Path is in a crisis because of the types of applicants it attracts and accepts:
1. low board scorers (since the boards are mostly path, this is worrisome)
2. slackers (obviously)
3. FMGs trying to get into the system so that they can raise their kids affluently(I vehemently disagree with this. If you want to play in the major leagues, you gotta come up through the minors. Go to med school here)
4. Type B personalities (easily bullied and lack the balls to either stand up for themselves or work through it)
1. Not true. I thought Step I scores on average were slightly above the national mean. That's fine. If we cut the number of residency slots, the mean would undoubtedly increase. I never had the impression that people chose pathology because of low board scores. I also don't think board scores are the best predictor of talent as a pathologist. Step I does not test the same knowledge as the AP and CP pathology boards. A couple of months of lectures and medical school small groups doesn't introduce you to much pathology. I was part of a group that did not need Step II and III to match, and many of us took them with 2 to 3 weeks of preparation and passed. I'm not sure you can use those scores as valid comparisons of intelligence or knowledge between the specialties, although you would expect pathologists to score lower on Step III for certain (you'd sort of hope that was the case, but I'm actually not sure that it is).
2. I'm at a program where you have to be very careful not to exceed work hour restrictions, and clinical pathology call may keep you awake all night. Our residents are exceedingly competitive, engage in numerous research projects, and bust ass. Some clinicians do not appreciate that you cannot render a preliminary diagnosis on a core biopsy that was placed in fixative seven minutes ago. Others become angry when a frozen section diagnosis is delayed because we are inundated and inadequately staffed, but if pathology residents truly slacked-off, then the entire hospital would come to a screeching halt. We don't stay in the hospital when we are on call. We get to sit down throughout the day more often than do clinicians. We also have some very light clinical path months, but on the AP side we run around. Things slow down on the weekends, but we are usually in-house previewing slides, studying, or working on projects.
3. Some of the most talented residents at my program received medical training outside of the United States. We are fortunate to attract the best of the best. You make it sound like no ambitious American med school grad in her right mind would choose pathology; then I would rather look to the outside for a stellar colleague than put up with one of your so-called low board scoring, type-B personality slackers.
4. Someone should probably present data on the personality types that are likely to enter each specialty of medicine. There are obvious stereotypes of each kind of physician, but to categorize any group of physicians as wimpy or reticent is questionable. To make it in medicine, you need to be outgoing and decisive. You need to be aggressive and confident. I see these characteristics in my colleagues.
...and also because of the applicants it repels:
1. people who desire prestige
2. people who desire money
3. people who desire moderate amounts of respect for their work
4. people who do not like to cut up dead bodies
5. people who desire to do something that is considered valuable
So far path fails on all fronts.
1. Not true. We have a lot of these.
2. Not true. We historically have been compensated above what is considered the mean compensation for a physician and reportedly we work fewer hours as attendings.
3. Not true. I have not met a pathology resident who does not want respect. I have encountered different hospital environments and in some atmospheres pathologists receive more respect than in others. This is a direct reflection of the leadership. There may be a culture at some hospitals where it is acceptable for clinicians to mistreat pathologists or vice versa, but this is not a universal truth.
4. Not true. We have a lot of these and most of them will not perform autopsies routinely as attendings. The majority of them will not perform autopsies as attendings at all. Most attending pathologists wear a shirt and tie to work and don't worry much about getting dirty. That is not true of every clinical specialty and especially not of the ones that offer higher pay or serve as the focus of television dramas.
5. Not true. People who understand just how valuable pathology is will laugh at this. The average Joe may not know what a pathologist is, but he learned everything he knows about medicine from watching Scrubs and Grey's Anatomy. I have relatives who insist that their biopsy was read by a machine and not a human, that coagulation studies are performed in a little back room somewhere and overseen by the treating clinician, and that ABO compatibility is the only thing you really have to consider when transfusing red cells. Most people think there is a disease called "cancer" that comes in one flavor equally affecting different organs. There are abundant misconceptions and that is fine. What is embarrassing is when a clinician has misconceptions about what a pathologist does and does not do, how diseases are diagnosed, how to properly use a laboratory study, etc. In surgical pathology alone, the volume of information we need to cram into our heads is too much for any clinician to have time to memorize. Patients want to know what they
have and not what the clinical impression dictates, so as long as physicians want to look smart and make accurate decisions, then they need to partner with pathologists.
