Downside

[Primate]

What do you all see as the downside(s) to pathology. Into every field some rain must fall, so what do people think are (honestly) the parts about pathology that they don't like/enjoy. Comments on residency and what you think about life in practice would be welcome. I know there must be some.

Just curious. Apologies in advance if this has been covered - I searched the archive but either didn't use the right words or it hasn't been discussed.

P

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[yaah]

Hmm...Downsides. I put the slow movement of Mahler's 5th symphony in the old victrola for inspiration, so let's see.

#1: Too many people (including other doctors, amazingly) do not actually know what patholgists do, and assume it is all related to autopsies and decomposing bodies.
#2: Lack of consistent patient contact, seeing people when they initially present or actually formulating clinical diagnoses.
#3: Work load can be pretty heavy, lots of people depend on pathologists for information/diagnosis, and when you have a high volume of tough cases it can be quite stressful.
#4: Lifestyle is not quite the posh life that many portray it as. Residents often work 12 hour days, and the amount of info you have to know requires a lot of reading. But this isn't that different from other fields.
#5: Parts of the job can be somewhat repetitive, particularly if you are on services like GYN cytology.
#6: Residency, particularly AP/CP combined, covers an enormous amount of information.
#7: Having a bunch of people depending on you to make a difficult call on a pancreatic cancer frozen section can be very stressful.
#8: Increasing technological advances in immunohistochemistry and molecular techniques has the possibility of decreasing a lot of the "fun" of making a diagnosis and looking at slides. Not likely to change all that much though.
#9: Pathology offices are often stuffed in the basement or crammed into small spaces, because the chairman of surgery usually needs to have a gigantic suite with a nice view.
#10: A lot of people don't think pathologists are very interesting.
#11: Formalin.
#12: Grossing in perforated bowels.
#13: Autopsies on the septic and obese, s/p multiple bowel surgeries.
#14: Salary in the future is probably not going to be as high as in the past, or as high as other specialties. Pathology departments currently generally are profitable though.

I'll stop there, now that Mahler has moved on to the final movement and things are not so dreary appearing. A lot of these I came up with are really not real bad drawbacks. The upside is a lot better.

 

[Molly Maquire]

HI,

For me, the main drawback to going for Path is difficulty of finding employment in a place I actually want to live following residency. I know there has been hundreds of posts on this board discussing the job outlook and salary of pathologists, but it is still a concern.

I grew up in New York City and go to school in New York City, so at this point, I would be miserable if I had to leave. It's not like I can go live in Nebraska. I don't want to graduate and be told where I have to live. On an intelectual level, Path is still my favorite specialty, but it seems like employment prospects and flexability in rads, gas, and neuro, my other interests, are much better.

 

[Primate]

Only 14?!? Dang. I hope the upside(s) are significant for you, Yaah, or it'll be a long haul. Whatdya think? Love to hear what you'd come up with listening to something a bit more uplifting (the 4th of the 9th?).

PS - Victrola? If you have that and the vinyl to match, I'll be impressed. (closest emoticon to classical music)

 

[Formalin]

5

 

[yaah]

I don't really have a victrola. My parents do have the vinyls of all of Ludwig's 9 children, but I much prefer CDs, honestly. Well, when I listen to the 4th of the 9th (of Herr Beethoven, at least) I can't really do much of anything else. Same with the 4th of the Eroica. I did listen to Vaughn Williams' "Thomas Tallis" fantasy this AM and found myself thinking about match day and that I'm happy I chose the right field. Vaughn Williams has a way of taking many different sounds and textures and weaving them into a coherent message. Out of minor chaos comes wonder.

But I could probably come up with significantly more than 14 for my "upside" list. And, as a couple of the responders have pointed out, some of these 14 drawbacks I thought of are some of the things that draw many of us to the field. It was all pretty crystallized for me during 3rd year of school when I discovered where my true interests and passion in medicine lie. I really like being able to meet a patient, take their history, help guide them through their illness, but what I see in pathology appeals to me more. A lot of the drawbacks I listed are also things that you find in any career. And what formalin said about pathologists providing a unique service, it is pretty true. I just sat in on a frozen section on a patient where the ddx was sarcoid vs lymphoma, and the first slide came up, and the surgeon said it looked like sarcoid to him. But I was looking at it, and it looked like fibrous tissue, walls of big blood vessels, etc, and this wasn't lesional tissue. In short, I was right, surgeon was wrong. I'm not trying to brag, it was simply a result of me having had a year of path training already and knowing that that lesional tissue doesn't always show up on a slide of the biopsy. But this was an experienced surgeon, trained for many years, just simply didn't know a ton about path. Some do, of course, but the field of pathology is somewhat unique. And I thought to myself, during this experience, would I rather have been in the OR, trying to obtain the right tissue and waiting for pathology to tell me the results, or do I want to be in the FS room, making the dx. Easy choice for me.

On the jobs issue, I am not sure how limited to path that is. I understand it is probably easier to find a job in a big city if you are in a field like medicine, but it's tough to predict how things go from year to year. A lot of it is probably based on tradeoffs. I don't have a clue as to where I will end up practicing. Big city or rural, east or west, whatever. By the time I finish residency, I might have a family to provide for and that might make my decision for me, who knows. I am not going to worry a lot about it now.

 

[ttusom04]

What happens in 2006 when two classes graduate? What will the job market be like then?

 

[yaah]

Well, there won't be two classes finishing at the same time for any future years, so it should only have some effect on those finishing that year. So many people do one or more fellowships though that it's hard to predict how many new entrants into the job market there will be.

It's also not usually that useful to try and make predictions, because inevitably things will change, unforeseen events, cosmic interference, alien landings, new testing methods, etc.

 

[jbernar1]

Anybody regret their decision to go into path versus another specialty they may have been considering? A friend of mine does and I don't want to be the same way.