Do 8-5 residencies exist?

[moosepatrol77]

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Long-time lurker... As I start to apply to residencies and go on interviews, I've noticed that most places I've picked are no where near "8-5" type schedules. I love pathology, I love scope time, and I like to work while I'm in the lab, but the 3rd year of medical school has been a real drain on my family life and I was hoping to overcome that in residency. CP seems pretty reasonable at most places and granted that is half your schedule, but the other side of the coin is the 55-80 hour weeks on surgical path the other 6 months of the year.
I have no problem working 8-9 hour days, but I just start getting worn down on rotations that have heavier work loads. Besides losing energy, I'm most afraid about not having time to read, which is where I tend to excel the most when I have the time. I've really been looking around hard to try to find a place that would be closest to a "normal" job. I don't want to be considered whiney nor a slacker, but I really want to find a place where I can fit in, a place where surgical pathology doesn't completely monopolize half of your year. I love pathology and I can't see myself doing anythng else right now. Any recommendations on places I should be looking at more closely?😕

 

[KeratinPearls]

Long-time lurker... As I start to apply to residencies and go on interviews, I've noticed that most places I've picked are no where near "8-5" type schedules. I love pathology, I love scope time, and I like to work while I'm in the lab, but the 3rd year of medical school has been a real drain on my family life and I was hoping to overcome that in residency. CP seems pretty reasonable at most places and granted that is half your schedule, but the other side of the coin is the 55-80 hour weeks on surgical path the other 6 months of the year.
I have no problem working 8-9 hour days, but I just start getting worn down on rotations that have heavier work loads. Besides losing energy, I'm most afraid about not having time to read, which is where I tend to excel the most when I have the time. I've really been looking around hard to try to find a place that would be closest to a "normal" job. I don't want to be considered whiney nor a slacker, but I really want to find a place where I can fit in, a place where surgical pathology doesn't completely monopolize half of your year. I love pathology and I can't see myself doing anythng else right now. Any recommendations on places I should be looking at more closely?😕

My program is pretty much 8-5 on all CP rotations; however, you will be working 8-12 hour days on surg path. Autopsy here is pretty much 8-5 if you have one autopsy a day. We have small surgicals here where we sign out biopsies, which can also be 8-5 depending on which attending you are with.

It's definitely possible to find 8-5 programs, but how you find that information is the hard part.

 

[deschutes]

The short answer is: There are programs with 8-to-5 surg path rotations, but I would probably find it difficult to recommend them in good faith if you plan on practising general surgical pathology. 8-to-6 is much more likely. Building up a solid diagnostic surgical pathology foundation is difficult, particularly if you don't have a strong histology background to start with.

I'd venture that if a surg path rotation is 8-to-5, then chances are you're looking at a lower-middle to lower-tier program. And I've pontificated on the effects of that on fellowships and the job hunt previously. If you plan on not living in too desirable a location however, then you can pretty much do whatever you please in residency.

 

[cjakrun]

The short answer is: There are programs with 8-to-5 surg path rotations, but I would probably find it difficult to recommend them in good faith if you plan on practising general surgical pathology. 8-to-6 is much more likely. Building up a solid diagnostic surgical pathology foundation is difficult, particularly if you don't have a strong histology background to start with.

I'd venture that if a surg path rotation is 8-to-5, then chances are you're looking at a lower-middle to lower-tier program. And I've pontificated on the effects of that on fellowships and the job hunt previously. If you plan on not living in too desirable a location however, then you can pretty much do whatever you please in residency.

So sorry to hijack the thread, but how do you find/define high to middle to low tier programs?

 

[moosepatrol77]

The short answer is: There are programs with 8-to-5 surg path rotations, but I would probably find it difficult to recommend them in good faith if you plan on practising general surgical pathology. 8-to-6 is much more likely. Building up a solid diagnostic surgical pathology foundation is difficult, particularly if you don't have a strong histology background to start with.

I'd venture that if a surg path rotation is 8-to-5, then chances are you're looking at a lower-middle to lower-tier program. And I've pontificated on the effects of that on fellowships and the job hunt previously. If you plan on not living in too desirable a location however, then you can pretty much do whatever you please in residency.

I really have no preference as to geography. I'm willing to go wherever I can find a good lifestyle and a place to be happy at. I know if I have "reading time" that I'll have a much higher chance of being a successful pathologist versus burning out. Going to a low-mid tier or a low tier place doesn't scare me in the least. I know I can be a quality pathologist, I just want to take the least painful route in getting there.

 

[Circumflex]

Like everyone has said, it depends on the program, but being good at surgical pathology means developing your skill of looking at slides. While reading is important, looking at slides is essential. It's like learning to play an instrument - you have to practice. At most residencies, it is the previewing of cases for the next day's sign-out that can spill into the evening. If you want to be good, you have to practice. Sometimes it takes more time than a standard 40-hour work week.

 

[moosepatrol77]

Like everyone has said, it depends on the program, but being good at surgical pathology means developing your skill of looking at slides. While reading is important, looking at slides is essential. It's like learning to play an instrument - you have to practice. At most residencies, it is the previewing of cases for the next day's sign-out that can spill into the evening. If you want to be good, you have to practice. Sometimes it takes more time than a standard 40-hour work week.

I agree with you wholeheartedly that practice is extremely important. But, from what I have seen, grossing until 8 and later doest not equal learning. If previewing and grossing quality cases were all that residents did, I wouldn't be posting this. I have seen residents who work at a high efficiency path lab and get slammed and I have seen residents who work at a low efficiency lab and yet still have to stay late. Maybe "efficiency" is more of what I'm looking for. I think an efficient program should be able to get the day's work done within a reasonable amount of time if they have the infrastructure to handle their workload.

 

[fna]

The question is, will you get an 8-5 job? If you are connected (related or close friends with a pathologist who will save a spot for you in their lab), then by all means find a training program where you'll have plenty of time to read during the day till you takeoff at 5pm.

If not, perhaps you should prepare for the unfortunate possibility of working 55-80 hour weeks as a pathologist. There's no better way of building up your energy reserves than working 55-80 hours a week as a trainee.

You might also want to re-consider your assumption that choosing a "low-tier" program will have optimal results. If you think that you've trained at a (in your own opinion) low-tier program, how do you think you'll compare against graduates from (what you see as) high tier programs? You may be paying for your nice lifestyle when it comes time to find a job, and you may even have the opportunity to work zero hours a week for a while.

Also, God forbid you ever need a Whipple, but if you do, would you rather have a self-proclaimed "quality surgeon" who had plenty of time to read at a low-tier surgical program? Or someone who actually does a couple dozen per month?

I'm all for efficiency and family time, but if you need to provide for your family, you'll want to be the best pathologist that you can be. Sadly, that means earning it through hard work, long hours, getting your hands dirty, and pushing lots of glass as a resident.

If the 77 in your username means you were born in 77, then you're on the border of GenY. During these interesting economic times, it might be better to go with the GenX mindset- Life isn't fair and you're entitled to nothing. In other words, prepare for bad times ahead and don't expect a bailout if things don't go your way.

 

[versalog]

but the other side of the coin is the 55-80 hour weeks on surgical path the other 6 months of the year.

It will serve you well in residency to be a little more long-suffering and far-sighted. Rough surgical rotations make CP rotations, with tolerable workhours, a treat like a piece of cake. Funnelling your career options based upon perceived workload sounds like it should have occurred prior to you going to medical school.

I am sorry to be rough, but we have a resident or two with your priorities at my program, and they are neither respected by their peers nor relied upon for good work by their faculty, and that's a detrimental position to occupy in many ways.

 

[deschutes]

Learning is not an efficient process. In any surg path system, given enough PAs, residents are not vital to patient care. Turnaround time is fastest when resident previewing and double-scoping is bypassed, when slides go directly to attendings and get signed out. So the most efficient system would have no resident teaching at all, or would have residents doing grossroom duty as the majority of their service work.

Going to a lower tier place might not scare you now, but it should. The crappier your training is, the more unlikely it is that you'll find a "good lifestyle and a place to be happy at", because that is what everyone is looking for. I've said it before and I'll say it again - in pathology, you either suffer now or suffer later. As fna says, with lousy training, your chances of being unemployed after residency soar.

I've talked about tiers in the FAQs. But that post was made during my first year of residency, and I would want to reword it when I have the time because of what I've learnt.

Connections trump everything else. Therefore the split in programs goes something like:

Top tier:
Has big names. Big names actually teach, know their residents by name and know where they've gone. Big names work hard, and expect residents to work hard. Residents manage cases from start to finish (from grossing to wording reports). Senior residents get to see consult material. In your final year, big names will call around and put you in touch with great fellowships or jobs, because they know the people who run those fellowships or jobs, and they can vouch for your integrity. Hell, people in the community will be calling these programs looking for grads to hire. These programs' entry requirements are also high to begin with (their first-year residents will be rattling off DDx that a mid-tier third-year might never have heard of).

Mid-tier:
Has a handful of big names. Maybe they don't have much contact with residents, maybe there is faculty in-fighting that affects residents. You have to schmooze said big names up on your own. They might write you a letter of recommendation. But chances are they won't be calling around to find opportunities for you. You'll be reading a lot (because scope-teaching is patchy) and making a lot of mistakes before you get on the right track because there's no real mentorship. You'll ask questions, and maybe get laughed at or derided. You'll have to sniff out opportunities on your own. But at least you'll still get to go to USCAP/CAP if you write that abstract and meet the leaders in the field there.

Lowest tier:
No names. No teaching, apart from residents teaching residents. Many IMGs who are not proficient in English. Residents graduate, try to pass boards and fail, can't find jobs and end up becoming research assistants.

Obviously these are step-wise descriptions of what really is a slope.

Each tier will have its own brand of pain, so it's impossible to say which is least painful.

 

[cjakrun]

Obviously these are step-wise descriptions of what really is a slope.

Each tier will have its own brand of pain, so it's impossible to say which is least painful.

I hope it is more of a slope than that steep of a trichotomy. It seems like low tier may be better off not matching. I read what others have said about tiers and obviously the best place is where you can learn. However, beyond the high tier schools which I have seen only 8-10 names listed how do we figure out where the other 150 or so fall? Scutwork has some reviews, but not many.

It is not the fear of work that I have, but the fear of winding up in a place that either I fall to or thought was great on a one day view.

 

[lsuhockeyplayer]

I know this might not be on topic but is there a site which "ranks" the top path programs (high, mid, low tier)?

Sorry ahead of time if this hijacks the thread.

 

[yaah]

I'm curious as to how you think your surgical pathology training will be very effective with minimizing your hours. As said, it is possible, but why? What is your overarching goal? Residency is supposed to be hard, and is supposed to be work. While there are programs for whom the long work hours are spent mostly grossing and doing busywork, that is not true for most quality programs. And despite what many junior residents seem to think, gross pathology is an incredibly vital skill to master - it improves your overall diagnostic abilities a great deal.

Residency is a four year commitment. You have the rest of your life to leave early. It may be a more difficult four years, but it pays off if you take it seriously. If you take it less seriously, your first job will end up being 90+ hours as you struggle to master basic tasks. Even the worst pathology residencies are better than 3rd year of med school when it comes to time commitments, call responsibilities, etc.

 

[KeratinPearls]

I know this might not be on topic but is there a site which "ranks" the top path programs (high, mid, low tier)?

Sorry ahead of time if this hijacks the thread.

There's no such classification bro.

There are programs which are known to be ranked highest tier because it's historically known to be a great program. There are those programs which can be ranked as high or mid based on who you talk to.

 

[yaah]

I know this might not be on topic but is there a site which "ranks" the top path programs (high, mid, low tier)?

No. All rankings are arbitrary and subject to the whims and biases of the ranker, as well as the one who is interpreting the rankings. What defines best? Breadth of specimens? Range of attending experience and expertise? Quality of job or fellowship landed after training? Apparently work hours also? There have been many threads on this forum discussing what makes a good program or a "top" program, but ultimately it comes down to what YOUR goals are and how each program fits into this. This requires more work on your end in evaluating programs and learning about important factors, asking lots of questions, etc. But it is far better to come to your own conclusion than to take whatever random person's biased conclusions as gospel. Not to say you should discount outside opinions, but recognize where they are coming from and whether you should trust it.

 

[lsuhockeyplayer]

No. All rankings are arbitrary and subject to the whims and biases of the ranker, as well as the one who is interpreting the rankings. What defines best? Breadth of specimens? Range of attending experience and expertise? Quality of job or fellowship landed after training? Apparently work hours also? There have been many threads on this forum discussing what makes a good program or a "top" program, but ultimately it comes down to what YOUR goals are and how each program fits into this. This requires more work on your end in evaluating programs and learning about important factors, asking lots of questions, etc. But it is far better to come to your own conclusion than to take whatever random person's biased conclusions as gospel. Not to say you should discount outside opinions, but recognize where they are coming from and whether you should trust it.

Thanks that's kind of what i figured. What is your opinion of the path residencies in Louisiana? LSU-NO or Tulane? I know they are smaller however i think that is what is appealing to me, less people to fight to be able to get microscope time in.

 

[EUA]

I am sorry to be rough, but we have a resident or two with your priorities at my program, and they are neither respected by their peers nor relied upon for good work by their faculty, and that's a detrimental position to occupy in many ways.

Sure enough. I wouldn't be advertising in any way that you are looking for some cruise ship of a residency so you can "spend time with your family". We all have lives outside of the hospital. Part of residency is learning to balance them as best you can.

Also, a big thumbs up to FNA and his comments about Gen-X vs. Gen-Y. This is not the time to be a pansy, because you will get left in the dust. This is the time to turn it up a notch.

 

[deschutes]

I hope it is more of a slope than that steep of a trichotomy.

🙂 It is very much a slope, hence my disclaimer.

Characterizations like these are extremely difficult to write, and vary with context. (And the context in this case was a med student who is perhaps a little too eager about the lower tier of programs without knowing what they might be getting themselves into.) To make it applicable to every individual's circumstance, I'd have to put in all kinds of qualifiers starting with "lower range of top tier" and "upper range of mid-tier" which would be a headache both to write and read. My descriptors were not meant to be a checklist for which all criteria had to be fulfilled - rather I was going for characteristics that I have noticed in each tier. There is a great deal of overlap. But I wanted to put this out there, partly because I suppose I am old, senile and cynical and wanting to reach into the past to my younger self that was looking for help 🙂

Rest assured, for the average American grad, you'll make it into the middle tier without even trying (all those interviews you've previously been on will have trained your perceptive acumen at least somewhat). And like I said in previous posts on outlook, if you want to stay regional or go rural, you don't need the bigwigs. You just need local connections.

Connections matter, but what makes a great connection varies depending on where you want to end up.

 

[MirkoCrocop]

moose, don't listen to these labrats...

today, i worked 0806 to 445 and i'm on a surg-path rotation. i go to a small family-friendly program. the times have changed. you can find all the info you need on the internet/textbooks these days. heck, wikipedia is more useful than their decrepit attendings. and i dont care where you go, at most places you can see slides if you try.

you'll miss out on some job opportunities, yes, if you don't go to harvard (or whatever it is in path), but at least you'll still be married and be a part of your kids' lives.

they're trying to manipulate you into thinking you have to go to some top-tier program in order to get a decent education so they can try and justify their own perverted sense of self-worth, poor decision-making, and failed/lack of relationships!

gotta go... the 5:00 news is on!

good luck.

 

[moosepatrol77]

Sure enough. I wouldn't be advertising in any way that you are looking for some cruise ship of a residency so you can "spend time with your family". We all have lives outside of the hospital. Part of residency is learning to balance them as best you can.

Also, a big thumbs up to FNA and his comments about Gen-X vs. Gen-Y. This is not the time to be a pansy, because you will get left in the dust. This is the time to turn it up a notch.

I'm not interested in being a pansy, but my career goals have been changing lately. I'm not interested in being that concert pianist (although I do admire the talent it takes), I'd rather be the happy guy who plays for tips at the bar. I'm not interested in a giant salary like I used to be, even something under six figures doesn't sound bad right now (I'm sure everyone's jaw just dropped). I know that my goals are drastically different from most of the people's on this forum, but I'm just looking for some place to be happy and fit in like everyone else does. I've been through enough rough patches in my life that I've decided that I need to make the "good life" happen now and not wait for some delayed gratification that may or may not come some day. I'v realized after a third child that my family is becoming an increasing portion of my life and not one I want to neglect for four years. They mean too much. Again, I'm looking for a quality program that fits my needs, not a "cruise ship."

I'm sure hours sound like everything for measuring the intensity and quality of a "good" pathology program, but I don't believe you have to dog yourself for 80 hours a week in order to learn effectively. Even though surgery residents worked 120 hours a week back in the day, I don't believe the new surgeons are becoming any less qualified. I think the same analogy could be extended to pathology. You shouldn't have to work 80 hours per week necessarily to become a competent, qualified, board certified pathologist.

 

[Psychopathology]

I'd be scared of an 8 to 5 pathology residency.

Including fellowship, you only have about 5 or 6 years remaining before people get the funny impression that you're an attending. That's pretty frightening. Scares the hell out of me.

Sign me up for some learnin'.

Then again, I value my relationships outside of work and take care of myself. I'd hate to be chronically sleep deprived and stressed-out. Some programs have garnered this sort of reputation, but these programs are also among the more prestigious names and tend to attract hard workers who would love more than anything to scare off slackers. Hell, I'll be saying the same thing about my program, wherever I match: Yep, it's a wonderful program. No regrets. Glad you're interested and I hope you enjoy working 🙂

Camaraderie, a good location, vacation time, fair rotation scheduling, and helpful relationships between faculty and staff can allay some of the inevitable hardships of even the roughest, most demanding surge path rotation at Mount Saint Uptight Hospital. I'm going to put a lot of stock into the interviews that I am fortunate to be receiving. I've applied to a buncha programs that are reputedly competitive and demanding. I hope to match at the place that is a best fit for my personality... even if the sun sets before I finish previewing.

 

[yaah]

they're trying to manipulate you into thinking you have to go to some top-tier program in order to get a decent education so they can try and justify their own perverted sense of self-worth, poor decision-making, and failed/lack of relationships!

Um, yeah, that's exactly right. 🙄

There are some people who can go to a smaller program, read voraciously, show lots of curiosity and aptitude, and come out of training with more knowledge and skill than others at top programs. Much of training comes from what you put into it. But the simple fact is that at larger programs you have more opportunities and breadth of education, type of specimens, teachers, all that. You're creating a false dichotomy which implies that going to a top program means you are sacrificing personal life. Not true. There are gradations with everything. I had very long days on surg path (14-16hrs) but these were rare in comparison to 10 hour days. I have a very nice life with lots of free time and have had dinner with my wife every night since we have been married, except the ones I was on call.

I don't think anyone was suggesting you have to go to a top tier program to get a good education. What was said is that this will provide you more opportunities, and that sacrificing things you want out of a program in order to serve some preconceived notions about how it will improve your time away from work is probably something you need to seriously think about.

It is definitely true that there are small programs out there who do an excellent job of training pathologists, but there are a lot more who do not. And to discount the positive impact on one's career of quality faculty mentors and teachers is extremely questionable.

 

[Pianoboe01]

Check out Ball Memorial in Muncie, IN. Community program with nice hours and excellent fellowship placement. Few IMGs. http://ballhospital.org/

 

[deschutes]

I was thinking about this thread over sushi. (mmm.. sushi..) How's this for some practical advice:

If you are looking for a solid mid-tier program,

(1) Sit down with your partner, and make a list of locations where you can see yourself living long-term.
(2) Apply to the residency programs in those areas (state schools are usually pretty safe), particularly those which have rotations at VAs.
(3) While residency may not always be 8-5 (more like 8-6), if you impress the VA folks, then you stand a good chance of getting hired there. Hours are 8-5 for the most part (you could negotiate for a 0.6 position), a pension, 401k, plus all the random VA holidays (like Columbus Day!)

 

[deleted57552]

This thread is hilarious. Some of you are missing the point.

Whether you go to an elite program or not, it is up to you as to what hours you put into your work during your residency.

People seemed misinformed that the residency program provides some kind of absolute structure that dictates what kind of hours one will work.

Yes, there are some programs where the individual will not be "forced" to work as much (whether it be because of low volume, etc) but some people in that environment will work hard and supplement their education by reading. Fine. More power to them.

Then, there are these "top tier" programs, on the other hand, that will "force" people to work ridiculous hours perhaps against their will. These trainees will have cases crammed down their throats whether they like it or not and they will learn from it.

Whatever the case may be, the residency program YOU choose to dedicate the next 4-5 years of your life is what YOU make of it.

LMAO.

I trained at one of these so called "top tier" residency programs. We had a mix of folks. Many people worked 14-16 hour days. Others worked much shorter, predictable days and also got far by sucking a lot of dick...and not taking their education as seriously as their peers. But these are the people who I would never trust and will likely be sued within the next 5 years because they are so concerned about leaving work by 5 pm everyday...karma will bite them in the ass for sure and I have absolutely no sympathy for these people.

I don't care what kind of residency program you decide to join but take your learning seriously because in the end, that's all that matters. Whether you go to a program that enforces long hours vs. predictable hours is superficial to the big picture at hand...that is how you, as a pathologist, can best serve your patients and the clinicians that treat these patients.

 

[KeratinPearls]

This thread is hilarious. Some of you are missing the point.

Whether you go to an elite program or not, it is up to you as to what hours you put into your work during your residency.

People seemed misinformed that the residency program provides some kind of absolute structure that dictates what kind of hours one will work.

Yes, there are some programs where the individual will not be "forced" to work as much (whether it be because of low volume, etc) but some people in that environment will work hard and supplement their education by reading. Fine. More power to them.

Then, there are these "top tier" programs, on the other hand, that will "force" people to work ridiculous hours perhaps against their will. These trainees will have cases crammed down their throats whether they like it or not and they will learn from it.

Whatever the case may be, the residency program YOU choose to dedicate the next 4-5 years of your life is what YOU make of it.

LMAO.

I trained at one of these so called "top tier" residency programs. We had a mix of folks. Many people worked 14-16 hour days. Others worked much shorter, predictable days and also got far by sucking a lot of dick...and not taking their education as seriously as their peers. But these are the people who I would never trust and will likely be sued within the next 5 years because they are so concerned about leaving work by 5 pm everyday...karma will bite them in the ass for sure and I have absolutely no sympathy for these people.

I don't care what kind of residency program you decide to join but take your learning seriously because in the end, that's all that matters. Whether you go to a program that enforces long hours vs. predictable hours is superficial to the big picture at hand...that is how you, as a pathologist, can best serve your patients and the clinicians that treat these patients.

Wow. This is what I was thinking as well. Your program may not be top tier, but I think if you have the volume, you can def be a very good pathologist depending on how much work you put into it.

 

[LADoc00]

Im going to go ahead and render my opinion on this.

Are there AP path programs with 40 hours or less work weeks? YES. Absolutely.

Are these good programs? YES.

Again I would have liked not to believe my 100+ hour work weeks were in vain..but frankly 40 hour weeks + lots of reading time is flat out superior.

 

[KeratinPearls]

i think a plus with the top tier programs is that you can ask experts about cases. No BS. However, the same information could be sought by pulling out books like LA said and do your reading and correlate cases with pictures. Also, these "experts" may be too busy with research to actually teach or some just don't like to teach (I'm not sure how often this happens).

The smaller programs also may not have as much variety as the bigger programs, but you'd prob see enough bread and butter cases to be more than competent.

 

[DW]

Depends on how you define "working". I include reading at the hospital and spending extra time looking articles in how much I work (often here 12+ hours), but if I just wanted to get my work done and survive, it would be about 40 hours, sometimes even less. I think how much and what you gross is an important fact to consider. We have great PA support so I rarely gross BS specimens. I know you need to know how to gross, but if you're 8 months into surg path and you're staying late to gross because of gallbladders, appendices, and your 4th fibroid uterus and 6th LEEP of the day, I think you've hit diminishing returns.
Most people would agree you will suck at path if you don't study considerably on top of just getting the bare minimum done. I think whether you go to a program with huge volume and little time to read versus smaller volume and a lot of time to read is a matter of personal preference. I personally feel that the volume of specimens is significantly less important than A) how good your attendings are/aren't and B) how good your educational curriculum is/isn't, but thats just me.

 

[moosepatrol77]

Anyone willing to PM me with places that might fit what I'm looking for in a residency? I've gone on two interviews so far and they definitely weren't places I would want to end up. It makes me really wonder about the interview list I have now...

 

[Ale]

Anyone willing to PM me with places that might fit what I'm looking for in a residency? I've gone on two interviews so far and they definitely weren't places I would want to end up. It makes me really wonder about the interview list I have now...

I can not tell you where to apply, but I can tell you where to not to apply. If you don’t want to work a lot, stay away from big cities and you should be OK. Make sure the place has a PA. Also, know what scut means in pathology. (Specimen transport, accessioning, counting blocks, filing slides, slide retrieval, setting the machines in the evening, calling the physicians to fix mistakes in the requisition, etc). All that scutwork is what makes some of these programs an 80 hr week thing. It takes hours to file cases or count the blocks at the end of the day, been there done that. Ask bluntly, don't be timid.

The other thing is be careful of programs in which you S/O in the morning and have to gross in the afternoon. What happens when your attending shows up at 10 am? Ask the residents how strict they are at starting their 8:00 am S/O. If they are wishy washy with their answer walk away.

Generally speaking, anything under ~80 cases per day should be manageable (20K cases/year; as long as it’s GENERAL surgical pathology). Otherwise ,volume in a program doesn’t mean much. Imagine a program that has surgeons that only do hernias and cholecystectomies. You could get 200 cases a day and be fine. On the other hand, if the hospital has surgeons that only do pelvic exenterations and laryngectomies, you are going to be there very very late. Even the days you get only 20 cases. Now, add to all that work the specimen accessioning and trying to find who wrote what in the accession sheet... Get the point.

As for big names and finding jobs, you won’t find jobs where there are none, no matter where you go for a residency. Most likely what will happen at the end of your four years is you are going to take a crappy job in the city you want to live in or relocate your family to the middle of nowhere. Push comes to shove you stay in your program as an instructor (<100K a year), get yelled more than a surgery intern and leave after you have the ">3 years experience".

 

[yaah]

Bear in mind that at a lot of programs with "heavy" work hours, experience and efficiency on your part will drastically decrease this. We have this problem at our program - some residents cannot get work done in a reasonable amount of time. They may say or think that they are being "more thorough" than others, but that's often crap (although it may be true, depending on who they are comparing themselves to). By the end of my 2nd year I was done with my duties generally by 4 or 5pm every day, although sometimes late work came in and had to stay later. But I tried to make my days efficient. Many people skip conference, arrive just in time for signout, spend 2 hours in the afternoon shopping for shoes on the web, and then take an hour break to have a donut with another person. Of course they are going to stay until 8pm. Amazingly, services that maintain a constant steady volume will be "manageable" and have the resident out by 6pm and then the next week when the residents switch rotations it suddenly becomes unmanageable.

While work level and work hours vary from program to program, do not forget the crucial fact that work hours vary dramatically from resident to resident. Going to a busy program allows you to work on your own efficiency. I am not an advocate for quiet, non-busy programs. I know others are, I have seen both in action and there is simply no comparison from my perspective - book learning does not replace actual on the job learning, it supplements it.

 

[fna]

moose, don't listen to these labrats...

today, i worked 0806 to 445 and i'm on a surg-path rotation. i go to a small family-friendly program. the times have changed. you can find all the info you need on the internet/textbooks these days. heck, wikipedia is more useful than their decrepit attendings. and i dont care where you go, at most places you can see slides if you try.

you'll miss out on some job opportunities, yes, if you don't go to harvard (or whatever it is in path), but at least you'll still be married and be a part of your kids' lives.

they're trying to manipulate you into thinking you have to go to some top-tier program in order to get a decent education so they can try and justify their own perverted sense of self-worth, poor decision-making, and failed/lack of relationships!

gotta go... the 5:00 news is on!

good luck.

Textbooks and the internet provide more education than your "decrepit" attendings? Family-friendly program? Let me login to the interweb and Google into your soul... ahh, here it is: http://money.cnn.com/magazines/fortune/fortune_archive/2007/05/28/100033934/

Anyway, someday you might realize that picture matching is a diagnostic technique that in the wrong hands has low specificity and reproducibility. Hopefully that occurs before you have actual signout responsibilities. My advice: before you diagnose anything that you weren't trained to diagnose, close your book and just FedEx the entire case to a top-tier program. It'll be good for you and your patient.

Back to Moosepatrol:
Like I said, I'm all for maximizing family time, but if your confidence outweighs your competence you will eventually hurt your patients. If your responsibility to your patients is not enough of an incentive for you to err on the side of over-training, then consider the possibility that you get sued for a legitimate mistake and lose. Or maybe it isn't even a clinically significant mistake, but your employers and customers (clinicians) no longer trust you. Maybe you'll lose your job and can't find anyone willing to hire you. If your family situation is tough now, will it be better or worse if you are unemployable in the field you spent 4+ years training for? (Yes, this has happened)

Now if your family is truly going to fall apart if you have to work more than 45 hours a week, you should consider working in a lab or something until things stabilize a bit. Or maybe pick a different specialty- I hear PM&R is pretty cush, and you won't have to worry about missing/overcalling cancer. If you insist on pathology, I agree that the VA is a good goal. Alternatively, become a PA- salary meets your 5 digit criteria (in some parts of the country 6), limited hours, limited legal exposure.

And remember, this recession will not be pretty. Retirements may be delayed, fellowships may be a refuge for the unhired, and by the time you're out, multiple "fellowships" may be the norm (again). Just something to keep in mind.

Good luck balancing your short term and long term goals.
http://www.youtube.com/watch?v=1SBC1Aga1xk

 

[LADoc00]

8-5ers off the top of my head and my list might not be as current anymore:
UC Davis/Irvine and maybe San Diego
Loma Linda
Creighton
SLU
UColorado
UNebraska
UKansas
Iowa
Arkansas
most places in Ol' Miss.
Dartmouth
Kaiser residencies, if any are left
VA programs throughout the country
Military residencies
etc.

 

[LADoc00]

Textbooks and the internet provide more education than your "decrepit" attendings? Family-friendly program?
Good luck balancing your short term and long term goals.
http://www.youtube.com/watch?v=1SBC1Aga1xk

Um yeah, Im sorry there is ZERO, NONE as in absolutely flipping nothing to support a connection between the number of hours residents work doing scut and their competence as a practicing pathologist.
read the above again.

I would challenge you to find one single supporting study to back up this claim as my extensive anecdotal experiences find this often laid out fallacy to be complete CRAP. And this is coming from a guy who slept regularly in the space underneath his desk while on surg path rotations.

 

[cjakrun]

8-5ers off the top of my head and my list might not be as current anymore:
UC Davis/Irvine and maybe San Diego
Loma Linda
Creighton
SLU
UColorado
UNebraska
UKansas
Iowa
Arkansas
most places in Ol' Miss.
Dartmouth
Kaiser residencies, if any are left
VA programs throughout the country
Military residencies
etc.

Anyone have a list of places to with excessive and unnecessary scut?

 

[deschutes]

Make sure the place has a PA.

...who doesn't spend five hours per workday on Gmail chat/smoke breaks/yelling at residents. Or who takes the day off without warning several times a month.

 

[fna]

Um yeah, Im sorry there is ZERO, NONE as in absolutely flipping nothing to support a connection between the number of hours residents work doing scut and their competence as a practicing pathologist.
read the above again.

I would challenge you to find one single supporting study to back up this claim as my extensive anecdotal experiences find this often laid out fallacy to be complete CRAP. And this is coming from a guy who slept regularly in the space underneath his desk while on surg path rotations.

As Obama would say, LaDoc is absolutely right.

Scut does not lead to competence. Scut is routine menial work, and menial refers to work "appropriate for a servant". If you run your own practice or are a tenured professor, anything related to the practice of pathology can be called scut since you can find someone else to do the work.

But most of us aren't in that position and never will be. Is grossing your 50th fibroid scut? It may not be high-yield but since many community practice pathologists gross larges, I wouldn't call it scut. Is grossing your 50th biopsy scut? I'd say yes, since biopsies are often grossed by a tech. How about cutting frozens? Doing more than your required 50 autopsies? Proof reading gross dictations? Pulling slides? Calling clinicians for more history? Giving tumor board? Tracking down missing slides?

Lots of tasks aren't educational as in book-learning, but they are the same exact responsibilities that many staff pathologists have. It may look like scut now, but unless you actually have a "servant" who can do it for you, guess what- it's your job. In reality, the proportion of time you spend on things that look like scut should greatly decrease when you're legit. But if your lab is short-staffed or when everyone else has left for the day you get to play resident again.

By the way, I'd say 90% of my time on surg path, even during my 80 hour weeks, was spent on the same tasks that I do at my job now. So no, compared to someone at a 40 hour program, it was not an extra 40 hours of scut, a lot of it was book-type learning. No research is needed, it's just common sense. Practice doesn't guarantee perfection, but it should increase your chance of success.

 

[gungho]

8-5ers off the top of my head and my list might not be as current anymore:
UC Davis/Irvine and maybe San Diego
Loma Linda
Creighton
SLU
UColorado
UNebraska
UKansas
Iowa
Arkansas
most places in Ol' Miss.
Dartmouth
Kaiser residencies, if any are left
VA programs throughout the country
Military residencies
etc.

how do you know this info?

 

[EUA]

As Obama would say, LaDoc is absolutely right.

Scut does not lead to competence. Scut is routine menial work, and menial refers to work "appropriate for a servant". If you run your own practice or are a tenured professor, anything related to the practice of pathology can be called scut since you can find someone else to do the work.

But most of us aren't in that position and never will be. Is grossing your 50th fibroid scut? It may not be high-yield but since many community practice pathologists gross larges, I wouldn't call it scut. Is grossing your 50th biopsy scut? I'd say yes, since biopsies are often grossed by a tech. How about cutting frozens? Doing more than your required 50 autopsies? Proof reading gross dictations? Pulling slides? Calling clinicians for more history? Giving tumor board? Tracking down missing slides?

Lots of tasks aren't educational as in book-learning, but they are the same exact responsibilities that many staff pathologists have. It may look like scut now, but unless you actually have a "servant" who can do it for you, guess what- it's your job. In reality, the proportion of time you spend on things that look like scut should greatly decrease when you're legit. But if your lab is short-staffed or when everyone else has left for the day you get to play resident again.

By the way, I'd say 90% of my time on surg path, even during my 80 hour weeks, was spent on the same tasks that I do at my job now. So no, compared to someone at a 40 hour program, it was not an extra 40 hours of scut, a lot of it was book-type learning. No research is needed, it's just common sense. Practice doesn't guarantee perfection, but it should increase your chance of success.

Yes... very true. I think it's the "I'm above this menial B.S." prima donna attitude that I find amusing, because much of it is what your "real" job is going to entail in the future. It's part of this pervasive attitude I am seeing from residents that says "I don't want to work hard and I shouldn't have to". Hearing someone say flat out that they want an 8-5 residency is part of it.

I DO NOT discount the importance of balancing work and family/personal life. However, if there is one time where you spend more time on work, it should be during residency, which is your time to learn (and get paid to do so) and have a 24/7 safety net underneath you. To do otherwise is a disservice to your own education, and thus, your future patients.

 

[LADoc00]

how do you know this info?

God. or depending on where you are in the world, Allah.

 

[green mantis]

8-5ers off the top of my head and my list might not be as current anymore:
UC Davis/Irvine and maybe San Diego
Loma Linda
Creighton
SLU
UColorado
UNebraska
UKansas
Iowa
Arkansas
most places in Ol' Miss.
Dartmouth
Kaiser residencies, if any are left
VA programs throughout the country
Military residencies
etc.

UCI wasn't 8-5; it was closer to 7:30-5:30. These hours held true for CP rotations & grossing rotations (VA & private hospital) away from the university medical center.

I think someone mentioned these points earlier, but I'd just like to reiterate.

1) What's not an 8-5 rotation when you're a 1st year may be one when you're 3rd or 4th year. You should be getting better & faster as you gain experience.

2) Just because you have a long day doesn't necessarily mean you're always working, whether it be by choice or not. One of my co-residents took numerous breaks while grossing, so she always wound up staying late. She was single & didn't have anyone to go home to, so she didn't mind. If you want to go home & have dinner w/ your wife & kids, you just have to be more efficient.


----- Antony

 

[path28]

Moosepatrol77 - don't lose heart based on some of the replies. For those trying to make the argument that wanting family friendly hours = laziness, incompetance, etc. that is ridiculous. Putting in more hours does not always correlate to being a better pathology resident or pathologist. There are so many factors that can come into play such as:

1) Efficiency. I have 2 kids, a busy working spouse who is also a doctor with unpredictable hours. I can pretend all day long that I don't care about hours but the daycare closes at a certain time, and one of us has to pick the kids up by that time. Therefore I make myself as efficient as possible at work - when other residents are taking coffee breaks, checking email or taking time for lunch, I don't take any breaks, I work through lunch, I stay off the internet, I minimize socializing. If I have down time I use it to read. That has worked very well so far for me - on my current rotation I was told by other residents that they were leaving at 6 or 6:30 pm, sometimes 10 pm. I have left every day at 4:45 pm. I go home, put the kids to bed at 7 pm, then read from 7-10 pm rather than staying at work to read.

2) Inherent intelligence, deductive abilities, memorization skills. Genetics matters. There are some people who have to work 10 times harder to learn something than others. Just to use my husband as an example - he has a photographic memory and also can understand complex concepts quickly - he'll read a textbook once and can quote verbatim from page 452. His fellow residents were more than annoyed when he would study 1 month for a test that they studied an entire year for, and yet kill them score-wise. So just because resident Joe Schmoe says he is working & reading every waking hour of his life doesn't mean you'll have to do so to attain the same level of competence. Be honest about your own abilities. At the same time - don't get caught leaving early when you're supposed to stay late. Some rotations you'll have a set amount of work to do, others the hours are unpredictable and you have to stay until it's done. Use the down time to read.

3) Learning style. It is well documented that different people have different learning styles. Some are visual learners, some do best by reading, some learn from lectures. I have personally seen how 1 resident can visually see a certain case only a couple times, and easily recognize it the third time, whereas a different resident has to see the case 10 times before it visually finally clicks for them. Again just know your strengths and weaknesses and that may dictate where you need to focus more of your time learning than others. Maybe you'll be someone who has to spend evenings looking at slides to reinforce, or maybe the volume at the place you're at will be sufficient. If you're honest with yourself you should know whether you're "getting it" or not.

Bottom line is - don't let people make you feel bad for wanting to balance family & work and don't buy into the line that you have to just "suck it up" during residency and work crazy hours. Besides I think a lot of times residents like to get into the whole "I'm working harder than you" competition and stay late so they can complain about it the next day. Stay out of that race, focus on your learning and you'll be fine. Good luck!

 

[KeratinPearls]

Moosepatrol77 - don't lose heart based on some of the replies. For those trying to make the argument that wanting family friendly hours = laziness, incompetance, etc. that is ridiculous. Putting in more hours does not always correlate to being a better pathology resident or pathologist. There are so many factors that can come into play such as:

1) Efficiency. I have 2 kids, a busy working spouse who is also a doctor with unpredictable hours. I can pretend all day long that I don't care about hours but the daycare closes at a certain time, and one of us has to pick the kids up by that time. Therefore I make myself as efficient as possible at work - when other residents are taking coffee breaks, checking email or taking time for lunch, I don't take any breaks, I work through lunch, I stay off the internet, I minimize socializing. If I have down time I use it to read. That has worked very well so far for me - on my current rotation I was told by other residents that they were leaving at 6 or 6:30 pm, sometimes 10 pm. I have left every day at 4:45 pm. I go home, put the kids to bed at 7 pm, then read from 7-10 pm rather than staying at work to read.

2) Inherent intelligence, deductive abilities, memorization skills. Genetics matters. There are some people who have to work 10 times harder to learn something than others. Just to use my husband as an example - he has a photographic memory and also can understand complex concepts quickly - he'll read a textbook once and can quote verbatim from page 452. His fellow residents were more than annoyed when he would study 1 month for a test that they studied an entire year for, and yet kill them score-wise. So just because resident Joe Schmoe says he is working & reading every waking hour of his life doesn't mean you'll have to do so to attain the same level of competence. Be honest about your own abilities. At the same time - don't get caught leaving early when you're supposed to stay late. Some rotations you'll have a set amount of work to do, others the hours are unpredictable and you have to stay until it's done. Use the down time to read.

3) Learning style. It is well documented that different people have different learning styles. Some are visual learners, some do best by reading, some learn from lectures. I have personally seen how 1 resident can visually see a certain case only a couple times, and easily recognize it the third time, whereas a different resident has to see the case 10 times before it visually finally clicks for them. Again just know your strengths and weaknesses and that may dictate where you need to focus more of your time learning than others. Maybe you'll be someone who has to spend evenings looking at slides to reinforce, or maybe the volume at the place you're at will be sufficient. If you're honest with yourself you should know whether you're "getting it" or not.

Bottom line is - don't let people make you feel bad for wanting to balance family & work and don't buy into the line that you have to just "suck it up" during residency and work crazy hours. Besides I think a lot of times residents like to get into the whole "I'm working harder than you" competition and stay late so they can complain about it the next day. Stay out of that race, focus on your learning and you'll be fine. Good luck!

I wish I was like your husband. Life would be A LOT easier. I know these types...they are so laid back cause they don't have to study as much as ppl like me, who study all day and everyday (seems like it)!

 

[zao275]

The Houston programs (Methodist, Baylor, and UT Houston) all have fairly reasonable hours from my experience. I am very happy at Methodist. We work hard and have fun doing it, but our program is very focused on our education and on balancing work with family. Surgpath days are longer of course, but usually 8-6 or so, with occasional days maybe until 7 or so. But we have 5 PA's which is awesome, and they are incredible at teaching grossing. Numerous experts in pathology are in our department, all of which are incredibly nice and very accessible, and they know the residents on a first name basis (ie - they are not stuffy or condescending....all of the residents love our attendings). Anyway, I don't get paid to promote Methodist (all though I should try to arrange for that!), but I am truly happy there and I feel our training is excellent (our fellows who trained elsewhere repeatedly corroborate this). However, I have also spent a month at both UT Houston and Baylor, and I think they are both great programs. The Texas Medical Center is an amazing place to train with so many institutions being right across the street from each other, and we have joint conferences (as well as happy hours) with residents from both of the other programs. Houston is a very nice place to live (I grew up in Ohio and Florida, for perspective), and it is cheap. Really cheap if you are from the NorthEast or CA. Have I convinced you yet?

Bottom line about work hours...work hard when you are at work and then go home and have a life. Nothing is wrong with that. Being lazy is not good (I speak to myself here too), but I have at times chosen to do extra projects and gotten overwhelmed with that, and it can consume you. So balance is the idea here. You can't just work. I have done that at times by choice and as much as I love my job and specialty, it's still not worth it if I lose everything in my life other than work. Other reasonable minds may differ on this, but that is my take.

Jerad
PGY-3

 

[fna]

UCI wasn't 8-5; it was closer to 7:30-5:30. These hours held true for CP rotations & grossing rotations (VA & private hospital) away from the university medical center.

I think someone mentioned these points earlier, but I'd just like to reiterate.

1) What's not an 8-5 rotation when you're a 1st year may be one when you're 3rd or 4th year. You should be getting better & faster as you gain experience.

2) Just because you have a long day doesn't necessarily mean you're always working, whether it be by choice or not. One of my co-residents took numerous breaks while grossing, so she always wound up staying late. She was single & didn't have anyone to go home to, so she didn't mind. If you want to go home & have dinner w/ your wife & kids, you just have to be more efficient.


----- Antony

Just curious Antony, what's the surg path volume at UCI?

Another thought- there are trainees and attendings who leave work at a reasonable hour, like 4pm, to spend the evening with their families, attend the kid's soccer game, etc. But when the kids are asleep, they go back to work (real work not reading) until they're done. So, 8am-4pm, 10pm-? am. The acgme would frown upon this if you are a resident or acgme-fellow.

 

[green mantis]

Just curious Antony, what's the surg path volume at UCI?

UCI is composed of 3 hospitals. Here's the approximate surgical pathology volume at each, which includes routines & biopsies.

1) UCI Medical Center - 12K
2) Long Beach VA - 6K
3) Long Beach Memorial - 20K+

By far, the university medical center had the most complicated cases, though the same surgeons also operated at the VA. Aside from #3, residents grossed all of the specimens.


----- Antony

 

[fna]

UCI is composed of 3 hospitals. Here's the approximate surgical pathology volume at each, which includes routines & biopsies.

1) UCI Medical Center - 12K
2) Long Beach VA - 6K
3) Long Beach Memorial - 20K+

By far, the university medical center had the most complicated cases, though the same surgeons also operated at the VA. Aside from #3, residents grossed all of the specimens.


----- Antony

Thanks for satisfying my curiosity.

And now, to summarize this thread with three youtube videos:

1. What is your profession? http://www.youtube.com/watch?v=IReMfvamQ28

2. Some people really need it. http://www.youtube.com/watch?v=RzGCnNvurwo

3. Doesn't make a difference if we make it or not. http://www.youtube.com/watch?v=aEvTOdqqVD4

Actually #2 might have been from a different thread.

 

[listeriaismfb]

Yes they do exist. Look to places with minimal scut to save time without sacrificing quality.

By the way, just because you leave at 5 doesn't mean your work is done. There may be stuff that comes home with you, like writing or presentations. Suck it up, because it can & will happen when you're a "grown-up" too.

 

[88Keys]

Long-time lurker... As I start to apply to residencies and go on interviews, I've noticed that most places I've picked are no where near "8-5" type schedules. I love pathology, I love scope time, and I like to work while I'm in the lab, but the 3rd year of medical school has been a real drain on my family life and I was hoping to overcome that in residency. CP seems pretty reasonable at most places and granted that is half your schedule, but the other side of the coin is the 55-80 hour weeks on surgical path the other 6 months of the year.
I have no problem working 8-9 hour days, but I just start getting worn down on rotations that have heavier work loads. Besides losing energy, I'm most afraid about not having time to read, which is where I tend to excel the most when I have the time. I've really been looking around hard to try to find a place that would be closest to a "normal" job. I don't want to be considered whiney nor a slacker, but I really want to find a place where I can fit in, a place where surgical pathology doesn't completely monopolize half of your year. I love pathology and I can't see myself doing anythng else right now. Any recommendations on places I should be looking at more closely?😕

No problem. You may just have to pick different places, probably your criteria eliminates about half the available resident positions (harder programs tend to have more residents) but that said, path residency is nothing like 3rd year of medical school. I find my 11-hour surgpath days quite enjoyable, even refreshing and would not trade them for a 7-hour day of third year medschool 🙂