Death of an idealist

[SadPath]

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After five years in private practice, I have been forced and succumbed to accept my chosen career as just a job, and not a profession. I thought I did all the right things – went to a top 10 university and graduated summa cum laude, attended a top 5 medical school, spent residency and multiple fellowships at one of the top pathology programs in the country – but that does not mean anything in the real world. My experience and education did not yield any fruit.

I went into this profession to provide excellent patient care and to improve the quality of service in pathological diagnoses. I relished being involved in laboratory processes, workflow and quality improvement. I wanted to give patients the best and most accurate diagnosis. I wanted to be part of a group that wanted to improve itself and keep abreast of the changes in the field. However, my enthusiasm and interest has been penalized, and I have now realized that the only value that I bring is a diagnosis – not the right diagnosis, but just a diagnosis. I have joined a practice that does not prioritize patient care and safety and quality in processes, and does not offer any sort of collegiality.

And so, therefore I will follow the example of my current peers in practice. I will come into work, do the bare minimum, and collect my paycheck.

And therefore, I join the drones…

There is no room for improvement or betterment of myself or my career. Not just that, but there is no leadership nor insight that this complacent attitude will result in the death of the practice. In this day and age, keeping one’s head in the sand will just allow others to swoop in and take your clients (as is already occurring). The days of the small private practice group are numbered…

(created a new account for this post due to anonymity)

 

[Over9000]

Get out then. That's what I'm working on. I hope you have good step scores.

 

[schrute]

Since when in the last 30 years has medicine been a "profession" for anyone?

It's unfortunate that you feel you have "wasted" your education, though in truth whether one attends a "top 10 university" with "summa cum laude" honors, a "top 5 medical school", and a "top pathology program" vs an avg no-name state school, avg medical school, and avg path program (such as myself) is not--and never has been--a measure for success, and I would hope you haven't assumed as much being presumably near 40 and just NOW realizing how the world, much less medicine, works...no offense.

Though I would add you obviously don't seem to mesh with your group, or don't like the way it is set up. So leave; easier said than done, yes, but if the alternative is "SadPath", it's worth a look.

 

[SadPath]

Not an option in a saturated job market with geographic restrictions (sound familiar?). And in this competitive market, starting out on my own is not an option.

I never assumed that my training would assume success. But I did presume that working hard and having a good CV would result in finding a job where I was satisfied with my day-to-day. Not true. That is the impetus for posting this thread. Nothing is guaranteed in life, however, job mobility should be an option. Unfortunately it is not in this field and geographic location. I am sharing this so that other "idealists" who go into this field realize that there comes a time to "grow up." There's more to your training, or choosing your career than "I love pathology." That is the reality of the situation.

 

[schrute]

Not an option in a saturated job market with geographic restrictions (sound familiar?). And in this competitive market, starting out on my own is not an option.

I never assumed that my training would assume success. But I did presume that working hard and having a good CV would result in finding a job where I was satisfied with my day-to-day. Not true. That is the impetus for posting this thread. Nothing is guaranteed in life, however, job mobility should be an option. Unfortunately it is not in this field and geographic location. I am sharing this so that other "idealists" who go into this field realize that there comes a time to "grow up." There's more to your training, or choosing your career than "I love pathology." That is the reality of the situation.

...janitors "work hard"...teachers "work hard"...everyone "works hard"...the difference is your work, which you have honed and fine-tuned for years and years is--despite being still the work of a technician (we're all technicians...the route we take is equivalent to a protracted vocational school, not an "education"), immensely more impactful on immediate lives of people; if you're no longer concerned about making "the right" diagnosis, you're disillusionment has taken a turn for the worse. I'm not trying to come down hard on you, brah, I just read your post more as a "woe is me" cautionary tale than a cautionary tale NOS, and that "doing the right things" amounted to high-strata training programs and martyrdom to the field of pathology or the "profession" of medicine".

 

[WEBB PINKERTON]

Why in the world would someone need to create a new account to preserve anonymity on an annonymous message board?

Just make your money and move on to another career. It's not that hard. The lab industry is a race to bottom.

 

[Over9000]

...janitors "work hard"...teachers "work hard"...everyone "works hard"...the difference is your work, which you have honed and fine-tuned for years and years is--despite being still the work of a technician (we're all technicians...the route we take is equivalent to a protracted vocational school, not an "education"), immensely more impactful on immediate lives of people; if you're no longer concerned about making "the right" diagnosis, you're disillusionment has taken a turn for the worse. I'm not trying to come down hard on you, brah, I just read your post more as a "woe is me" cautionary tale than a cautionary tale NOS, and that "doing the right things" amounted to high-strata training programs and martyrdom to the field of pathology or the "profession" of medicine".

Everyone has different motivations and who are we to judge, really. One thing that is for certain is that if you're unhappy, you can react by directing the anger inefficiently - outward as rage or inward as regret - or you can use it to work towards another goal.

It's hard. I'm even having second thoughts about it, and the sting of regret that I've wasted years of my life on something is hard to ignore. That'll only get worse over time unless I do something about it.

 

[schrute]

Everyone has different motivations and who are we to judge, really. One thing that is for certain is that if you're unhappy, you can react by directing the anger inefficiently - outward as rage or inward as regret - or you can use it to work towards another goal.

It's hard. I'm even having second thoughts about it, and the sting of regret that I've wasted years of my life on something is hard to ignore. That'll only get worse over time unless I do something about it.

I understand that...some people are motivated by such an immense challenge...but that motivation can be terribly blinding, case in point.

 

[SadPath]

Just make your money and move on to another career. It's not that hard. The lab industry is a race to bottom.

Exactly.

And schrute, sorry if the tone sounded either egotistical or self-serving. Perhaps a side effect of the emotional side of the situation. However, this situation does put into question whether I should have even tried to "work hard" in the first place, when in fact we are just doing the work of a technician. And I have always been concerned with making the right diagnosis..however that is not the example that is followed by those around me, which was what I was trying to communicate.

 

[schrute]

I understand.

 

[gbwillner]

So... why are you geographically restricted? Have you thought about returning to academia? At least in the latter you would find a lot of what you appear to be seeking.

 

[mario2010]

SadPath: I understand what you are saying here. Look at the bright side here, you are a physician and no one can take that away from you. No matter how bad the state of things are you will still be making more than 98% of the population of the country. At the end of the day it's still just a job, you go to work get your stuff done and get the hell out of there. If you don't like your group leave them, take an academic job, commercial lab, medical school teaching or join a VA. Life is just too short to waste on things that we do not have any control ! If you are absolutely miserable, do another residency FP or IM but still there is no guarantee you will find satisfaction in your work. Just remember, after all there is life outside work !

 

[SadPath]

Thanks for the support mario2010. I completely agree with your advice to focus on life outside of work. Being a well-rounded individual and having a support structure is important in all aspects of life. And yes, the point of my post is that this has become just a job...you punch in, punch out and get on with life.
My disappointment is that I could have achieved that state without the grueling training involved. In hindsight, the advice given to me time and time again of "go to the best school and the best program and you will have no issues with finding a good job" has just not been the case in my situation. And so now, I'm stuck. But you're right, in that it is still a better situation than the majority of the population.

gbwillner - geographically restricted due to my spouse's occupation. But this may change...so I'll sit tight. I have thought about academia as well, although the thought of "pressure to publish" does seem daunting. A clinical-track position would probably be a better fit.

Thanks to the above posters for the insight and comments. schrute - your comment about motivation and losing sight of the reality of it all is appreciated. As for some history, the position I took, although it seemed favorable at the time, was also the only opening in the area. So I chose geography over everything else, which now doesn't seem to have been the best decision.

To those of you in training, I hope that this just illustrates the difficulty of job mobility in our field, especially with geographic restriction in a saturated job market. I wonder if this would have happened if I were a surgeon..?

 

[Over9000]

I moved to butthole nowhere to get a job. Let me tell you, it's not any better in the wilderness.

Hospitals, especially rural ones, bend over backwards for essentially all physician specialists except family docs, hospitalists, psychiatrists and pathologists. We're all a dime a dozen.

I'm sick of devaluing myself. I'm starting from scratch.

 

[AZpath]

Rural jobs get just as many applicants as urban jobs for pathology.

There is no extra money either. Insure companies often pay 50% of MC now.
They can get that from Quest, a small rural practice does not have a chance.

Market conditions for pathology are poor. Even if you find a good job now, the future is very uncertain.

 

[gbwillner]

Rural jobs get just as many applicants as urban jobs for pathology.

There is no extra money either. Insure companies often pay 50% of MC now.
They can get that from Quest, a small rural practice does not have a chance.

Market conditions for pathology are poor. Even if you find a good job now, the future is very uncertain.

I agree that market conditions are apparently far from ideal. It is worth noting that this statement is generally true across all specialties. Hospitals and networks are buying out all types of practices. There is less revenue to be has by all- those that are profiting are markets where there is effectively no regulation on price like pharmaceuticals, and they are going to have their own issues as well. We are generally a smaller market and may see the pressures on health care a little more acutely that other fields. But I think your last statement is definitely true across all fields- the future IS uncertain. Things could definitely improve or get worse. Starting over in another specialty may not improve your situation either. If you went into IM or Peds you could find getting a job easier in a more desirable location. However, you may make 1/2 of you current salary, and may find yourself also doing a job you don't particularly like much (you probably picked pathology for a pretty good reason). If that sounds ok then a switch may help your situation.

 

[mlw03]

Here's my question when I read this. Why is it that providing any ol' diagnosis has become acceptable? Why aren't there consequences for continually churning out bad diagnoses? Getting sued? Losing the trust of your clinicians? Excuse my ignorance on this, as I'm a government-employed forensic pathologist. Don't the clinicians care enough anymore to ensure the diagnostic opinions they are using to treat their patients are valid diagnostic opinions?

 

[Over9000]

Because 1. most referring physicians have no idea about pathology and thus hinge on our word as final, happy to turn off their brains upon reading our consultation 2. we, as a professional group, are all too happy to give that sort of impression of an all-knowing oracle rather than a realistic depiction of the primarily subjective nature of our work, further absolving the referrer of any independent thought and 3. nobody knows if we're right or not, including us, until something bad happens, which can take decades to manifest.

At least with images, the images are open to interpretation by the referring physicians, and they can pick out things that don't make sense to them quite quickly. Imagers don't pretend that they're always correct and final, and the prognosis of images are generally measured in days to weeks, not years, so things are picked up quicker.

 

[LADoc00]

Sad path: I cant believe it took you 5 years to get there. I was there about 90 days in after fellowship.

WELCOME.

focus on your 401K balance, family, hobbies and set an actual date when you walk into work an announce you are "Audi"

 

[RustBeltOnc]

I moved to butthole nowhere to get a job. Let me tell you, it's not any better in the wilderness. Hospitals, especially rural ones, bend over backwards for essentially all physician specialists except family docs, hospitalists, psychiatrists and pathologists. We're all a dime a dozen.

To be honest, brah, most physician specialists are a dime a dozen in this scenario.

 

[RustBeltOnc]

Here's my question when I read this. Why is it that providing any ol' diagnosis has become acceptable? Why aren't there consequences for continually churning out bad diagnoses? Getting sued? Losing the trust of your clinicians? Excuse my ignorance on this, as I'm a government-employed forensic pathologist. Don't the clinicians care enough anymore to ensure the diagnostic opinions they are using to treat their patients are valid diagnostic opinions?

Yes, we care. A great deal.

 

[Pathwrath]

I thought I did all the right things – went to a top 10 university and graduated summa cum laude, attended a top 5 medical school, spent residency and multiple fellowships at one of the top pathology programs in the country – but that does not mean anything in the real world. My experience and education did not yield any fruit.. I have joined a practice that does not prioritize patient care and safety and quality in processes, and does not offer any sort of collegiality. And so, therefore I will follow the example of my current peers in practice. I will come into work, do the bare minimum, and collect my paycheck.

I'm going to go out on a limb based on this post and surmise that you took that particular job in the hopes of truly having it all--all the respect and privilege of a rarefied academic sinecure (commensurate with your considerable talent and accomplishments), plus the big bucks of a private practice gig. And, to your chagrin, you found out that you couldn't have it all. You found out that private practice means working with a$sholes, pushing glass like a machine, and, worst of all--that nobody really cares about you, your ability, or your credentials. All to make that sweet private practice money. Welcome, finally, to reality.

I'm sorry if this seems harsh. Anyone reading my posts knows that I care deeply about young pathologists and the crappy way they are treated. But you come across as very entitled.

 

[caffeinegirl]

Agree with Pathwrath and LADoc on this one..took you too long to grow up, kid. This is just a job, but at least you do care about what you do. Academics is probably the right track for you.

I do agree with the last part of your post, and will reiterate that the job market is tough out there, especially with the mega labs, mergers, consolidation, etc. Your situation can change, and you have to adapt in order to survive. When our hospital sold the outreach business to the megalab, we had to adapt and open our own lab to compete for what was our business. Pathology in the outpatient setting is a client and service based industry. It's not just about the diagnosis (which should always be righ!), it's about what the report looks like, customizing your report distribution, etc. I had to learn HL7 and SQL to set up our IT/LIS and EMR interfaces to keep up. Try to broaden your horizons, both personally and professionally.
As for the sweet private practice money..I don't think it'll last much longer, and is definitely not what it was 10 years ago.

 

[mlw03]

Yes, we care. A great deal.

Do clinicians' actions reflect this care then? On here the answer appears to be no.

 

[RustBeltOnc]

Do clinicians' actions reflect this care then? On here the answer appears to be no.

Most community oncologists have been known to badger/pester community pathologists if report isn't helpful or doesn't fit with clinical impression.

 

[Tissue issue]

After five years in private practice, I have been forced and succumbed to accept my chosen career as just a job, and not a profession. I thought I did all the right things – went to a top 10 university and graduated summa cum laude, attended a top 5 medical school, spent residency and multiple fellowships at one of the top pathology programs in the country – but that does not mean anything in the real world. My experience and education did not yield any fruit.

I went into this profession to provide excellent patient care and to improve the quality of service in pathological diagnoses. I relished being involved in laboratory processes, workflow and quality improvement. I wanted to give patients the best and most accurate diagnosis. I wanted to be part of a group that wanted to improve itself and keep abreast of the changes in the field. However, my enthusiasm and interest has been penalized, and I have now realized that the only value that I bring is a diagnosis – not the right diagnosis, but just a diagnosis. I have joined a practice that does not prioritize patient care and safety and quality in processes, and does not offer any sort of collegiality.

And so, therefore I will follow the example of my current peers in practice. I will come into work, do the bare minimum, and collect my paycheck.

And therefore, I join the drones…

There is no room for improvement or betterment of myself or my career. Not just that, but there is no leadership nor insight that this complacent attitude will result in the death of the practice. In this day and age, keeping one’s head in the sand will just allow others to swoop in and take your clients (as is already occurring). The days of the small private practice group are numbered…

(created a new account for this post due to anonymity)

You need to clarify this statement- your group has no QA process? What do you mean by wrong diagnosis- benign versus malignant or moderately differentiated versus poorly differentiated?

 

[stickyshift]

After five years in private practice, I have been forced and succumbed to accept my chosen career as just a job, and not a profession. I thought I did all the right things – went to a top 10 university and graduated summa cum laude, attended a top 5 medical school, spent residency and multiple fellowships at one of the top pathology programs in the country – but that does not mean anything in the real world. My experience and education did not yield any fruit.

I went into this profession to provide excellent patient care and to improve the quality of service in pathological diagnoses. I relished being involved in laboratory processes, workflow and quality improvement. I wanted to give patients the best and most accurate diagnosis. I wanted to be part of a group that wanted to improve itself and keep abreast of the changes in the field. However, my enthusiasm and interest has been penalized, and I have now realized that the only value that I bring is a diagnosis – not the right diagnosis, but just a diagnosis. I have joined a practice that does not prioritize patient care and safety and quality in processes, and does not offer any sort of collegiality.

And so, therefore I will follow the example of my current peers in practice. I will come into work, do the bare minimum, and collect my paycheck.

And therefore, I join the drones…

There is no room for improvement or betterment of myself or my career. Not just that, but there is no leadership nor insight that this complacent attitude will result in the death of the practice. In this day and age, keeping one’s head in the sand will just allow others to swoop in and take your clients (as is already occurring). The days of the small private practice group are numbered…

(created a new account for this post due to anonymity)

The most important kind of knowledge has nothing to do with test scores, Ivy League schools or prestigious residencies. The most important thing is self-knowledge. You have to know what's important to you and you have to make active decisions to maximize the chance that you get those things. Of course, that means that you will probably have to give up some things to get other things: it's hard to land a job that will get you the big paycheck, while simultaneously affording you a ton of personal/family time or a huge amount of intellectual stimulation.

Without self-knowledge, you can bust your ass making your CV glow in the dark, but just end up with the big prize which you realize--too late--you never really wanted in the first place.

 

[yaah]

Medicine has changed so much in the last 15-20 years since I (and probably you, since you have been out of training a similar length of time) started the journey. The practice itself of medicine hasn't changed as much as the extraneous stuff has. There is more administration, there is more competition, there is more consolidation, and there is much more pressure to control costs and make profit. So yours is a relatively common story in medicine. Have heard it from a lot of different types of docs. A huge amount does depend on your actual practice group and institution. In my area I know of several primary care docs who have significantly altered their careers (either outright quitting, or restricting their practice somewhat, or cutting back), as well as a lot of specialists who want to quit or change. Some can't because their loans are too great. Others don't have the loans but don't know what else to do and are jaded. But lots are happy and satisfied, they have carved out their own niche or adjusted to the problematic parts.

You might adjust too. You might just be at the point in your career (The "is this all there is?" point) where you question a lot of things. It might get better as things change in your work environment, or it might not. You might decide it isn't as bad as you think.

Sometimes what happens is that people go into medicine and get basically swallowed up and overwhelmed by it. When they finally come up for air after a few years of consistency in practice, they realize it isn't what they had hoped it would be. This happens in lots of careers, it just tends to happen a little later in medicine and can be harder to do anything about because of the financial burden of loans. Some people cope by finding another outlet (either a secondary career or just a hobby), others just by hunkering down and focusing on doing what they can. Others quit because it isn't worth it. If we all had total free will and were financially independent it would be a different world. Unfortunately we live in a world where a lot of the rules are made by hard-driven, often partially psychotic, people who create the expectation that work should be a full out, 100% effort that excludes all other parts of life. If you don't conform to that you can get marginalized in some ways.

Sometimes all it is is something of a mid life crisis, maybe you're experiencing it early.

 

[oldfatman]

Get a life. Seriously. Find something else besides work that makes your life meaningful. Be it family, children, volunteer work, church, drugs, sex, rock and rock, whatever. Welcome to adulthood.