family: "Path as a career?"

Discussion in 'Pathology' started by SLUsagar, Apr 19, 2004.

  1. SLUsagar

    SLUsagar rock chalk jayhawk
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    I'm a 3rd year med student and was wondering if people might be able to give some feedback/help regarding my dilemma in choosing a residency/career. I've read many of the postings on this forum, and agree that I feel like i might be choosing path as a "by default" choice in that I find so many nit-picky things wrong w/other fields and have ended up with PATH as last field left (i also think i'd enjoy the field of PATH as well....).

    The problem is that i'm getting a lot of heep from family members etc about choosing path. Main arguement is that they feel i'm a caring, considerate person [not trying to come off conceded, just giving the whole story] and that "the world be missing out on my gift" as my wife loves to constantly remind me anytime i mention PATH as a career. I agree w/her to some extent in that i wouldn't be interacting w/patients directly, but i just find so many other benefits in PATH that being able to "share my gift" seems like it would be less rewarding. I agree that i think i'm decent with people, but i honestly don't like it that much!

    The other choice i had been considerating was PSYCH, - yes i know, the apparant antithesis of the well-defined, structured, organized field of PATHOLOGY. The factor i care most about, besides interest of course, in choosing my field is lifestyle, thus probably explaining why it seems like PATH and PSYCH are the lone fields standing.
    I think PSYCH is okay, but i'm too scientific a person to be able to do that as a career, thus leaving PATH as a tentative choice. But i'm getting so much crap from family about always choosing "outlandish" fields like psych/path and not even considering "normal" things like Medicine. Have others who chose path gotten this feeling? Any input regarding my situation?

    Also, for completeness to my story, yes, I am planning on taking an elective in path this summer to solidify my tentative decision, and yes, am worried about how my family will respond to me saying that i love it.

    - - -
    Another brief question i had was regarding residency admission criteria to good path programs. I'm planning on staying in st. louis, and so SLU and WashU are my main choices/options. I've seen WashU's name many times in other threads about the best PATH programs, but was wondering what sort of criteria "good programs" have and how i'd compare:
    I've yet to take STEP 2, but have a STEP 1 score of 232, good pre-clinical and clinical grades, in process of junior AOA consideration, NO research experience, have NOT done PSF, and should be able to get good LOR from PATH electives this summer.
     
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  2. yaah

    yaah Boring
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    First off, I think you should do well in the match given your academic record. But definitely don't shirk on those LORs. As I see it, since you don't have much previous path experience, you are going to have to demonstrate your interest and potential ability in the field (obviously, no one is going to expect you to know much right away, but having the interest and the capability to learn is important). Your Step I is good and probably towards the higher end of applicants, but there will definitely be a few people with higher scores.

    Wash U is a pretty heavy research program. A lot of the people who end up there are preparing for academic careers, in both academic and clinical path. Wash U is a bit of an old-fashioned path residency program where you work hard, are encouraged to research, and of course learn a lot. If you are planning on a private practice career, it might not be the best choice. If you have a specific area you like and would like to do research in that area, more of a consideration. As a New Englander/partial great lakes regioner, I know really nothing about SLU. I only know a bit about Wash U from looking into it and applying there. I did turn down my interview so I never got to see it.

    In terms of "wasting your gift," well, there are a bunch of us who have heard that line before. I had a medicine attending tell me it would be "an absolute waste" for me to not go into internal medicine, both because of my personality/way of relating to patients as well as my way of looking at clinical problems. The surgeons also told me I had "the perfect surgeon temperment." One time when the resident was putting in a femoral line on a trached patient, I wasn't doing anything so instead of watching him do the same thing over and over, I went up to the head of the bed and held the patient's hand. And she squeezed back really hard. The nurse saw this and said, "I hope you're going into surgery." Then I had another patient, on medicine I think, and the residents all went in on rounds to see her, I was delayed and getting something, and came in late, and when I came in the patient started beaming and smiling and talking, whereas before she had been sullen and not very cooperative. Believe you me, don't listen too much to outside pressure. It is all well and good to hear this praise, but if it isn't what you want to do, your incredible gift is not going to do you that much good, and probably will end up making you unhappy you chose that field, and your patient relations may end up suffering anyway. Of course, the pathologists also told me it would be a waste if I didn't go into path.

    Path needs good people too. Pathologists end up teaching a lot, and have lots of interactions with other doctors and support staff, consequently sometimes interpersonal skills can be even more important (that's debatable, but certainly they are important). I had a lot of great interactions with people during my PSF and path rotations thus far, and I have come to the conclusion that being a nice person is a benefit to the field. You may not get to cry with patients and their families, or encourage a patient to quit smoking or follow other healthy advice, but there are other benefits. Path as a specialty will consistently challenge your intellect and abilities, which also sounds important to you. I have a father who is a doctor, and a nurse mother, and both of them think pathology is a great career choice. Some relatives and friends not in the health care fields will give quizzical looks when I explain what I am going into, as though that is "not what a real doctor does." It sounds more like research and working in a lab than it sounds like working in a hospital.

    So, in the end, it is going to have to be up to you. I would not recommend choosing a career that you don't see yourself liking, because after all it is the rest of your life. Your family will come around no matter what you choose, and will be happy and proud of you no matter what. When they figure out what you will be doing with your day, they will probably feel happier about it and not so convinced that you are throwing away your gifts. You probably have many talents, and just because one of them (the personality side) is the most outwardly apparent does not necessarily mean that is the one that you feel is your strength, or actually IS your strength.

    I definitely agree with doing at least one path rotation to see what it is like before you decide. You may find you don't like it, but give it a chance and be aggressive in your learning so you can see just what it is path residents do all day.

    You don't want to do psych. The patients that need the medications don't want to take them and spit in your face, and the patients that need counseling or other therapies just want the pills. Either way, you don't get paid much and no one is truly happy. Sorry, don't listen to me, I'm just bitter about my psych rotation.

    Come back and visit us, ask more questions! And other people with advice should chime in too, I am far from the only opinions in these matters.
     
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  3. Mindy

    Mindy Senior Member
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    Hello SLU!

    I cannot begin to tell you how much I wrestled over these very issues. My mom tells her friends that I do mostly forensic work, including all the crime scene investigation like the TV shows, and that when there are no deceased people to investigate, I do "some surgical stuff." These is how she describes my first year of residency, because she believes it sounds a lot cooler than what I actually do!

    My husband wanted me to go into whatever field made me happiest, which was refreshing. Of course, I also know he liked the fact that pathology would be advantageous time-wise.

    I worried a lot about "spreading my gift" too. After all, I am a kind, caring, considerate person. People always have told me that. I hold doors, shake hands, comfort sad people. I have given away my last bite of food. I have held the hands of patients with their first diagnosis of cancer. I don't do this because I feel obligated. I do it because I want to.

    But I am not a chaplain. I am not a nurse. I am not a counselor. I am not a social worker. I am trained as a medical doctor. My job, broadly speaking, is to precisely identify and treat disease. And I am most concerned about the precision. This is where pathology fits in. It is the crux of most physical medicine. All of the hand-holding of a cancer patient in the world will not determine the stage of disease or the origin of a carcinoma. It is only by treatment that a cure (i.e. hope) is offered to a patient. The "gift" of an excellent and precise pathologic diagnosis is what I want to offer the world. And by the surge in patient-driven second-opinion consults MGH path dept receives, I can assure you that many patients do understand the value of a good pathologist.

    A hug is nice, but you do not need special training to be good at it. Medicine is not hugs and kisses and patient adoration. It is cold hard reality with lots of death, dying, disease. I have always felt like doctors are soldiers fighting the enemy--death--that we know we can never beat, but may be able to hold back for a few more months, years, decades. Unfortunately, our loved ones outside of medicine often only see the rewards we receive for our losing battle. They do not always understand what we give up, how we feel, how painful it can be. Hugs, and a shoulder to cry on, are most useful when there is nothing left to hope for, when all other actions have been unsuccessful. For a patient, whether they know it or not, pathology is often where their hope begins. SLU, it is up to you to decide what your real gift is.

    Mindy
     
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  4. Stinger86

    Stinger86 Intern year? Ha!
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    Wow, great post!

    SLU, I am in a very similar position as you. All of my family and friends think that I need to go into a clinical specialty because I'm a caring person with the technical abilities to make a difference in other people's lives. The problem, as stated by Mindy, is that people outside the medical professional have absolutely no idea what goes on in our world. While there is a lot of happiness in the field, there is also a ton of sadness, and even a lot more stress. I think that the stress is the one thing people just don't understand. There are highs and lows to every field, and you absolutely have to pick the one that matches you as closely as possible, or you're going to hate your job and your life. And how would your family feel if you did what they wanted you to do, but you hated every minute of it?

    To keep this short, I think that if you talk to your family about what you like about path and dislike about the other fields, they'll be more likely to support your ultimate decision. Once I explained the logical advantages of a career in path that aren't offered in other fields, my family become more than open to the idea. As is usual, most people don't know anything about the field of path, and when you don't know anything about something, you either try to learn more about it, or you just blow it off. And for some reason, families like to just blow it off :rolleyes: , especially when it has to do with medicine.

    Good luck with your decision!
     
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  5. ruby_1

    ruby_1 Junior Member
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    This was a tough decision for me as well. I had received many positive comments about how good I was with people and so on. When I finally decided to go into path, part of me felt that I would miss that contact. Fortunately, my biggest supporter for choosing path was my wife. She just wanted me to be happy. People still ask me if I miss the people contact and I remind them that we interact with people all the time. We are constantly discussing cases with other physicians and occasionally with a family member of a recently deceased patient on final autopsy findings. We see patients during our blood bank rotations and when we do FNA's. Sure, we don't see them as much as other specialties but it's not like we don't see them at all. As stinger86 points out, many people don't have a good idea of what we do. My mother still asks me what I do even after I explain it to her. My sibling, who is in family practice, tells my mom I work with dead people. I think that's what most people think. They are caught up in the CSI stuff and think pathologist spend their time with autopsies. Perhaps an important revelation for me was knowing that I could be good with patients and also be a good pathologist. Both still contribute to patient care. I love being able to give answers (diagnosis) that will guide treatment or alleviate patient fears. In many ways, I think it's one of the best specialties in medicine that few people know about. I have to admit, I love what I do.

    Good luck
     
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  6. gungho

    gungho gungho
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    The problem, as stated by Mindy, is that people outside the medical professional have absolutely no idea what goes on in our world.

    Interestingly, when I told my supervisor, who is an internist practicing about as long as I have, that I was returning to residency to become a pathologist, he said, "Now, what is it you would be doing?". That's a shame.
     
  7. yaah

    yaah Boring
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    Somehow we should be able to transfer this thread to somewhere where more people who haven't decided on a career yet would read it. Some very good points made. Especially since so many people think that the ideal of medicine is the doctor with the black bag, present from a patient's birth to their death, caring for everything from "baby's first rash" to the snuffles, chicken pox, junior's first STD, Buffy's teenage pregnancy, Mom's perimenopausal depression, Dad's midlife crisis, Dad's foray into erectile dysfunction, and everyone's problems with their bowels.

    Unfortunately, medicine is a bit different now, and sometimes people don't realize this until they are well into their clinical years and are already embarked on the path towards something else when they haven't even considered other specialties like pathology because of misinformation about what the career actually is or idealization of different specialties. Some people then end up miserable in their careers. Of course, this is not to suggest that all pathologists are happy, and everyone who doesn't enter this field is destined to be miserable. There are many miserable pathologists out there. But it's a career that has a lot to offer.
     
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  8. Doctor B.

    Doctor B. Slappin' That Glass
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    Not to simply repeat what's been said above but don't let your family influence your decision too much. Understandably one is affected by familial opinions. But this is your choice, and a very large one at that, so trust yourself in your decision. I've written a little piece on my website about how and why I chose path. You can read it at http://choosepath.blogspot.com/. Hope it helps somewhat. Feel free to post any questions or PM me.
     
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  9. paaricmc

    paaricmc Junior Member
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    i really loved reading that one.kudos to u ...obviously it was straight from u r heart.quite inspirational.
     
  10. pathdr2b

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    This is the EXACT same thing my Mom tells her friends and I have yet to matriculate into med school. :laugh: It's as if cancer research isn't "prestigous" enough! :rolleyes: :laugh:

    Great posts Mindy and Yaaah!
     
  11. Primate

    Primate Senior Member
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    My oldest kid tells people that "Daddy tells other doctors what's wrong with their patients!" :D :D

    Gotta LOVE that one!

    Path all the way, baby.

    P :eek:
     
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  12. yaah

    yaah Boring
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    That's a great description! I may start using that one when all these people start asking me what pathologists do. I was half hoping you were going to end that sentence, "daddy tells other doctors where they can stick it!"

    Does this mean, primate, that you have seen the light and disregarded the possible ophtho or neuro careers?
     
  13. Primate

    Primate Senior Member
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    I'm in - now sufficiently differentiated to say that it's path. Although aerospace medicine still holds some appeal . . . . ;)

    I think AP/CP, then NP, although that's only marginally beating out AP/NP (but that is the topic of another thread, I suppose).

    As far as describing pathology, I think son #1 has hit on something. Amazing how a little-one hits the nail on the head when I've heard so many path residents (by the time one's an attending, I suppose one no longer even tries to explain) struggle with it.

    P :eek:
     
  14. ny skindoc

    ny skindoc Senior Member
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    As far as your career goes your familys feelings are irrelevant.They know as little about what an internist really deals with as they know what a pathologist does.They will not be be dealing with the hassels of internal medicine practice..you will.They will not be answering phone calls at 2am and weekends. There is nothing wrong with picking a specialty by default as many do this successfully.I agree you must be a bit more confident in your choice so a rotation in path is essential.There is nothing wrong with Psych however,its interesting,there are many jobs available and it is no less "scientific" than many other specialties,especially as taught in academic centers.Be happy you have learned at this point in your training that lifestyle is important.Many learn this too late! (especially internists)
     
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  15. Smitty

    Smitty Senior Member
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    to SLUsagar: I'm also in a very similar situation right now. I've been trying to decide path vs. psych for a while now! I'm 1 week into my 4th year path elective, and so far it's pretty cool, although up to now I've only done autopsy (I start surg path next week). I even have the exact same Step 1 score and also no research experience! I think I'm more interested in the neuroscience behind psych than the actual talking to patients thing, even though I really think that talking to patients is more important, and I've been told I am good with patients and a "nice guy". In fact, I really don't feel like I fit in with the sterotypical path person (who, at least at my insitution seems to be a little on the grumpy/gruff side-I can't believe I just used the word "grumpy", but I can't think of a better way to describe them, I mean, I'm not exactly full of love first thing in the morning, but I feel like a damn pep rally cheerleader next to some of these guys!). I guess when it comes down to it you have to do what makes you happy first, then worry about how you can save the world, because you spend too much of your life working to have a job you don't enjoy. However, I feel your pain. Sometimes I feel like I'm "giving up" by going into path, even though I know that's ridiculous. I'm going to take a psych elective soon after my path elective and just go with my gut feeling.
     
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  16. yaah

    yaah Boring
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    Smitty, if you go through a lot of the old threads on this forum, you will find lots of discussion about this whole, "you're too nice to be a pathologist" thread. It seems like quite a few of us have heard this. It basically never stopped for me, I think almost all of my evaluations since I started telling people I wanted to go into path (basically starting around my medicine rotation which was the last rotation I did third year) have included the phrase, "I wish you would go into internal medicine" (or neuro, or specialty x). They say that since I do well talking with people, establishing relationships, sense of humor, etc, that I am well suited for clinical medicine. Fine, I say. This is good to know, since I went to med school thinking that's what I wanted to do and I do enjoy it to some extent. But I know that I am more suited for path. I don't really have the patience to deal with a lot of parts of clinical medicine (paperwork, phone calls, long winded patients, people who don't take care of themselves, obnoxious other residents/attendings dumping work on me, etc etc etc). My mind is more suited to path, that's the way I think, despite the fact that the neurologist told me I think like a neurologist.

    I think, also, that you will find that many people who go into path are the antithesis of the old guff and grumpy curmudgeon. It kind of takes a different kind of person to go into path. You have to be comfortable with yourself and know yourself well. Of course there are obnoxious and/or socially inept people in the field, but there are people like that in EVERY field. You usually don't have to look hard to find them. I even saw them in child psych which one would think would be a disqualifying factor.

    Trust me though, if you go into path and have a good attitude and have fun, people around you will do the same. Attitude is contagious.
     
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  17. yaah

    yaah Boring
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    This thread should be bumped too. Everyone should have a look at it.
     
  18. LADoc00

    LADoc00 Gen X, the last great generation
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    Im a pathologist who travelled through the stories halls of some of the better programs in the nation. Having graduated from WashU their program is a legendary ball buster. I could write Homeric epics on pathology training programs and the mistakes I have made. Overall, the best place I feel (in 20/20 hindsight of course) is Brigham.
     
  19. yaah

    yaah Boring
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    That's funny, because I talked to a former Brigham graduate who said he would never go there again, that they do a lousy job of training people, etc. Then I talked to another Brigham graduate who said it was great, they supported the residents well, etc. I also heard two opposite opinions on almost every program I visited...I'm not trying to badmouth the Brigham here, just to show that there are all kinds of opinions out there and everyone has to make their own. Personally I thought Brigham was a great program, just not for me. The best program will be different for everyone depending on your goals and way of learning, conducting yourself, etc.

    LADoc it sounds like you have lots of experience and viewpoints - I hope you stick around and pass some of it around! We need more veterans out here.
     
  20. LADoc00

    LADoc00 Gen X, the last great generation
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  21. yaah

    yaah Boring
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    You're right there...I think every program does have a few black sheep graduate every once in a while. Problem was, the graduate I talked to was the farthest thing from sucking I have ever met. He left Brigham to do fellowships in dermpath and blood bank because he wanted to go into private practice and thought that the Brigham left him, basically, completely unprepared. He has also had a very successful career both as a pathologist and at a national level in terms of committees, etc.

    I didn't know quite how to interpret this when I mentioned my interest in some programs to him and he told me this.

    Again, not trying to badmouth the Brigham. Perspectives are just strange. That's why I always take every perspective, including my first impression, with a large grain of salt.
     
  22. LADoc00

    LADoc00 Gen X, the last great generation
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    Who would do a fellowship in BB/TM AND Derm? That doesnt make any sense. And he was AP/CP I assume?? Right there this guy becomes suspect. Alot of people float through path as slackers, heck even I was one (but at least I published), but now applying for jobs I can look back on what are good and bad choices and why. I could tell why Brigham is the best (And Ive been there too so I wonder who this guy is) but it would it take a bit. Stanford is a close second IMO.
     
  23. yaah

    yaah Boring
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    Hmmm...I've heard people unhappy with the Stanford program as well. Having not visited it (not a west coast person), I can't claim expertise. But they have trained some well known people.

    He did BB and Derm to do private practice and make himself more competitive (plus he felt his training had been lacking in these areas). This was awhile back, when having such cross training was desirable in certain community positions (because you could cover blood bank and derms which are common private practice specimens). You're right, right now this probably wouldn't make sense and would be impractical. He is not a recent graduate. But he stays on top of training programs because as I said he has had, in the past, some strong involvement in national positions. But that's all I'm going to say now, I'm not going to compromise his identity any more, suffice it to say that I am not lying, he was certainly not a slacker, and he is a pathologist many would admire.

    Like I said, I have talked to other Brigham graduates who say it's a great place.

    Yeah, people do float through as slackers. I can't control what other people do or think. I can only control my own effort and work. I have no doubt that people around the country have trouble finding jobs. But it ain't true for everyone.
     
  24. AnnieGraham

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    Apologies for reviving an old thread but I found this in the FAQ section and wanted to know more about working in pathology. I am currently struggling between anaesthesia and pathology as future career choices and would like to hear what the pathologists have to say (thank you very much) :).

    I am not fussed about "spreading my gift" mainly because I generally suck with patients anyway :rolleyes:. Probably because I am lazy and hate physical exams or counseling patients trying to get them to stop smoking when I know they will keep doing it anyway etc. I came from a strong scientific background in mathematics and physics so the more "abstract" side of medicine such as reading slides and interpreting labs appealed to me through out the last couple of years.

    I enjoy knowing things and the more I know the more I don't know and thus the more I challenge myself to know more (what a mouthful). I've read some comments saying "pathologists need to know everything/have a broad knowledge base [etc.]". Well I presume pathologists don't need to know everything but I am interested to know what it means to have a broad knowledge from the perspective of a pathologist (or trainee).
     

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