- Joined
- Jun 28, 2019
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As we are fast approaching the upcoming match application year, I would invite any curious medical students or other prospectives that have considered or are considering pathology as a career. As a current pathology resident looking down at the upcoming job market at mid tier residency, I would whole-halfheartedly dissuade anyone from entering this path. However, anecdotal evidence will only go so far, and I feel as if natural innate biases tend to ignore unfavorable anecdotes in light of anecdotes that follow a pre-set belief. So lets talk about some real problems that will not likely correct in the near future:
1) Job market - For the following argument consider having a background of 4 years of medical school; 4 years residency; 1-2 years fellowship. Most students will carry significant debt (>200K in loans) if they are AMGs. The median salary for a job starting out is $203,000 ( Source: College of American Pathologists, 2017 Practice Characteristics Survey Report) not including the medical instructor route (80-100K salary). Over 50% of all graduating residents/fellows since 2016 reported at least moderate difficulty with less than half receiving more than one job offer and 20% receiving no job offer(The State of Pathologists Job Market and Compensation). 42% of newly trained pathologists had to move to a new region/state (An Error Occurred Setting Your User Cookie). These trends have remained consistent in the past few years, however due to way the CAP researchers altered the statistics they made it seem like it was slightly trending positive (one should always remember statistically significant does not mean clinically significant).
Additional things to consider: Even before COVID there was evidence of laboratory consolidation and pathologists required to work more for less reimbursement; now with COVID there will be a bigger push for this.If you are unable to secure a job, since there is no internship required, there is limited to no alternatives to practice medicine in the US.
2) CAP leadership - It is clear that CAP leadership has conflicting interest. One of the major ways it gets reimbursed is through the CAP inspections. Another is that by having significant ties to academia, CAP also has incentive to push for more residents/residency programs (ie for government funding, cheaper labor, further consolidation by driving market demand down, etc). CAP has accomplished this by "creating" a future pathology shortage through statistically manipulated data and ignoring criticism from the community. This is evident in conflicting new data about how there was a significant under-counting of pathologists by 40% (Reevaluation of the US Pathologist Workforce Size and Concerns about the pathology job market dominate a popular online pathology forum and likely deterred American medical students from pursuing pathology residency).
Additional things to consider: Talking with CAP members leadership has not changed their stance on anything as of yet. Even before COVID, CAP was struggling and failing to prevent reimbursement cuts for pathology services. Now with COVID, they have less of a chance and will likely lose political ground for misleading congress and other political affiliates about expected pathology shortages.
3)Academia - For those interested in academia, please note that with the increased consolidation of labs and path-related services the model has been moving towards a hyper-specialized and solely clinical role. Because academic centers are increasing the clinical work load there is less ability for academically minded individuals to pursue a tenure track or independent research. Also, with academics it is difficult to negotiate contracts to reflect the work you are signing out, barring exceptions. Also, in pathology, like most of medicine, is extremely hierarchical; however, unlike other specialties you get less respect from other fields and it is harder to escape a hostile working environment.
In summary, it laments me to see this profession brought so low. Given that pathology is a intellectually challenging endeavor with high accountability it should make no sense for it to be in the position that it is in. I love pathology, but I cannot in good conscious recommend it. There is a reason why pathology is considered the most noncompetitive specialty. For those who are hopeful things will change I would strongly encourage to read the myriad of posts on this site and to review the literature to realize that this will not happen. Second, for those who think they are special and immune to these factors and will rise above; you aren't special, no one is. With so much uncertainty in the future why take a risk on something that is known to have a bad outcome when there are so many guaranteed positives you can do with a medical degree.
1) Job market - For the following argument consider having a background of 4 years of medical school; 4 years residency; 1-2 years fellowship. Most students will carry significant debt (>200K in loans) if they are AMGs. The median salary for a job starting out is $203,000 ( Source: College of American Pathologists, 2017 Practice Characteristics Survey Report) not including the medical instructor route (80-100K salary). Over 50% of all graduating residents/fellows since 2016 reported at least moderate difficulty with less than half receiving more than one job offer and 20% receiving no job offer(The State of Pathologists Job Market and Compensation). 42% of newly trained pathologists had to move to a new region/state (An Error Occurred Setting Your User Cookie). These trends have remained consistent in the past few years, however due to way the CAP researchers altered the statistics they made it seem like it was slightly trending positive (one should always remember statistically significant does not mean clinically significant).
Additional things to consider: Even before COVID there was evidence of laboratory consolidation and pathologists required to work more for less reimbursement; now with COVID there will be a bigger push for this.If you are unable to secure a job, since there is no internship required, there is limited to no alternatives to practice medicine in the US.
2) CAP leadership - It is clear that CAP leadership has conflicting interest. One of the major ways it gets reimbursed is through the CAP inspections. Another is that by having significant ties to academia, CAP also has incentive to push for more residents/residency programs (ie for government funding, cheaper labor, further consolidation by driving market demand down, etc). CAP has accomplished this by "creating" a future pathology shortage through statistically manipulated data and ignoring criticism from the community. This is evident in conflicting new data about how there was a significant under-counting of pathologists by 40% (Reevaluation of the US Pathologist Workforce Size and Concerns about the pathology job market dominate a popular online pathology forum and likely deterred American medical students from pursuing pathology residency).
Additional things to consider: Talking with CAP members leadership has not changed their stance on anything as of yet. Even before COVID, CAP was struggling and failing to prevent reimbursement cuts for pathology services. Now with COVID, they have less of a chance and will likely lose political ground for misleading congress and other political affiliates about expected pathology shortages.
3)Academia - For those interested in academia, please note that with the increased consolidation of labs and path-related services the model has been moving towards a hyper-specialized and solely clinical role. Because academic centers are increasing the clinical work load there is less ability for academically minded individuals to pursue a tenure track or independent research. Also, with academics it is difficult to negotiate contracts to reflect the work you are signing out, barring exceptions. Also, in pathology, like most of medicine, is extremely hierarchical; however, unlike other specialties you get less respect from other fields and it is harder to escape a hostile working environment.
In summary, it laments me to see this profession brought so low. Given that pathology is a intellectually challenging endeavor with high accountability it should make no sense for it to be in the position that it is in. I love pathology, but I cannot in good conscious recommend it. There is a reason why pathology is considered the most noncompetitive specialty. For those who are hopeful things will change I would strongly encourage to read the myriad of posts on this site and to review the literature to realize that this will not happen. Second, for those who think they are special and immune to these factors and will rise above; you aren't special, no one is. With so much uncertainty in the future why take a risk on something that is known to have a bad outcome when there are so many guaranteed positives you can do with a medical degree.
in vinegar, sit on your ass while you explain to any clinician looking for a report, that the specimen is in “decal” and kinda look at him like he should know we can’t cut bone. Only do the T.C. portion.
