a field where communication is so essential. Enter early 90s and Path continues its slide both economically and professionally.
Enter today, the job market to be fair is not the hell it was say in 1989 but it isnt peaches and cream either. Many groups hire entry level at very low salaries and instead of partnership, they get flushed after about 3-5 years. Enter the concepts of the "revolving door pathologists" and the "robber barons." The robber barons are a group of elite old timers who own large groups and fondly remember their heyday of big bucks, they are highly reluctant to share power, are insanely greedy and care as much as about you as Carnegie did his blue collar steel workers in the industrial revolution. Revolving door pathologists are an itinerant group of poor souls who travel to jobs doing locums for 6-8 months a year in different God forsaken corners of America.
How bad is it you say? My headhunter (supposedly the best in the US) told me last week there were 6, yes SIX whole private practice jobs in the continental US open at the moment. You know how many open radiology spots there were? Over 250!! When the Harvards/Stanfords/WashUs are having problems like this, I shudder at the thought of what the hell everyone else is going through.
Is it hopeless? Not quite but you can make yourself be far more competitive by just a few things. Remember you dont have to outrun the bear, just outrun that other guy so he gets eaten instead.
1.) Go to the BIGGEST name you can get into for AP/CP: JHU, WashU, Virginia, Stanford, UCSF, Harvard, Penn (forget Yale, forget UCLA, skip Texas, esp forget Mayo, the "Mayo Way" is simply not applicable to life outside Rochester)
2.) Plan on doing a fellowship in either: Derm, Heme or Cyto (Surg Path is iffy, if you didnt go to a big name place, yeah sure go to Sloan or MD Anderson)
3.) Stay single and be willling to move, this is the most critical point! I cant emphasis this enough. When the ultimate offer comes calling from central Idaho, you need to be flexable enough to jump at it.
4.) Dont take starting offers for less than 180K FT, you DILUTE the field for the rest of us.
There's lots more but Im tired now and want to leave work.
LADOC
Pathology in the 70s and early 80s was a golden era. The field was growing far faster than programs were producing newly boarded people, incomes were astronomical. It was a combination of supply/demand and the fee structure for the billing of lab tests. Every chem panel, every glucose had a professional fee attached and that made up a big part of a group's income. It was not uncommon for pathologists to have incomes in excess of a million a year in some areas.
Then mid 80s that changed, it was percieved (YET UNTRUE) that the restructuring of medicare had made this dubious practice illegal. Income dropped by 50% literally overnight. Then the billing for some surgical specimens was even rolled back, with more emphasis on the technical rather than the professional component. Many groups didnt own their histology labs so they were forced to buy them from hospitals to prevent even further erosion of their income. This sapped alot of capital and changed the way neophyte pathologists entered the system. Many people began taking on more cases to float income back to the 70s level. Towards the end of the 80s, groups almost stopped hiring new people completely (this meant more cash to split over less people). The unemployment among new pathologists was incredible. Think post cold war East Germany.
Where pathology had been the domain of AOA types and gunners, it became a clearing house for IMGs. The influx of IMGs created all sorts of new problems in a field where communication is so essential. Enter early 90s and Path continues its slide both economically and professionally.
Enter today, the job market to be fair is not the hell it was say in 1989 but it isnt peaches and cream either. Many groups hire entry level at very low salaries and instead of partnership, they get flushed after about 3-5 years. Enter the concepts of the "revolving door pathologists" and the "robber barons." The robber barons are a group of elite old timers who own large groups and fondly remember their heyday of big bucks, they are highly reluctant to share power, are insanely greedy and care as much as about you as Carnegie did his blue collar steel workers in the industrial revolution. Revolving door pathologists are an itinerant group of poor souls who travel to jobs doing locums for 6-8 months a year in different God forsaken corners of America.
How bad is it you say? My headhunter (supposedly the best in the US) told me last week there were 6, yes SIX whole private practice jobs in the continental US open at the moment. You know how many open radiology spots there were? Over 250!! When the Harvards/Stanfords/WashUs are having problems like this, I shudder at the thought of what the hell everyone else is going through.
Is it hopeless? Not quite but you can make yourself be far more competitive by just a few things. Remember you dont have to outrun the bear, just outrun that other guy so he gets eaten instead.
1.) Go to the BIGGEST name you can get into for AP/CP: JHU, WashU, Virginia, Stanford, UCSF, Harvard, Penn (forget Yale, forget UCLA, skip Texas, esp forget Mayo, the "Mayo Way" is simply not applicable to life outside Rochester)
2.) Plan on doing a fellowship in either: Derm, Heme or Cyto (Surg Path is iffy, if you didnt go to a big name place, yeah sure go to Sloan or MD Anderson)
3.) Stay single and be willling to move, this is the most critical point! I cant emphasis this enough. When the ultimate offer comes calling from central Idaho, you need to be flexable enough to jump at it.
4.) Dont take starting offers for less than 180K FT, you DILUTE the field for the rest of us.
There's lots more but Im tired now and want to leave work.
LADOC
