Glut of Bad Programs and CAP

[HeyDalaron]

Again, I must raise the question that if the CAP is not serving the practice interests of its members, why can't the members start their own advocacy group?

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[octopusprime]

At the end of the day, everyone has to acknowledge that pathology is not a high-demand field: a handful of pathologists can cover a large territory, but have 0 clinical contact/ability to generate business from patients.
This fact, combined with consolidation going up, reimbursement going down, and GI/derm/GU groups trying to squeeze blood from every stone they can, would suggest that an unregulated production of newly minted pathologists is not in the interest of anyone other than those that stand to profit from an abundance of cheap labor (both in training and after), namely, academics, corporate labs, hospital based gigs...et al arrangements that work to commoditize pathology services and benefit from "the going rate" being as low as possible....I feel like I'm repeating myself over and over.
Why is pathology different than any other service, healthcare or otherwise?

 

[deleted314957]

At the end of the day, everyone has to acknowledge that pathology is not a high-demand field: a handful of pathologists can cover a large territory, but have 0 clinical contact/ability to generate business from patients.
This fact, combined with consolidation going up, reimbursement going down, and GI/derm/GU groups trying to squeeze blood from every stone they can, would suggest that an unregulated production of newly minted pathologists is not in the interest of anyone other than those that stand to profit from an abundance of cheap labor (both in training and after), namely, academics, corporate labs, hospital based gigs...et al arrangements that work to commoditize pathology services and benefit from "the going rate" being as low as possible....I feel like I'm repeating myself over and over.
Why is pathology different than any other service, healthcare or otherwise?

Well, you kinda answered your own question. Nobody ever has an appointment to go see “their” pathologist.

 

[Drifter76]

I know most will crap all over my positive anecdote. Maybe I'm just lucky, but those who have a good deal are a lot less likely to have a reason to post on SDN.

I am roughly 10 years out of training, have only been in private practice, and have moved around a bit, but always on my own terms. Good private jobs are still around. My senior colleagues have been fair and generous with me. I'm not the smartest nor was the best trainee, but am friendly and can communicate well. I've learned admin skills on the job and my colleagues like me in that role.

Hope everyone out there finds a position they like. My only advice is to keep hustling and be personable. Path is a niche field and turnover is low. You have to be opportunistic and constantly vigilant about open positions and the field at large. I check job boards everyday out of curiosity, even though I'm not looking. Part of my constant vigilance is checking SDN routinely for 15+ years.

Private groups want diagnostic competence of course, but in my opinion, it's more important that people like having you around, you can wear different hats for the group, and you are constantly hustling to try to improve your group's standing/workflow/culture (while efficiently managing your service caseload). If you can do all those things, any group should make you partner, or at least make it worth your while. If they don't, move on. Best of luck everyone.

I’ve always moved “on my own terms” in the sense that it was voluntary. But it was always the lesser of two evils I was moving to- never had the option of anything good. My senior colleagues didn’t want a colleague- they wanted a subordinate they could take advantage of. And that was true for multiple jobs I’ve had. “Keep hustling”- been there, done that. I’ve been working the phones and going to meetings for years. I’ve found a few opportunities that way but nothing really worth pursuing. I check job boards daily as well- have been doing it for years- and I actually apply to anything that looks promising, although jobs that look promising don’t show up there all that often.
“If you can do all those things, any group should make you a partner...” I agree, but the key word there is should. What should happen and what does happen are two entirely different things.
“If they don’t, move on”- and then you end up making a bunch of lateral moves from one crap job to another. You may think you are moving on to something better but then people lie and you find out about all the lies as time goes by at the new place. If you had a somewhat normal job market, with a reasonable ratio of supply to demand, then what you are saying would work. You could have some bad actors in the market on the employer side, that then have people leave them, and they have to deal with the turnover. They eventually have to change what they are doing, or have their reputation affected so that no one will work for them. Market forces would tend to keep people a little more honest and ethical. But what we have now is not a normal market- it is something entirely different.
I’m aware of a few younger pathologists who got decent jobs early on, and a very few who even got good ones. It seems to be based on gamesmanship, nepotism, or just blind luck in many cases- just being in the right place at the right time. I think those people are in the minority.

 

[Drifter76]

Again, I must raise the question that if the CAP is not serving the practice interests of its members, why can't the members start their own advocacy group?

I recently had a lengthy conversation with a pathologist who I used to work with who is very involved with CAP- someone who has been on the board of governors and an officer. I asked about this “pipeline” initiative they have to try and get more U.S. medical students interested in pathology, and also about the supply/demand mismatch. He bluntly told me that he wants the market to be “more favorable to employers” because “I don’t want to have to offer too much to get someone” when he has an opening. This particular person is a partner and board member for a very large practice that is running a 2 tiered system. They have a bunch of underpaid employee pathologists subsidizing a smaller number of partners at the top. They need the job market to be bad in order to sustain a system where they can recruit and retain “colleagues” that they can take advantage of financially. I suppose he didn’t really tell me anything I didn’t already know, but I was surprised at his candor.

 

[RE-Tired]

Been retired out of Path over two years and have to say my generation has done well. But my former colleagues are working longer hours for the same or sometimes even less pay. At least for them most are now treated as a commodity. I agree with most posters that there is an oversupply of Pathologists.
I follow job listings on a regular basis as I seek locum situations. It seems to me that less than 10% of jobs offer a partnership track and I have to wonder if some of those are "bait and switch". I am very pessimistic for the field and I have told the young people I know in medical school or planning on medical school not to do pathology. Unfortunately I think the bread and butter of private practice pathology (88305) will decrease dramatically in the next decade due to non-bx screening and directed biopsies instead of saturations biopsies.
Anyone in a poor job situation now has few options since the best jobs are highly competitive or require a non-desirable location. I think for those who went into Path not because they can stay in their office and sign out cases but are willing to participate in hospital committees there is some hope because the medical staff will see you more than just a tissue monkey. Unfortunately these situations are becoming less frequent. If pathologist had a strong organization that supported our profession I think the situation might be different, but it is probably too late now for that.

 

[Drifter76]

Been retired out of Path over two years and have to say my generation has done well. But my former colleagues are working longer hours for the same or sometimes even less pay. At least for them most are now treated as a commodity. I agree with most posters that there is an oversupply of Pathologists.
I follow job listings on a regular basis as I seek locum situations. It seems to me that less than 10% of jobs offer a partnership track and I have to wonder if some of those are "bait and switch". I am very pessimistic for the field and I have told the young people I know in medical school or planning on medical school not to do pathology. Unfortunately I think the bread and butter of private practice pathology (88305) will decrease dramatically in the next decade due to non-bx screening and directed biopsies instead of saturations biopsies.
Anyone in a poor job situation now has few options since the best jobs are highly competitive or require a non-desirable location. I think for those who went into Path not because they can stay in their office and sign out cases but are willing to participate in hospital committees there is some hope because the medical staff will see you more than just a tissue monkey. Unfortunately these situations are becoming less frequent. If pathologist had a strong organization that supported our profession I think the situation might be different, but it is probably too late now for that.

I’ve already taken and left multiple jobs that were “bait and switch”. I’ve actually left a job due to it being bait and switch, made a long distance move to something that was supposed to be better, only to find out after getting there that the new job was also a bait and switch. The new job was supposed to be a partnership track job with a stable group, and the allegedly stable group lost their main professional services contract just a couple months after I made a cross country move. I gave up a year of retirement benefits, and a lot more including moving to a relatively undesirable location, so I could jump onto a sinking ship right before it sank.

 

[WEBB PINKERTON]

I’ve already taken and left multiple jobs that were “bait and switch”. I’ve actually left a job due to it being bait and switch, made a long distance move to something that was supposed to be better, only to find out after getting there that the new job was also a bait and switch. The new job was supposed to be a partnership track job with a stable group, and the allegedly stable group lost their main professional services contract just a couple months after I made a cross country move. I gave up a year of retirement benefits, and a lot more including moving to a relatively undesirable location, so I could jump onto a sinking ship right before it sank.

No wonder you call yourself Drifter76.

There is little stability in this career. Get as many side hustles going as you can so you can thrive when your pathology gig disappears. Who the hell wants to move all over the country chasing specimens? Thanks to formalin you are competing with EVERY other pathologist in the US.

 

[octopusprime]

Well, you kinda answered your own question. Nobody ever has an appointment to go see “their” pathologist.

the rhetorical "how is pathology different" question I ended with was regarding the correlation between supply and demand...

 

[Alteran]

I recently had a lengthy conversation with a pathologist who I used to work with who is very involved with CAP- someone who has been on the board of governors and an officer. I asked about this “pipeline” initiative they have to try and get more U.S. medical students interested in pathology, and also about the supply/demand mismatch. He bluntly told me that he wants the market to be “more favorable to employers” because “I don’t want to have to offer too much to get someone” when he has an opening. This particular person is a partner and board member for a very large practice that is running a 2 tiered system. They have a bunch of underpaid employee pathologists subsidizing a smaller number of partners at the top. They need the job market to be bad in order to sustain a system where they can recruit and retain “colleagues” that they can take advantage of financially. I suppose he didn’t really tell me anything I didn’t already know, but I was surprised at his candor.

I'm one of the fortunate few to be in a partnership position where for the foreseeable future I'll be ok. Because of this pathologist surplus my group could, if we wanted to, hire newly minted pathologists for "partnership eligible" positions and then not renew their contracts prior to partnership only to just as easily find others to replace the FTEs - and we could probably do this for the next 30 years. All the while, I'd be billing over twice the RVUs from that pathologist than what I'm paying for that FTE. While my group doesn't do this, all the other groups around me do exactly that. One particular group has gone through 3 pathologists in ten years they supposedly promised partnership to. Another very large group with a near monopoly in a large and desirable metro area does the same thing. They hire you and if you don't bring in a new account or some business, your likely gone - as in your contract isn't renewed. If you happen to land an account they let you stay on without a significant bump in pay. And while you'll only be made a partner after one of the fixed number of partners retires, you're expected to still be earning for the group.

I'll just be straight up and say that if you're a medical student looking at pathology, I'd say please reconsider. Yes you will get a job, but you are increasingly unlikely to have a career and certainly increasingly unlikely to have any form of financial equity with respect to your work.

 

[octopusprime]

I'll just be straight up and say that if you're a medical student looking at pathology, I'd say please reconsider. Yes you will get a job, but you are increasingly unlikely to have a career and certainly increasingly unlikely to have any form of financial equity with respect to your work.

This x 10000.

 

[caffeinegirl]

This x 10000.

This times a gazillion. You are right on the ball Alteran. Pathology will be a job, but not a career in private practice. You are more a cog in the wheel rather than a physician who is a specialist, and who is valued for your expertise. And, you will likely only get a small fraction of the income you generate from the practice.
My experience is very similar to Drifter's, as well as the other groups Alteran mentioned. I had to get a side hustle in wound care in long-term care facilities to make ends meet for a while, as I was geographically restricted.

 

[deleted314957]

This times a gazillion. You are right on the ball Alteran. Pathology will be a job, but not a career in private practice. You are more a cog in the wheel rather than a physician who is a specialist, and who is valued for your expertise. And, you will likely only get a small fraction of the income you generate from the practice.
My experience is very similar to Drifter's, as well as the other groups Alteran mentioned. I had to get a side hustle in wound care in long-term care facilities to make ends meet for a while, as I was geographically restricted.

Interesting side hustle. I guess I could have fallen back on hyperbaric stuff as i was trained by the Navy in diving ,radiation, hyperbaric/submarine medicine. The tables they use ( or did) were all USN tables like a table 6. It gets hot as hell in a manned, attended chamber at 165’ . Plus you get a little narced which ain’t bad at that depth.

 

[Napoleon1801]

I’ve always moved “on my own terms” in the sense that it was voluntary. But it was always the lesser of two evils I was moving to- never had the option of anything good. My senior colleagues didn’t want a colleague- they wanted a subordinate they could take advantage of. And that was true for multiple jobs I’ve had. “Keep hustling”- been there, done that. I’ve been working the phones and going to meetings for years. I’ve found a few opportunities that way but nothing really worth pursuing. I check job boards daily as well- have been doing it for years- and I actually apply to anything that looks promising, although jobs that look promising don’t show up there all that often.
“If you can do all those things, any group should make you a partner...” I agree, but the key word there is should. What should happen and what does happen are two entirely different things.
“If they don’t, move on”- and then you end up making a bunch of lateral moves from one crap job to another. You may think you are moving on to something better but then people lie and you find out about all the lies as time goes by at the new place. If you had a somewhat normal job market, with a reasonable ratio of supply to demand, then what you are saying would work. You could have some bad actors in the market on the employer side, that then have people leave them, and they have to deal with the turnover. They eventually have to change what they are doing, or have their reputation affected so that no one will work for them. Market forces would tend to keep people a little more honest and ethical. But what we have now is not a normal market- it is something entirely different.
I’m aware of a few younger pathologists who got decent jobs early on, and a very few who even got good ones. It seems to be based on gamesmanship, nepotism, or just blind luck in many cases- just being in the right place at the right time. I think those people are in the minority.

On the job search myself now and all these sentiments in these posts ring pretty true. I'm checking job boards daily and trying to find a non-crap place with a decent culture. Thankfully, I'm not geographically restricted and have some experience behind me, but it's still a challenging prospect.

 

[TrojanRaggy]

Shouldn't current pathologists be focusing on getting more US grads to get into the system to strengthen their voices regarding decreasing the training spots instead of dissuading them from entering into a pathology career? I mean what is the end game of private pathologists in dissuading US grads from entering the field? We already have 60-70% IMG trainees in pathology. If you convince every single US grad to not enter this field, do you think anything will be done differently? They would just hire 100% IMG trainees and these voices of dissent will dissolve completely. Being an IMG, I can tell you that even the worst and most toxic job environments that you guys describe are still better than what we have in our home countries. IMGs have and will keep bending to any and every demands of the employers if they could get a visa and/or green card sponsorship.

 

[Alteran]

Shouldn't current pathologists be focusing on getting more US grads to get into the system to strengthen their voices regarding decreasing the training spots instead of dissuading them from entering into a pathology career? I mean what is the end game of private pathologists in dissuading US grads from entering the field? We already have 60-70% IMG trainees in pathology. If you convince every single US grad to not enter this field, do you think anything will be done differently? They would just hire 100% IMG trainees and these voices of dissent will dissolve completely. Being an IMG, I can tell you that even the worst and most toxic job environments that you guys describe are still better than what we have in our home countries. IMGs have and will keep bending to any and every demands of the employers if they could get a visa and/or green card sponsorship.

I think you'd change your tune if the only positions you could get are non-partnership with a max salary of $140K/year, no production bonuses, 6 weeks vacation, 40+ cases/day, and call Q3. My wallet would love it if I got 3 such pathologists on those terms. The only thing stopping me are my worries about the quality of work I'd be releasing to my clinicians through such hires. But I'm sure some groups out there don't have the same concerns I do.

 

[deleted314957]

Agree with you completely Alteran. The only metric i would change in your example is 40/day to 80/day.

 

[deleted314957]

Shouldn't current pathologists be focusing on getting more US grads to get into the system to strengthen their voices regarding decreasing the training spots instead of dissuading them from entering into a pathology career? I mean what is the end game of private pathologists in dissuading US grads from entering the field? We already have 60-70% IMG trainees in pathology. If you convince every single US grad to not enter this field, do you think anything will be done differently? They would just hire 100% IMG trainees and these voices of dissent will dissolve completely. Being an IMG, I can tell you that even the worst and most toxic job environments that you guys describe are still better than what we have in our home countries. IMGs have and will keep bending to any and every demands of the employers if they could get a visa and/or green card sponsorship.

I don’t have a dog in this fight anymore. However, the situation in the field of pathology ( can’t comment on academia) has deteriorated to the point that it has lost most of the attractive aspects it had 30 years ago. I intend to do what i can to knock the naivety out of some starry eyed med student who needs to know what they will face.

 

[Allegri]

I dunno, I think there are now a lot of desperate pathologists, many IMG, willing to accept terms like those. I think Trojan has a point; however, people should also be honest when asked their opinion about the state of the field.

 

[PATHDOCNYCNJ]

I felt my training was akin to being a glorified med secretary and advanced PA. The OR was very busy and you could find yourself grossing until midnight. Starting out, you would be trained by a senior pathologist. Sometimes the senior pathologist was in a sub specialty like cytology and had no clue how to help you. Then when you got your slides the next day, you were expected to match slides with paperwork and divide them up according to sub specialty attending: i.e., thyroid cases to ENT pathologist, GI cases to GI pathologist, junk cases like hernia sacs to the general pathologist, lung cases to the pulmonary pathologist, gyn cases to gym pathologisT, etc, etc. Then you are running all over the floor tracking down these attendings. Once you sit down with the attending, you become their stenographer and write down what they dictate to you. The learning is extremely passive. You get, “this is fibromatosis” next slide- here you see a funding gland polyp, look at that cardiomyopathy, next case, etc. They assumed that by dictating diagnoses to residents as human dictataphones, we would absorb the info and match it to what the attending zooms by the slide stage.

One time the administrators wanted to remove the ditzels from our grossing case load. The chair didn’t even bother telling the PA’s and it was up to chief residents to train them. The PAs revolted and decided that they are getting screwed because “pathology residents don’t want to work.” This was a major contention in my last year. But it seemed the PAs were treated better than the residents.

When I came to the program, the residents told me that the chair is so well known, all he has to do is pick up a phone and get you a job. When it came my time to graduate, after 2 fellowships, he just told me to go pick up a phone and look for a job. I found NOTHING! Recruiters were useless, other institutions preferred their own grads and places like Quest said I “DID NOT HAVE ENOUGH EXPERIENCE”! What was the point of going to residency then? To cut dead meat, learn to transcribe quickly and collate the batches of papers and slides. Often I had orphaned paperwork where I spent all morning tracking down the slides, or vice versa- slides with no paperwork.

I finally found a gig at a Medicaid slide reading mill which I supplemented by tutoring college and high school students bio and English. It took over a year to finally find a full time pathology job.

 

[Alteran]

I felt my training was akin to being a glorified med secretary and advanced PA. The OR was very busy and you could find yourself grossing until midnight. Starting out, you would be trained by a senior pathologist. Sometimes the senior pathologist was in a sub specialty like cytology and had no clue how to help you. Then when you got your slides the next day, you were expected to match slides with paperwork and divide them up according to sub specialty attending: i.e., thyroid cases to ENT pathologist, GI cases to GI pathologist, junk cases like hernia sacs to the general pathologist, lung cases to the pulmonary pathologist, gyn cases to gym pathologisT, etc, etc. Then you are running all over the floor tracking down these attendings. Once you sit down with the attending, you become their stenographer and write down what they dictate to you. The learning is extremely passive. You get, “this is fibromatosis” next slide- here you see a funding gland polyp, look at that cardiomyopathy, next case, etc. They assumed that by dictating diagnoses to residents as human dictataphones, we would absorb the info and match it to what the attending zooms by the slide stage.

One time the administrators wanted to remove the ditzels from our grossing case load. The chair didn’t even bother telling the PA’s and it was up to chief residents to train them. The PAs revolted and decided that they are getting screwed because “pathology residents don’t want to work.” This was a major contention in my last year. But it seemed the PAs were treated better than the residents.

When I came to the program, the residents told me that the chair is so well known, all he has to do is pick up a phone and get you a job. When it came my time to graduate, after 2 fellowships, he just told me to go pick up a phone and look for a job. I found NOTHING! Recruiters were useless, other institutions preferred their own grads and places like Quest said I “DID NOT HAVE ENOUGH EXPERIENCE”! What was the point of going to residency then? To cut dead meat, learn to transcribe quickly and collate the batches of papers and slides. Often I had orphaned paperwork where I spent all morning tracking down the slides, or vice versa- slides with no paperwork.

I finally found a gig at a Medicaid slide reading mill which I supplemented by tutoring college and high school students bio and English. It took over a year to finally find a full time pathology job.

....and ACGME thinks this is perfectly acceptable for those of you who don't know (looking at you med students).

 

[Drifter76]

Shouldn't current pathologists be focusing on getting more US grads to get into the system to strengthen their voices regarding decreasing the training spots instead of dissuading them from entering into a pathology career? I mean what is the end game of private pathologists in dissuading US grads from entering the field? We already have 60-70% IMG trainees in pathology. If you convince every single US grad to not enter this field, do you think anything will be done differently? They would just hire 100% IMG trainees and these voices of dissent will dissolve completely. Being an IMG, I can tell you that even the worst and most toxic job environments that you guys describe are still better than what we have in our home countries. IMGs have and will keep bending to any and every demands of the employers if they could get a visa and/or green card sponsorship.

After what I have seen and experienced, encouraging medical students to go into pathology would be akin to encouraging someone to touch a hot stove or jump off a cliff.. would be immoral and unethical. Why would I do that? Maybe nothing will be done differently and the future of pathology is all IMGs working for big corporate entities. I agree that there is probably an almost unlimited supply of IMGs willing to come here and practice, in even the worst of our jobs. And that gets into a larger discussion about immigration. I think it would be true, for any profession, that if you allowed large numbers of foreign degree holders into the field, coupled with permissive immigration law, you could significantly denigrate the benefits of any profession here. If you routinely allowed immigrants who obtained a law degree abroad to sit for the bar in various states, if foreign dental school graduates were eligible to sit for boards and eligible to be licensed here without attending a U.S. dental school, vets, pharmacists etc. then the supply/demand of the job market for those professions would be shifted in a pretty significant way, to the detriment of all those entering the field here. In pathology under the current state, no matter how bad it gets, you can have your 600+ spots a year filled 100%, even if it ends up being 100% IMGs.
This system basically decouples supply from demand. Supply will remain very high, with 600 a year coming in, even if demand drops to the point where there are few jobs and the typical starting salary is bread crumbs.

 

[PATHDOCNYCNJ]

I'm one of the fortunate few to be in a partnership position where for the foreseeable future I'll be ok. Because of this pathologist surplus my group could, if we wanted to, hire newly minted pathologists for "partnership eligible" positions and then not renew their contracts prior to partnership only to just as easily find others to replace the FTEs - and we could probably do this for the next 30 years. All the while, I'd be billing over twice the RVUs from that pathologist than what I'm paying for that FTE. While my group doesn't do this, all the other groups around me do exactly that. One particular group has gone through 3 pathologists in ten years they supposedly promised partnership to. Another very large group with a near monopoly in a large and desirable metro area does the same thing. They hire you and if you don't bring in a new account or some business, your likely gone - as in your contract isn't renewed. If you happen to land an account they let you stay on without a significant bump in pay. And while you'll only be made a partner after one of the fixed number of partners retires, you're expected to still be earning for the group.

I'll just be straight up and say that if you're a medical student looking at pathology, I'd say please reconsider. Yes you will get a job, but you are increasingly unlikely to have a career and certainly increasingly unlikely to have any form of financial equity with respect to your work.

You hit the nail on the head 100%: pathology is a job, not a career and job security is non-existent. I worked at a community hospital where pay was so low that I had to hustle with side gigs in physician office labs. After working at that place for 15 years, a big name major hospital conglomerate took it over and then replaced all the pathologists with their own. There was no severance pay, and not one person in charge told me straight up that I would be unemployed July 1. I was forced to search for a new job and all the chair cared about was keeping me there until June 30 so they could squeeze the last drop of blood from me before throwing me to the curb. And even the chair in the hospital I was to attend next threatened to rescind the offer if I didn’t start on June 15. I was not a professional but a commodity, and had to choose between burning a bridge or destroying a job opportunity. But I needed the money so I chose the new hospital and ended up with a team comprising a toxic chair and colleagues humans. This job treated the pathologist as a dog and slide jockeys, and pitted pathologists against each other and shamed them for asking too many questions or being over 36 hours 0 minutes post-surgical benchmark with complex cases even if they were grossed by PA 24 hours post op.

I never felt that pathology was a career, just a job with no job security, where I needed side gigs to make ends meet.

 

[deleted314957]

You hit the nail on the head 100%: pathology is a job, not a career and job security is non-existent. I worked at a community hospital where pay was so low that I had to hustle with side gigs in physician office labs. After working at that place for 15 years, a big name major hospital conglomerate took it over and then replaced all the pathologists with their own. There was no severance pay, and not one person in charge told me straight up that I would be unemployed July 1. I was forced to search for a new job and all the chair cared about was keeping me there until June 30 so they could squeeze the last drop of blood from me before throwing me to the curb. And even the chair in the hospital I was to attend next threatened to rescind the offer if I didn’t start on June 15. I was not a professional but a commodity, and had to choose between burning a bridge or destroying a job opportunity. But I needed the money so I chose the new hospital and ended up with a team comprising a toxic chair and colleagues humans. This job treated the pathologist as a dog and slide jockeys, and pitted pathologists against each other and shamed them for asking too many questions or being over 36 hours 0 minutes post-surgical benchmark with complex cases even if they were grossed by PA 24 hours post op.

I never felt that pathology was a career, just a job with no job security, where I needed side gigs to make ends meet.

I notice in your post that it is all past tense and covers many years. Are you now retired or still in a morass or found anything better?

 

[PATHDOCNYCNJ]

I notice in your post that it is all past tense and covers many years. Are you now retired or still in a morass or found anything better?

These were events from 5+ years ago. I am in a better place, with better people in the path dept, but my institution as a whole is becoming “woke”(eg, journal club has been replaced with “anti-racism book club”). And I still have to hustle with side gigs to make ends meet (I am married with children, and don’t want to short change them). This gets demoralizing and difficult to do as I get into middle age. I plan on leaving the NY/NJ area ASAP.

 

[fecalith]

I dont understand where some people trained. At my program we gross max 5 hours a day (when on surg bench-subspecialty) on a worst day, we never gross on fridays. We have 6 PAs. All the paperwork is handled by secretaries, techs and other staff. We just receive the slides, preview (one day cycle). Done with sign out maximum by 12-1pm and then gross for a few and go home lol the gross room is spotless with amazing ventilation, u cant smell or feel the formalin. Most graduates are recruited from 3rd and 4th year. Many of the attendings did residency at the program. The program pays around 300k-350k for most of the attendings. I have seen it with my own eyes. I am not saying it is the best program in the country, but compare to these horror stories... it is amazing..!!

 

[deleted314957]

I dont understand where some people trained. At my program we gross max 5 hours a day (when on surg bench-subspecialty) on a worst day, we never gross on fridays. We have 6 PAs. All the paperwork is handled by secretaries, techs and other staff. We just receive the slides, preview (one day cycle). Done with sign out maximum by 12-1pm and then gross for a few and go home lol the gross room is spotless with amazing ventilation, u cant smell or feel the formalin. Most graduates are recruited from 3rd and 4th year. Many of the attendings did residency at the program. The program pays around 300k-350k for most of the attendings. I have seen it with my own eyes. I am not saying it is the best program in the country, but compare to these horror stories... it is amazing..!!

They train in one of a host of programs that have no need for residents other than having free labor. And the program directors and department heads have those folks cowed and completely under their thumb. The residents are not going to complain. Most are too passive and grateful to just be in the USA and have a residency. Any learning that occurs is by osmosis. Then they do two fellowships where the same rules apply (but less often or blatant) and the resident then gets to narrow their scope of what little ability they may have even further because the first 4 years were a bust. The end product is a gross monkey who knows very little about general AP, essentially nothing about CP and now has cytopath fellowship(🥳🤢) and surg path fellowship. Lest I forget, they have NEVER bottom-lined a report INDEPENDENTLY. Oh, and their experience in clinical medicine was 7 years ago presented to them in 6 or 7 passing exposures to several major specialties, each lasting a number of weeks. Their clinical colleagues know (and can tell) this.
Guess what comes out the end?

 

[PATHDOCNYCNJ]

They train in one of a host of programs that have no need for residents other than having free labor. And the program directors and department heads have those folks cowed and completely under their thumb. The residents are not going to complain. Most are too passive and grateful to just be in the USA and have a residency. Any learning that occurs is by osmosis. Then they do two fellowships where the same rules apply (but less often or blatant) and the resident then gets to narrow their scope of what little ability they may have even further because the first 4 years were a bust. The end product is a gross monkey who knows very little about general AP, essentially nothing about CP and now has cytopath fellowship(🥳🤢) and surg path fellowship. Lest I forget, they have NEVER bottom-lined a report INDEPENDENTLY. Oh, and their experience in clinical medicine was 7 years ago presented to them in 6 or 7 passing exposures to several major specialties, each lasting a number of weeks. Their clinical colleagues know (and can tell) this.
Guess what comes out the end?

“Any learning that occurs is by osmosis. Then they do two fellowships where the same rules apply (but less often or blatant) and the resident then gets to narrow their scope of what little ability they may have even further......The end product is a gross monkey who knows very little about general AP, essentially nothing about CP and....they have NEVER bottom-lined a report INDEPENDENTLY.”

THIS is the best description of pathology residency I have seen, and describes my program perfectly. A gross monkey/slide secretary was my skill set. All my scope diagnostic training I got on my first job and showing slides to older pathologists.

Yet when I applied to that program it was all “we have world-renowned pathologists, among the best in their fields, who provide you with knowledge and diagnostic skills the chairman is so well known he just has to pick up a phone to get you a job when you graduate.” I’ve gotten more honest pitches from used car salesmen.

 

[abc2019]

I dont understand where some people trained. At my program we gross max 5 hours a day (when on surg bench-subspecialty) on a worst day, we never gross on fridays. We have 6 PAs. All the paperwork is handled by secretaries, techs and other staff. We just receive the slides, preview (one day cycle). Done with sign out maximum by 12-1pm and then gross for a few and go home lol the gross room is spotless with amazing ventilation, u cant smell or feel the formalin. Most graduates are recruited from 3rd and 4th year. Many of the attendings did residency at the program. The program pays around 300k-350k for most of the attendings. I have seen it with my own eyes. I am not saying it is the best program in the country, but compare to these horror stories... it is amazing..!!

Where is this program?

 

[fecalith]

Where is this program?

New England

 

[abc2019]

New England

Which program?

 

[Iceman24]

After what I have seen and experienced, encouraging medical students to go into pathology would be akin to encouraging someone to touch a hot stove or jump off a cliff.. would be immoral and unethical. Why would I do that? Maybe nothing will be done differently and the future of pathology is all IMGs working for big corporate entities. I agree that there is probably an almost unlimited supply of IMGs willing to come here and practice, in even the worst of our jobs. And that gets into a larger discussion about immigration. I think it would be true, for any profession, that if you allowed large numbers of foreign degree holders into the field, coupled with permissive immigration law, you could significantly denigrate the benefits of any profession here. If you routinely allowed immigrants who obtained a law degree abroad to sit for the bar in various states, if foreign dental school graduates were eligible to sit for boards and eligible to be licensed here without attending a U.S. dental school, vets, pharmacists etc. then the supply/demand of the job market for those professions would be shifted in a pretty significant way, to the detriment of all those entering the field here. In pathology under the current state, no matter how bad it gets, you can have your 600+ spots a year filled 100%, even if it ends up being 100% IMGs.
This system basically decouples supply from demand. Supply will remain very high, with 600 a year coming in, even if demand drops to the point where there are few jobs and the typical starting salary is bread crumbs.

Guess what, foreign vets, pharmacists, and dentists are able to be licensed in the states without going to the schools, yet the job prospects in these fields are way superior than in path.

 

[deleted314957]

Guess what, foreign vets, pharmacists, and dentists are able to be licensed in the states without going to the schools, yet the job prospects in these fields are way superior than in path.

FWIW I hear dentistry and vet med are cut throat.

 

[Sawback3]

Sounds like Mount Sinai? Could be anywhere though...

I felt my training was akin to being a glorified med secretary and advanced PA. The OR was very busy and you could find yourself grossing until midnight. Starting out, you would be trained by a senior pathologist. Sometimes the senior pathologist was in a sub specialty like cytology and had no clue how to help you. Then when you got your slides the next day, you were expected to match slides with paperwork and divide them up according to sub specialty attending: i.e., thyroid cases to ENT pathologist, GI cases to GI pathologist, junk cases like hernia sacs to the general pathologist, lung cases to the pulmonary pathologist, gyn cases to gym pathologisT, etc, etc. Then you are running all over the floor tracking down these attendings. Once you sit down with the attending, you become their stenographer and write down what they dictate to you. The learning is extremely passive. You get, “this is fibromatosis” next slide- here you see a funding gland polyp, look at that cardiomyopathy, next case, etc. They assumed that by dictating diagnoses to residents as human dictataphones, we would absorb the info and match it to what the attending zooms by the slide stage.

 

[Drifter76]

Guess what, foreign vets, pharmacists, and dentists are able to be licensed in the states without going to the schools, yet the job prospects in these fields are way superior than in path.

There may be occasional cases of that- but there must be some significant barriers because it doesn’t happen nearly to the extent that it happens in medicine. Some of that may vary by state, with a few states being more lenient in those fields. I personally have never met a foreign vet school grad or dental, or law school grad practicing those fields in the U.S., but foreign educated physicians are obviously numerous. If you want more of an apples to apples comparison, you could allow 2 foreign dental school graduates to be licensed to practice dentistry in the U.S. for every one US graduate (akin to the approximately 2:1 ratio of IMGs to US students filling pathology spots in the match every year), let that go on for a couple of decades, and see what it does to the market in dentistry.

 

[Iceman24]

There may be occasional cases of that- but there must be some significant barriers because it doesn’t happen nearly to the extent that it happens in medicine. Some of that may vary by state, with a few states being more lenient in those fields. I personally have never met a foreign vet school grad or dental, or law school grad practicing those fields in the U.S., but foreign educated physicians are obviously numerous. If you want more of an apples to apples comparison, you could allow 2 foreign dental school graduates to be licensed to practice dentistry in the U.S. for every one US graduate (akin to the approximately 2:1 ratio of IMGs to US students filling pathology spots in the match every year), let that go on for a couple of decades, and see what it does to the market in dentistry.

I was responding to original claim that " if foreign dental school graduates were eligible to sit for boards and eligible to be licensed here without attending a U.S. dental school, vets, pharmacists etc."
And my statement is that they are eligible to sit for the boards without going to US schools.
Apparently, there are some barriers, as well as barriers for foreign doctor to sit for the board as well.