Doom and gloom?

[cozmopak]

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I love pathology; I did a year long student fellowship in the pathology department. Reading this forum, though, has started pushing me more in the direction of radiology. Is it really that bad in path?

 

[KeratinPearls]

I love pathology; I did a year long student fellowship in the pathology department. Reading this forum, though, has started pushing me more in the direction of radiology. Is it really that bad in path?

Do whatever makes you happy and where your true interests lie. Radiology reimbursements will be cut in the near future, along with cardiology, to decrease the gap between different specialties and primary care.

The two fields really are different. You can do well in pathology if you are truly enthusiastic about the field.

Radiology has better pay and the job market is much stronger at this moment.

 

[yaah]

I love pathology; I did a year long student fellowship in the pathology department. Reading this forum, though, has started pushing me more in the direction of radiology. Is it really that bad in path?

I suggest you read all the posts and not just the ones that are negative. I would also advise you to not base your career decisions on the rantings of anonymous internet posters. I'm sure you'll find plenty of doom and gloom in radiology too, given that radiology is the major target for reimbursement cuts.

 

[v112233s]

I assume OP has genuine interest in both rad/path and hence the debate between the two. Of course always pick the one you love more....

Radiology reimbursements will likely be cut, but even with a cut of 20-30%, radiologists will likely still have a high income and more stable job market. Also, rad training 4 yrs vs path 4+fellowship. I briefly browsed through the radiology forum, I don't get the same sense of ranting about no good jobs there, though.

The interesting catch is this... A pathology attending told me after tumor board that if he were to do residency again, he would pick radiology ?!!!
Of course that might just be his personal interest, I just have a hunch that income disparity (even within academic institution) might play a factor.

 

[Kitra101]

Fyi radiology is a tran§itional or prelim year plus 4 year residency plus a fellowship (just as important in path). Therefore the training is longer by a year in rads, you have a prelim year and you are an even bigger target in med reform than path. That's what makes this decision so uncertain because both fields are so unstable right now. The reality is that because obama has pitted pcps against specialists in a time when he and the politicians are leading a witchhunt on docs, we stand divided to fall. If pcps think that he will not make incentives to replace them with nps and pas they are crazy. This is all about money and while they may take a raise at the expense of specialists, when it comes down to it, if a study shows equal quality between pcps and nps or pas, the day of the pcp will be no more.

 

[yaah]

You should always pick what you want to do and not base it on trends in the job market. Radiology was a bad job market as recently as 15 years ago (I think about 15 years). At the time, people were doing multiple fellowships. Now 15 years later everyone is so sure it will be the same in another 15 years? Of course, in radiology, they reduced the number of training spots in anticipation of a worsening job market (whereas in pathology programs seemingly continue to expand). There is no abstract available on this article here but if you read it it refers to a "tight" job market in 1995, with "fellowships considered essential." So, things are cyclical. There were a lot of things, however, that would have predicted the radiology job market explosion a few years later, that don't seem to exist in pathology now.

 

[v112233s]

my fault.... thought radiology training is just 4 years. I am personally not interested in radiology so didn't look into it closely.

My question is: How come radiology was able to cut their training slots in anticipation of a poor job market, but pathology can't? Why are the leaders advocating for more training slots in their programs? This is quite disappointing...

 

[Torsed]

I wouldn't change specialities for the world or everything in it. Pathology is always challenging and always markedly interesting. I enjoy going to work everyday and the hours have to be the best kept secret in medicine. My pal in radiology says 1/3 of his boards is straight up physics, I wouldn't have hacked that, make sure you know whats gonna be required of the field before you jump into it, if you can't pass either pathology or radiology boards there is always family medicine residency in BFE.😍

 

[2121115]

My question is: How come radiology was able to cut their training slots in anticipation of a poor job market, but pathology can't? Why are the leaders advocating for more training slots in their programs? This is quite disappointing...

I was having a similar discussion with an attending at my program recently...

Here is the issue. There are a handful of pathology programs in America that *train* residents. In other words, they kick your ass and expect you to be good, and if you are not good they will keep kicking your ass until you become competent. They expect you to function in 3rd/4th year like a senior resident in another specialty (i.e. internal medicine 3rd year runs the ward with minimal input from the attending, etc). By contrast, there are A LOT of pathology programs in America that have very low expectations of residents and many, many of their trainees slip through the cracks. At these programs there may be an occasional resident that is an overachiever, but that is the exception. The programs that fall into the former group should probably train a few more residents, while those programs in the latter group should probably be shut down completely. The real problem is that many programs in the latter group consider themselves to be in the former group.

 

[cozmopak]

There are a handful of pathology programs in America that *train* residents. QUOTE]

Which programs are those?

 

[Notsoanon]

QUOTE: "There are a handful of pathology programs in America that *train* residents."

"Which programs are those?"

The University of Utah and I heard one of the Boston programs too. I don't remember which one.

 

[2121115]

There are a handful of pathology programs in America that *train* residents. QUOTE]

Which programs are those?

Of course I am not going to name programs. If you go around on a few residency interviews and ask a few appropriate questions of practicing pathologists it shouldn't be too hard to figure out though. Just ask a few "where are they now" type questions.

 

[Sulfinator]

You should always pick what you want to do and not base it on trends in the job market.

After reading several of yaah's posts, you get the feeling that he is dispensing good advice (or at least I get that feeling). I think he's right on this one.

 

[exPCM]

You should always pick what you want to do and not base it on trends in the job market.

Now I frankly must disagree with this statement.
If you were living in the 1950's as transistors were replacing vacuum tubes would you advise someone to become a vacuum tube engineer if they loved it regardless of job market trends?

Would you advise someone to become a meter reader if they loved it even though these jobs are going away as the ability to read meters remotely multiplies?

Would you advise someone to become a medical transcriptionist if they love it even though voice recognition software is becoming more widespread?

Would you advise someone to go into nuclear medicine which has been decimated as V-Q scans have fallen out of favor and the job market for straight nuclear medicine docs is practically non-existent as radiologists are reading many nuc scans?

Syphilis is a complex systemic illness with protean clinical manifestations caused by the spirochete Treponema pallidum. It holds a special place in the history of Western medicine because of its earlier prevalence and its variable clinical presentations, for which it earned the epigram "the great imitator" or "the great impostor." The first medical specialists treating this disease were called syphiliologists and they established special clinics. In addition, one of the first specialized medical journals appeared, the American Journal of Syphilis, Gonorrhea and Venereal Disease http://www.mdconsult.com/das/book/body/149159662-2/0/1259/1890.html
Would you advise someone to specialize in treating only syphilis patients today?

 

[Sulfinator]

Now I frankly must disagree with this statement.
If you were living in the 1950's as transistors were replacing vacuum tubes would you advise someone to become a vacuum tube engineer if they loved it regardless of job market trends?

Would you advise someone to become a meter reader if they loved it even though these jobs are going away as the ability to read meters remotely multiplies?

Would you advise someone to become a medical transcriptionist if they love it even though voice recognition software is becoming more widespread?

Would you advise someone to go into nuclear medicine which has been decimated as V-Q scans have fallen out of favor and the job market for straight nuclear medicine docs is practically non-existent as radiologists are reading many nuc scans?

Syphilis is a complex systemic illness with protean clinical manifestations caused by the spirochete Treponema pallidum. It holds a special place in the history of Western medicine because of its earlier prevalence and its variable clinical presentations, for which it earned the epigram “the great imitator” or “the great impostor.” The first medical specialists treating this disease were called syphiliologists and they established special clinics. In addition, one of the first specialized medical journals appeared, the American Journal of Syphilis, Gonorrhea and Venereal Disease http://www.mdconsult.com/das/book/body/149159662-2/0/1259/1890.html
Would you advise someone to specialize in treating only syphilis patients today?

Your point is clear, but Pathology is much more diverse and adaptive than those "fields" you've just mentioned. As such, it has much greater potential to evolve. I think the landscape of pathology will change, but this doesn't mean that pathologists are out of luck. It just means that they need to be prepared to capitalize on new niches and be proactive in driving the speciality towards important areas in the brave new world of medicine.

A person in the 1950's who is heavily invested in vacuum tube technology ought to be enthusiastic about developing the improved technology of transistors, as long as that person is willing to be actively invovled and invested in that technological transition.

 

[yaah]

Now I frankly must disagree with this statement.
If you were living in the 1950's as transistors were replacing vacuum tubes would you advise someone to become a vacuum tube engineer if they loved it regardless of job market trends?

Would you advise someone to become a meter reader if they loved it even though these jobs are going away as the ability to read meters remotely multiplies?

Would you advise someone to become a medical transcriptionist if they love it even though voice recognition software is becoming more widespread?

Would you advise someone to go into nuclear medicine which has been decimated as V-Q scans have fallen out of favor and the job market for straight nuclear medicine docs is practically non-existent as radiologists are reading many nuc scans?

Syphilis is a complex systemic illness with protean clinical manifestations caused by the spirochete Treponema pallidum. It holds a special place in the history of Western medicine because of its earlier prevalence and its variable clinical presentations, for which it earned the epigram “the great imitator” or “the great impostor.” The first medical specialists treating this disease were called syphiliologists and they established special clinics. In addition, one of the first specialized medical journals appeared, the American Journal of Syphilis, Gonorrhea and Venereal Disease http://www.mdconsult.com/das/book/body/149159662-2/0/1259/1890.html
Would you advise someone to specialize in treating only syphilis patients today?

These are completely fallacious arguments. One does not become a "vaccuum tube engineer" and one does not specialize in the treatment of syphilis only patients these days, unless you become a super specialist. The correct argument would be to equate pathology to something more general than your arguments, like a transportation engineer, or a journalist for a daily newspaper. And yes, if someone has a passion for these things, they should still go into them. They will likely find ways to make themselves and their careers relevant. The other careers you mention (medical transcription, meter reader) are also laughable comparisons, to be frank.

I agree with sulfinator's comments as well.

Obviously with any career one should have some knowledge of the field itself, and some of the challenges involved. And not be a doe-eyed optimist who thinks everything will work out fine so long as they smile and work hard. But beware the eternal pessimist as well.

 

[MOHS_01]

yaah,

I very much disagree (in general, if not specifically because I have not delved into the pathology job market). Given the very finite career of a physician, ignoring trends and demographics in lieu of dogma is catastrophically poor advice. A ten year swing in trends can be a real career killer for a physician. If there truly is an oversupply issue -- especially in the worlds of pathology and radiology -- the leaders of your field have an obligatory duty to address it.

 

[yaah]

No, you see, you are missing the point. I even said above that it is always important to consider market issues, what you are going to do with that, etc, when you consider your career. But it is also catastrophically poor advice to base your career selection primarily on these issues (thus, dismissing pathology because of what you've heard about the job market). And it is also poor advice to dismiss a career that you might excel in because of such rumors. Your career is also your life - modifying it because of poorly defined job market issues can be a HUGE mistake (as, obviously, can careening head first into a career you know nothing about just because you have heard it's great or you think you might like it). Nowhere in my posts did I say that leaders in pathology do not have a duty to address job market issues. That should be one of their primary concerns.

 

[rockit]

yaah,

I very much disagree (in general, if not specifically because I have not delved into the pathology job market). Given the very finite career of a physician, ignoring trends and demographics in lieu of dogma is catastrophically poor advice. A ten year swing in trends can be a real career killer for a physician. If there truly is an oversupply issue -- especially in the worlds of pathology and radiology -- the leaders of your field have an obligatory duty to address it.

Two reactions to this: First, I saw (on interviews) one program that should be closed and two programs that should be half as big as they are. The great programs I visited had more work then the residents could do and used PA's and techs to help them out. The bad programs used residents to do the work.

Second, it's sometimes difficult to predict what's going to be a hot field. Tests come out of nowhere and research can redirect entire fields. I'm thinking of the impact that colonoscopies (and the fiberoptic scope in general) had on physician pay and the current emphasis on sleep medicine. It seems like a field can rise out of the grave by getting a new procedure and it may be difficult to predict what's the next new thing.

 

[MOHS_01]

No, you see, you are missing the point. I even said above that it is always important to consider market issues, what you are going to do with that, etc, when you consider your career. But it is also catastrophically poor advice to base your career selection primarily on these issues (thus, dismissing pathology because of what you've heard about the job market). And it is also poor advice to dismiss a career that you might excel in because of such rumors. Your career is also your life - modifying it because of poorly defined job market issues can be a HUGE mistake (as, obviously, can careening head first into a career you know nothing about just because you have heard it's great or you think you might like it). Nowhere in my posts did I say that leaders in pathology do not have a duty to address job market issues. That should be one of their primary concerns.

I understand now.... but I still contend that the capacity to "be good" at it does very little to pay the bills... and one has to land a job before anyone can determine whether they are "good" or not. It has also been my experience that the vast majority of medical students I have dealt with over the years are operating blindly based upon their experience upon rotations, their perceived competitiveness, perceived likes and dislikes, and reported earning potential. What you "like" at 25 may not be so fun at 35 with two kids (OB is the first thing that comes to mind). Someone needs to be practical, pragmatic, and honest about it, and if the leadership (read attendings and PD's) are not intellectually honest they are doing a great disservice to those who aspire to follow them.

rockit,

QFT. Micrographic surgery was one of the best things going prior to the AMA-CMS gang bang that occurred in 2007 and enacted in 2008. With the advent of the proposed healthcare "reform" I am sure that I can expect a repeat performance. My fear for pathology lies in its at risk status for outsourcing to larger labs/groups and the nasty "bill client" model that the leaders have allowed to gain acceptance. The specialty essentially cut it's own throat on pricing with that one, which will eventually come home to roost as that data becomes available to the OIG and other regulatory authorities (including private insurers).

 

[exPCM]

Agree completely with the well stated posts of MOHS 01.

 

[yaah]

It has also been my experience that the vast majority of medical students I have dealt with over the years are operating blindly based upon their experience upon rotations, their perceived competitiveness, perceived likes and dislikes, and reported earning potential.

That is definitely true - but then again med school lends itself to this phenomenon - and residency does to an even greater extent. Students have to decide on their residency of choice generally before they finish experiencing all of them, and some schools have regimented schedules that do not allow much flexibility to put the ones you want to see first. Residency is almost worse - you have to decide on your fellowship before you do everything, and in order to be competitive for the best ones, you have to start "expressing interest" earlier than that, which basically becomes day one of residency for many people.

Med students (and residents) also rely too much on hearsay, rumors, and "advice" from questionable sources.

Your point about the bill client model is very observant - I have been thinking about that too in the past couple of years. In letting sleaze become profitable, pathology in general has suffered and will continue to do so. Meanwhile, the sleaze will continue to proliferate because they have enough money and influence to force things their way. But this is how many things work - it is far from limited to pathology. We are seeing now a bit of a backlash towards physicians and hospitals who have treated medicine as a profit center (for profit hospitals, making money off of excessive unnecessary procedures, etc, as in the recent Atlantic article by Gawande). But who is going to be hurt by the necessary correction of this behavior? Not those who have already benefitted and who have and will continue to simply cash out while dumping the cost-centers off to others - but instead those who play by the rules.

 

[DarksideAllstar]

There are a handful of pathology programs in America that *train* residents. QUOTE]

Which programs are those?

I could tell you, but then I'd have to kill you...