Help needed deciding whether pathology is for me

[path or no path]

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Hi all,

I am a senior at a decent US allopathic med school. Just went through the match, and unfortunately didn't match into derm and at this point contemplating switching gears. I have basically narrowed down my choices to path (in hopes of pursuing dermpath) vs. medicine. Below are some of my pro's vs. con's for each field:

medicine
pros: very broad knowledge base, have to know at least something every disease in adults
- get personal satisfaction (at least once in a while) from making people feel better
- ample opportunities to subspecialize: my favorites include allergy/immuno vs. GI
- only 3 years of training and excellent job market even in most desirable places

cons: really really annoyed by endless paperwork (h&p, progress note, transfer note, discharge note...) you get the idea
- can't stand having to deal with social/dispo issues
- have little patience for noncompliant/difficult patients
- don't enjoy teasing out parts of HPI out of patients who are "poor historians" and having to redirect 20 times
- don't like being primary team and having to coordinate/track down specialists, social work, family members etc.
- hate the mentality of medicine being the dump for other services
- dislike the idea of being a "generalist" jack of all trade master of none

path
pros: love the microscope, love histology, love all sorts of stains
- love being the final say in a diagnostically difficult case
- really appreciate the scientific/intellectual aspect of being the ultimate diagnostician

cons: JOB MARKET JOB MARKET JOB MARKET. The idea of spending 5+ years in residency and not being able to find a good job in the location of my choosing really scares me. One resident I've spoken with said that it is mostly FMGs who are struggling due to language or cultural issues. Not sure what the reality is since I am a lowly MS4.
- the yuck factor, not sure how I'll handle autopsies
- not sure if going to miss patient contact

Please feel free to chime in and correct any inaccuracies or misconceptions in the above list. I would greatly appreciate any input. Thanks

 

[MirkoCrocop]

If you like being around relatively intellectually-nonstimulating peers, spending a significant chuck of residency studying a subject (clinical pathology) that you dislike and won't practice for the most part, realize that you'll need multiple fellowship to compete for your first job, feeling insecure that you'll even find a decent job, feeling insecure that you'll be able to pay back your student loans in the next 15 years, feeling insecure that you'll be able to live in the region you'd like to, and acquiesce to that fact that you'll eventually get poop in your mouth at some point in residency, then YES, by ALL MEANS, pathology is for you!

 

[thebouque]

The message above is extremely biased. Did you try an elective in pathology? Couldn't you do 1 year of internship, try a path elective and reapply?

 

[path or no path]

The message above is extremely biased. Did you try an elective in pathology? Couldn't you do 1 year of internship, try a path elective and reapply?

I have a path elective next. I am somewhat geographically restricted, and it's going to be hard finding a medicine prelim position in my region. My plan is to do research for a year, maybe do an away or two and reapply.

 

[pathstudent]

If you are inclined at all I would do one of the surgical subspecialties (urology, spine, neuro, thoracic, ortho, hand, ent, gyn-onc, optho, etc...) they reall rule the roost. They hire pathologists, anesthesiologists, and/or hospitalists and take a cut of their professional fee. They are heavily recruited and romanced by hospitals. They build their own surgical centers and sometimes hospitals and make megabucks off those. Large community hospitals pay them 2k a night to take call. A few local urologists who have a huge urology center making money off their path lab and pathologists are also paid 40k a year by a local community hospital to be "directors" of robotic surgery. It is all payola but they are the ones that stir the drink. If you love medicine and domt mind working hard and if you want a rewarding career with lots of security and great compensation, that is the way to go. That's what I would do if I could do it again.

 

[Arctic Char]

edit

 

[path or no path]

If you are inclined at all I would do one of the surgical subspecialties (urology, spine, neuro, thoracic, ortho, hand, ent, gyn-onc, optho, etc...) they reall rule the roost. They hire pathologists, anesthesiologists, and/or hospitalists and take a cut of their professional fee. They are heavily recruited and romanced by hospitals. They build their own surgical centers and sometimes hospitals and make megabucks off those. Large community hospitals pay them 2k a night to take call. If you love medicine and domt mind working hard and if you want a rewarding career with lots of security and great compensation, that is the way to go. That's what I would do if I could do it again.

Thanks for sharing your perspective. Unfortunately (or maybe fortunately) I am not really interested in anything surgical. Nor would I be competitive for any of the surgical subspecialties...

 

[path or no path]

if you want to struggle through an undignified residency for 5 years (assuming fellowship) and live in fear and frustration . . . do path. the residency blows, despite path being the best field in medicine IMHO. the training sucks, but it just might be worth it if you can swallow your pride for, well, the rest of your life

Can you elaborate on this? Do you mean the low prestige of path among other specialties?

 

[Arctic Char]

edit

 

[path or no path]

no dude, we get mad respect from clinicians and surgeons (most of the time) because they cant move without our input. but swallowing the pride is a consequence of the fact that just when you feel comfortable with something, you'll get thrown a curveball that will totally shatter your confidence. human biology is a weird world, and we're responsible for understanding it. it isn't always easy. therefore, senior pathologists will always look at a young trainees with nothing but disregard, no matter how smart you are. medicine is all about experience, and pathology is a shining example. so during your training years, you'll feel like you're trying to become a gourmet chef while being given the duties of a waiter. couple this with a bleak job market, and you'll be acting like that annoying waiter with a smile too big for the disdain that truly lays beneath

you see these are all aspects of path that appeal to me, I like the fact that you constantly have to learn and be humble about how much you know.... my biggest hesitation about path is questionable job market

 

[mlw03]

You're pros and cons list for both specialties seems pretty reasonable. No one on here can answer those questions for you. If you are geographically restricted, path is a risky bet to make. While there do seem to be jobs out there, in any given location there may not be; it's not like primary care, where you can go anywhere in the western world and find work fairly easily. for what you describe, it sounds like IM is the safer/smarter bet. you have a year or two to decide if you want to stay primary (hospitalist or outpatient) vs specialize, and the job market in IM is better than in path - period.

 

[BU Pathology]

It is important to look at the facts about the job market, to dispel the internet rumors about the poor job market. You will find useful information in the attached file, 2011 Resident Forum slides. The job market survey was based on responses from 905 pathologists, which is a much larger sample than the number of postings on this website saying that no jobs are available. The job survey information starts with slide 60. The entire slide deck was too large to upload, so those slides related to the job market were extracted.

Briefly, based on this survey last year done by the College of American Pathologists:

Everyone got a job.

If you look carefully at slide #68, you will notice that
100% of the respondents were invited to at least 1 job interview
100% received at least one job offer
100% of respondents accepted the position

In other words:

Everyone got a job.

This should reduce the anxiety of medical students considering pathology as a career, who are concerned about the postings on the job market on this web site. There will be some who may disparage the survey saying that the jobs are not good enough, that not enough jobs are partner track, that free parking was not included. But at the results of the survey show,

Everyone got a job.

The survey also covers the past 2 years, and it includes participants from US allopathic schools, osteopathic schools, and international medical schools. The results show:

Everyone got a job.

To those considering pathology as a career, you will find it rewarding, challenging and extremely satisfying. During a time period when unemployment in the United States rose dramatically, everyone finishing pathology training were successful in finding a position.

Daniel Remick, M.D.
Chair and Professor of Pathology
Boston University School of Medicine and Boston Medical Center

 

[gbwillner]

medicine
pros: very broad knowledge base, have to know at least something every disease in adults
- get personal satisfaction (at least once in a while) from making people feel better
- ample opportunities to subspecialize: my favorites include allergy/immuno vs. GI
- only 3 years of training and excellent job market even in most desirable places

cons: really really annoyed by endless paperwork (h&p, progress note, transfer note, discharge note...) you get the idea
- can't stand having to deal with social/dispo issues
- have little patience for noncompliant/difficult patients
- don't enjoy teasing out parts of HPI out of patients who are "poor historians" and having to redirect 20 times
- don't like being primary team and having to coordinate/track down specialists, social work, family members etc.
- hate the mentality of medicine being the dump for other services
- dislike the idea of being a "generalist" jack of all trade master of none

path
pros: love the microscope, love histology, love all sorts of stains
- love being the final say in a diagnostically difficult case
- really appreciate the scientific/intellectual aspect of being the ultimate diagnostician

cons: JOB MARKET JOB MARKET JOB MARKET. The idea of spending 5+ years in residency and not being able to find a good job in the location of my choosing really scares me. One resident I've spoken with said that it is mostly FMGs who are struggling due to language or cultural issues. Not sure what the reality is since I am a lowly MS4.
- the yuck factor, not sure how I'll handle autopsies
- not sure if going to miss patient contact

I had the same decision to make as you (except I never thought about derm). Ultimately, I felt that my inability to empathise with 60 YO patients who are drinking themselves to death would be too frustrating, and the spectrum of disease would be (usually) limited enough to make me bored with medicine too rapidly. I also loved patient interaction and the immediate satisfaction you could (sometimes) get from truly helping someone. I worried I would miss it in choosing pathology. After my sub I in medicine I just beleived that the endpoint for IM could never really be to make someone better (impossible much of the time), but to see how quickly you could get them discharged. Even still, I thought I wanted to do a 1-year prelim in IM, just for the experience (luckily I was convinced not to go through with it).

I chose pathology because the spectrum of disease is far more complex and keeps you interested daily. The satisfaction from personally helping someone is replaced by the satisfaction of making a difficult or rare diagnosis. All the interesting cases seen in the hospital every week are somehow routed through pathology. Every now and then you might DX a sarcoma or something else rare that excites the clinicalteam for a month - that becomes a daily blip on the radar screen in path.

I won't lie- I DID miss (and still do to some extent) patient interaction, but this really wanes over time. You get busy and interested with other aspects of patient care. You do have some opportunities to work directly with patients, either in CP (blood bank/transfusion/pheresis) or AP (FNA/cytopathology). It is no substitute for primary care, however. I also had similar misgivings about autopsy- but once I started, I realized I actually really enjoyed it.

RE: the job market, you have to realize a few things. First, there is a need for a lot of IMs because they can only see so many patients in a day and have to cover everything from cancer to a flu. Only a small percentage of (I would say the interesting) cases make it to pathology, meaning there aren't as many pathologists needed across the country. In smaller markets there could be just 1-2 groups with 3-6 pathologists each serving the entire area, and if they are not hiring you will simply never got a job there. There are enough IMs in every market that it's more of a rotating door of doctors. That's just the nature of these specialties. Second, some people biatch and moan about the job market on the internet mainly because they feel undercompensated for their work and blame it on a glut of graduating residents/fellows (which may or may not be justified), or they don't understand the point above. Third, as an ancillary service we are also at the whim of referring clinicians, who sometimes use this fact to take advantage of our specialty (see GI/GU), and large corporations who buy private groups and "steal" value. This drives down salaries for our specialty, as it is becoming increasingly difficult to own your own practice and work as an employee for Quest. Of course, many of these concerns are limitied ONLY to private practice, and if you are interested in academia there is absolutely no problem with the job market.

I am glad I chose pathology, but I'm sure that if I had chosen medicine I would be equally as happy (I'm just that sort of guy). But I comforted by the better lifestyle we get along with the equal (or slightly higher) compensation.

 

[Pathguy11]

I am beginning to think this job market thing is a bit blown out of proportion. My observations over the past few years:

-ALL of the qualified fellowship trained Pathologist I have known from my program and others have successfully found a job in the past 3 years. Actually, I don't know of anyone who didn't find a job and I have trained at 3 different large programs in the last few years,including residency and two fellowships

-You may have to be flexible on your location. I do know of many people who would have liked to have stayed in the city of their choice but that is not realistic, fo ANY specialty many times. While a few fellows picked their city of choice, I do know several Pathology fellows who ended up finding jobs in other areas of the state of their choice. Some ventured outside the state because they wanted to or had to. This is also true of some other specialties in my area. I have spoken to several interventional radiology fellows who have said the job market in certain cities is very competitive and thus they had to go to other areas of the state. The same is true for OB/GYN in which my wife is now practicing. Several of her colleagues out of residency would like to have stayed in a particular locations after training but had to find positions in other areas of the state or country. This is a recurring theme in many specialties...probably less so in some primary care fields

-Do not expect to he "courted" by groups straight out of residency. Sure it can happen, but most of the time you will need at least one fellowship. In general Pathology is now 5 to 6 years of training, not 4. Of course someone on here will chime in that they got a job right out of residency but that is still the exception, not the rule

-Reputable training, good people/communication skills, and leadership skills will then help you be more competitive in the job market. Most of the groups that I interviewed with wanted someone who would fit in well with their groups and be a future leader (assuming partnership track). Assuming you trained at decent residency and fellowship programs, your skills should be on par with anyone fresh out of training. Most groups understand this and do remember what it is like to be new in practice. Guess what? It is NOT just Pathology. My wife as a new OB/GYN is constantly asking her more senior partners their opinion on all kinds of things. This is the same for everyone she knows from her residency class. It is also true of our good friend who is a newly practicing Pediatrician. That does not mean you were not well trained, but rather you know your limitations. One of the biggest strengths a Pathologist can have is knowing when NOT to be a hero and ask for a consult

Anyway, this is my 2 cents worth. I agree with other people on here that you should do an elective or two, or even shadow some Pathologists before making the decision. I personally don't regret my decision to go into Path. I like what I do and will be reasonably compensated for it.

Pathguy11

 

[Euchromatin]

I just wanted to chime in and say that I have actually been enjoying my pathology residency. I'm not sure how much of it is related to the fact that I am in a "resident-friendly" residency program that gets plenty of interesting cases or the fact that I couldn't imagine doing any other field of medicine after my first path elective in med school or what.

Compared to a residency in pretty much any other field, the hours and lifestyle are great. I enjoyed the rather sharp learning curve at the beginning of surgical pathology training and the fact that we need a very broad knowledge base (one of your "pros" for IM, actually) - I want a career that is intellectually stimulating. I don't even mind the CP training, frankly. Hospital autopsies are not my favorite thing in the world, but I'd rather be doing that than admitting, rounding on, discharging, etc. patients on the floor (or most things in clinical medicine for that matter).

 

[rollwithit]

It sounds like a lot of folks are bitter that they aren't heavily recruited fresh out of residency like some of their former classmates may be. Pathology is a different beast in that its nature lends itself into being commodotized. That can't happen with surgery, IM, anesthesia, etc. It's simple logistics.

As a result, the training pathologist has to market themselves more intensely to make themselves known since it's not life/death scenario for a practice/department to fill a need with a new pathologist. It literally may be a life/death scenario for filling needs in other specialties, so practices/departments have to turn up the heat and go out and recruit hard to get qualified people.

Part of this has to be the supply side, no doubt about it. Pathologists would have a better chance at being "heavily recruited" if there were less of them - that is fact. However, the fact that a group with a need can more easily take their time in finding the right person to hire can also make it less likely that a newly trained pathologist won't have multiple practices fawning over them. They have the luxury of letting the talent come to them and tell them why they should be hired.

Combo this with the stereotypical pathology personality (self promotion not being a strong suit) and a well known forum to voice displeasure and you will get some loud messages about how bad the market it.

Instead of calling it a "bad market", it's likely more fair to simply acknowledge why the pathology market is different due to the field's inherent uniqueness compared to other specialties. These are known differences to anyone going into the field, so it's a little shortsighted to get overly pissed about it when the reality of it does set in.

 

[mlw03]

I agree with pathguy's comments, and think makes some excellent points. I think Dr. Remick is painting a bit too rosy of a picture, and would respond by saying we're not claiming there are no jobs out there, rather we are claiming that being a pathologist means you probably will not have the geographic flexibility of a primary care physician. So if you really, really care about location, pathology probably isn't for you. I'm a forensic pathologist, and we have a decent job market overall, but again, you have to be willing to move to where the job is. You may want to live in Blacksburg, VA really badly, but that's just not going to happen in FP without a massive commute because VA has a regional ME system and there isn't an office in Blacksburg - period. That's just a random example to make a point. Community pathologists may have it a little better since at least most decent-sized communities have a hospital that needs some type of pathology service.

The OP said finding a job in the location of their choosing is high priority to him, and if that's the case, how can anyone in good faith recommend they do pathology over primary care?

 

[Enkidu]

I agree with pathguy's comments, and think makes some excellent points. I think Dr. Remick is painting a bit too rosy of a picture, and would respond by saying we're not claiming there are no jobs out there, rather we are claiming that being a pathologist means you probably will not have the geographic flexibility of a primary care physician. So if you really, really care about location, pathology probably isn't for you. I'm a forensic pathologist, and we have a decent job market overall, but again, you have to be willing to move to where the job is. You may want to live in Blacksburg, VA really badly, but that's just not going to happen in FP without a massive commute because VA has a regional ME system and there isn't an office in Blacksburg - period. That's just a random example to make a point. Community pathologists may have it a little better since at least most decent-sized communities have a hospital that needs some type of pathology service.

The OP said finding a job in the location of their choosing is high priority to him, and if that's the case, how can anyone in good faith recommend they do pathology over primary care?

Is the primary complaint about Pathology that, although you will get a job, it may not be where you want, and although you will be paid more than an internist, it won't be as much as you would like, even though you have great hours and lifestyle?

Everybody seems to agree that the actual diagnostic (or forensic) work of pathology is challenging and interesting, so the question essentially boils down to having an interesting job in a boring place vs having a boring job in an interesting place.

My sense is that once you have kids, there is no benefit in living in an interesting metropolitan place, because you'll be spending all of your time with the kids. At least that's how it is for me. I vote for pathology.

 

[WEBB PINKERTON]

It is important to look at the facts about the job market, to dispel the internet rumors about the poor job market. You will find useful information in the attached file, 2011 Resident Forum slides. The job market survey was based on responses from 905 pathologists, which is a much larger sample than the number of postings on this website saying that no jobs are available. The job survey information starts with slide 60. The entire slide deck was too large to upload, so those slides related to the job market were extracted.

Briefly, based on this survey last year done by the College of American Pathologists:

Everyone got a job.

If you look carefully at slide #68, you will notice that
100% of the respondents were invited to at least 1 job interview
100% received at least one job offer
100% of respondents accepted the position

In other words:

Everyone got a job.

This should reduce the anxiety of medical students considering pathology as a career, who are concerned about the postings on the job market on this web site. There will be some who may disparage the survey saying that the jobs are not good enough, that not enough jobs are partner track, that free parking was not included. But at the results of the survey show,

Everyone got a job.

The survey also covers the past 2 years, and it includes participants from US allopathic schools, osteopathic schools, and international medical schools. The results show:

Everyone got a job.

To those considering pathology as a career, you will find it rewarding, challenging and extremely satisfying. During a time period when unemployment in the United States rose dramatically, everyone finishing pathology training were successful in finding a position.

Daniel Remick, M.D.
Chair and Professor of Pathology
Boston University School of Medicine and Boston Medical Center

Sound like a broken record. There are jobs available but you will be slaving for Ameripath or another entity. If that sounds good to you, then go into pathology. Since you like to show statistics so much BU PATHOLOGY, show the stats on how many more cases pathologists are now signing out each year. That number has increased dramatically. Some of the work we do is now under fire (too much screening etc) so specimens will be on the decline.

I couldnt recommend pathology as a career to anyone. Unlike other specialists, you will have NO JOB SECURITY and you will be competing with EVERY pathologist in the country.

 

[Torsed]

I am glad I chose pathology. Its not an easy road in any training program and I would recommend going to a program that has a good record of board pass rates and reputable to help you get a good fellowship. Since (like everyone else on the planet) you mentioned Dermpath I would HIGHLY RECOMMEND you go to a residency program with a dermatopathology fellowship so you can get a foot in the door, and start working on derm path research from the beginning of your training to get some articles under your belt. Be warned though, everyone harps dermatopathology as some nice, high paid cushy job above the others, but I assume its a high stress job, even with the proper training, I am glad that others do it and not myself.

There is no point in worrying about the job market right now, you still have 5 years at least before you get out and you can't even begin to predict the whys and wherefores of the location you might end up in. I didn't get my job until 5 months prior to fellowship ending and everyone I knew of in training at several institutions all got jobs ("good" is a relative term).

Good luck in your endeavors.

 

[Pathguy11]

Sound like a broken record. There are jobs available but you will be slaving for Ameripath or another entity. If that sounds good to you, then go into pathology. Since you like to show statistics so much BU PATHOLOGY, show the stats on how many more cases pathologists are now signing out each year. That number has increased dramatically. Some of the work we do is now under fire (too much screening etc) so specimens will be on the decline.

I couldnt recommend pathology as a career to anyone. Unlike other specialists, you will have NO JOB SECURITY and you will be competing with EVERY pathologist in the country.

I couldn't DISAGREE MORE! Does this person actually know what the heck he is talking about. Only a minority of Pathologist actually practice in the sort of setting described by the biased response. I am not sure what the status as "health student" means but I wouldn't put a whole lot of weight in this response.

Pathguy11

 

[Pathwrath]

- hate the mentality of medicine being the dump for other services
- dislike the idea of being a "generalist" jack of all trade master of none

This is also a fair description of a community general surgical pathologist. I would highly recommend investigating the field more before jumping in.

 

[path24]

Sound like a broken record. There are jobs available but you will be slaving for Ameripath or another entity. If that sounds good to you, then go into pathology. Since you like to show statistics so much BU PATHOLOGY, show the stats on how many more cases pathologists are now signing out each year. That number has increased dramatically. Some of the work we do is now under fire (too much screening etc) so specimens will be on the decline.

I couldnt recommend pathology as a career to anyone. Unlike other specialists, you will have NO JOB SECURITY and you will be competing with EVERY pathologist in the country.

I agree. Job security is not in pathology...makes it tough on a family, buying a house, student loans...etc. Pathologists are a dime a dozen. It is painfully obvious. Not one location in the entire US has an issue hiring a pathologist (seriously name one if anyone can). No matter how remote. A study that asks pathologists with jobs if they have a job....wow great study. He didn't seem to mention he had 37 applicants for his one job opening. What are the odds for medical school spots?

No way would I recommend pathology to anyone. Pathologists are commodities...just bought and sold by other old pathologists or mbas. Its all contracts...we don't control the patient....hence we don't control much of anything. No job security.

 

[mlw03]

This sounds like all the discussions we get into on here about the job market. Some folks say it sucks, a few say it's great, and we never get anywhere. It's like politics - people tend to polarize their views and moderates get pinched out. I think the reality is somewhere in the middle. Pathology jobs are not going away - we provide a valuable service to patient care and the healthcare system. But there seem to be a few too many of us, which isn't great for the job market. The mass retirement of older pathologist that was predicted does not seem to have yet occurred. Who knows if it ever will? I do agree with path24 that our job security is a bit less since we do not directly bring in much revenue and are dependent on surgeons and clinicians for the specimens we work up and bill for.

The OP has to weigh all of these factors, along with what he actually finds professionally satisfying, and decide what's best for him and his family.

 

[Pathguy11]

This sounds like all the discussions we get into on here about the job market. Some folks say it sucks, a few say it's great, and we never get anywhere. It's like politics - people tend to polarize their views and moderates get pinched out. I think the reality is somewhere in the middle. Pathology jobs are not going away - we provide a valuable service to patient care and the healthcare system. But there seem to be a few too many of us, which isn't great for the job market. The mass retirement of older pathologist that was predicted does not seem to have yet occurred. Who knows if it ever will? I do agree with path24 that our job security is a bit less since we do not directly bring in much revenue and are dependent on surgeons and clinicians for the specimens we work up and bill for.

The OP has to weigh all of these factors, along with what he actually finds professionally satisfying, and decide what's best for him and his family.

Agreed. Finally someone who seems to be able to look at thing logically and objectively. Most comments on this and other threads seem to be extremist rants, as opposed to actually trying to provide the OP with some helpful information.

Pathguy11

 

[2121115]

To the OP, pathology is not a good fit for you. You should look at other specialties. I'm being serious (and not because of the reasons stated in the above posts).

 

[thebouque]

To the OP, pathology is not a good fit for you. You should look at other specialties. I'm being serious (and not because of the reasons stated in the above posts).

What's the reason then if it's not one those stated above? I think the OP's list of pros and cons for path and internal is very good and realistic, the only thing he needs is an elective and he's planning to do one soon.

 

[scienceguy19]

There are two schools of thought on the future of the job market.

Reasons for a better market: 1) The average age of pathologists is older, therefore impending retirements. 2) Obamacare, leading to more patients 3) Patient population getting older 4) Increased analysis performed on specimens (molecular.. etc.) 5) Possible increased role of pathologists in guiding clinical testing due to accountable care organizations

Reasons for a worse market: 1) Stock market is down, therefore fewer retirements than anticipated 2) Obamacare, leading to more rationing of care (fewer specimens sent per patient, fewer tests per patient) 3) Molecular/genomic and automated high throughput testing will replace traditional diagnostic modalities leading to a smaller need for pathologists 4) Telepathology leading to increased competition nationally and internationally among pathologists 5) Increase of 'factory mill' type of jobs (podlabs and corporate labs) leads to increased productivity per pathologist.

Personally, I'm worried about finding a desirable job. For me, desirable means one that is in a specific geographic location (due to family), appropriate pay reflective of my level of education and medical training, and in my specialty of practice. A survey that asks people who are already practicing pathology whether they got a job is not very reassuring (the study design is inherently biased), especially when many people only got 1 job.

Even many unemployed people in America can get jobs if they wanted to, but they choose not to because they want jobs which make use of their training with salaries reflective of their level of training. I'm sure most lawyers don't want to be elementary school teachers. A pathologist doing a fellowship in blood bank or gyn pathology probably wants to a job in those respective fields. I'm sure a starting pathologist doesn't want to make the same salary as someone who just graduated from 3 years of law school or a college graduate working for facebook. Anyway, I have to say that job security in pathology is probably on the low end for medical specialties probably. It's unfortunate because I also find pathology to be the most interesting field (except for the autopsies).

What's the reason then if it's not one those stated above? I think the OP's list of pros and cons for path and internal is very good and realistic, the only thing he needs is an elective and he's planning to do one soon.

 

[thebouque]

Thanks for the reply but I wasn't talking about the job market

 

[Tissue issue]

　
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• "4,025 newly trained pathologists in practice less than 3 years received the survey"
  

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As has been stated multiple times before by multiple people, this survey was sent to pathologists who already had a job - they are "in practice". I don't want to get back into this job market argument, but this survey is specious.










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• 
  
  
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</dir></dir></dir>

 

[path or no path]

To the OP, pathology is not a good fit for you. You should look at other specialties. I'm being serious (and not because of the reasons stated in the above posts).

why not?

 

[path or no path]

I know for example, if you are a hospitalist in private practice, you can "eat what you kill", meaning the more patients you see the more you bill for, the more shifts you do, the more you can make at the end of the day. Is such "eat what you kill" type of practice possible with path? The more you sign out the more you make?

Thanks for all the great comments!

 

[scienceguy19]

Yes if you had more specimens, you would sign out more, and get paid more in the right setting.

The problem is not enough specimens per pathologist. We don't have the luxury of other fields to work as much as we want because of oversupply of pathologists relative to other medical specialists. Of course, if you work in academics, it's different story, and you can always do more research.

I know for example, if you are a hospitalist in private practice, you can "eat what you kill", meaning the more patients you see the more you bill for, the more shifts you do, the more you can make at the end of the day. Is such "eat what you kill" type of practice possible with path? The more you sign out the more you make?

Thanks for all the great comments!

 

[gbwillner]

No way would I recommend pathology to anyone. Pathologists are commodities...just bought and sold by other old pathologists or mbas. Its all contracts...we don't control the patient....hence we don't control much of anything. No job security.

How can you say this as a Path resident? why don't you quit and try something else if you feel the future is so bleak?

 

[Pathguy11]

How can you say this as a Path resident? why don't you quit and try something else if you feel the future is so bleak?

I agree!

Pathguy11

 

[path24]

How can you say this as a Path resident? why don't you quit and try something else if you feel the future is so bleak?

I am not a path resident...never changed the title. A lot of pathologists would like more work and we are fighting over it. (It would be interesting to know the number of underemployed pathologists...quite a few I would guess). A pathologist just doesn't quit there job and go down the street and practice at the next hospital....like the rest of medicine.

Ultimately this is a job and its for a paycheck. Pathologists are vastly oversupplied. Pathology is not a good choice...now or in the future. (Would love to be proved wrong, but no reason/evidence to believe otherwise)

 

[Sulfinator]

I am not a path resident... Pathologists are vastly oversupplied. Pathology is not a good choice...now or in the future. (Would love to be proved wrong, but no reason/evidence to believe otherwise)

No reason to try to prove this one way or the other with you . . . you are not in this field.

 

[gbwillner]

No reason to try to prove this one way or the other with you . . . you are not in this field.

I thought he was implying he is a practicing pathologist and not a resident....

 

[2121115]

why not?

I have seen this scenario many times. Yours is a classic story in pathology residency applications. I have never seen someone who applied to dermatology and didn't match, then applied to pathology with the intent of only doing dermpath, do well in pathology. It just doesn't work. They essentially always burn out in the first year and quit or become really unhappy. But it is really common to not match in dermatology and then try to do pathology with the intent of doing dermpath as a "back up plan". Savvy PD's and programs see straight through this.

Look. Pathology was not your first choice. It is not an easy residency; it is advertised as such, but trust me high volume surgical pathology is not easy and you will likely hate it. Again, I don't know you, but I've seen this same story 1000 times at least and it always ends the same way. Just do a transitional year and then re-apply to dermatology. You will be much happier chasing your true dream.

 

[path or no path]

I have seen this scenario many times. Yours is a classic story in pathology residency applications. I have never seen someone who applied to dermatology and didn't match, then applied to pathology with the intent of only doing dermpath, do well in pathology. It just doesn't work. They essentially always burn out in the first year and quit or become really unhappy. But it is really common to not match in dermatology and then try to do pathology with the intent of doing dermpath as a "back up plan". Savvy PD's and programs see straight through this.

Look. Pathology was not your first choice. It is not an easy residency; it is advertised as such, but trust me high volume surgical pathology is not easy and you will likely hate it. Again, I don't know you, but I've seen this same story 1000 times at least and it always ends the same way. Just do a transitional year and then re-apply to dermatology. You will be much happier chasing your true dream.

While dermpath would be nice, I realize it's very competitive and don't have my heart set on it going into path. I've listed the aspects of path that appeal to me above. At this point I am trying to explore whether I'd enjoy path as a career.

And who cares if path wasn't my first choice. Maybe it was blessing in disguise and I would be terrific at path and very happy and satisfied doing it. That's what I am trying to determine at this time.

 

[WEBB PINKERTON]

I couldn't DISAGREE MORE! Does this person actually know what the heck he is talking about. Only a minority of Pathologist actually practice in the sort of setting described by the biased response. I am not sure what the status as "health student" means but I wouldn't put a whole lot of weight in this response.

Pathguy11

We are always health students. I learn something everyday.

Its not biased at all. Its the reality of my area. Hell, maybe its sangri la in the next state over but I highly doubt it. Last time I checked, the ONLY job in my area was with Ameripath. I've watched quite a few young pathologists get shown the door in recent years thanks to selling out/hospital mergers/deciding to rent a path from Ameripath etc. I am fortunant to have a job but surgical volumes are dropping. Despite barely hanging on we get cold calls all the time from pathologists looking for work. Its pathetic. Look at how many NEW AP labs are being started that arent in-office labs. You can probably count on one hand the number. Not exactly a lot of competition for talent going on in pathology. We are a dime a dozen and nobody cares cause we are faceless. If you go into pathology, plan on moving is all I got to say. You will be bought and sold and have NO CONTROL over your fate.Luckily I have been transitioning to farming and that is what I will do in the future. Much rather be a farmer.

Hell, I saw a urologist get caught with 20 pot plants and still get hired on at a different hospital in the SAME area. Guess I am jealous that their market is so good and ours sucks all the time.

 

[lipomas]

Um yeah, well if the deciding factor on whether you want to be a pathologist is some anonymous blather on an internet forum where people say the job market isn't great I think that is a sign that you should not be a pathologist. If your deciding factor was anonymous blather saying the job market is great that is also a sign you shouldn't be a pathologist.

Main point: Don't let job market rumors and complaints sway your decision because frankly they should be essentially irrelevant to you. Whatever problems the job market in pathology has it is still vastly better than the majority of professions in this country. What are you going to do, go to law school? Unless you go to harvard/yale you are looking at a 50% unemployment rate. MBA? Unless you have connections or something to recommend you you are looking at the same jobs as thousands of others, many of whom are willing to work 120 hours a week for little pay just to get a potential better opportunity later on. The unemployment rate for COMPETENT pathologists is essentially 0%. What, you say jobs aren't as good as they used to be? Join the club for every single career in the world except for things associated with professional athletics or creating an internet business that someone can buy.

Dude above says he is going to be a farmer. OK buddy. Let us know how that works out. You can have a great life as a farmer if you own several of them as part of a corporation. You gonna own a family farm and work it? Enjoy your 20 hours days. The ONLY way to be a successful small farmer these days is to somehow manage to grow something illegal without authorities finding out or to make some bull**** herbal product that everyone thinks they can cure cancer by taking. And if it's the latter, your subsistence only exists based on the gullability of others.

So I think a little perspective is in order.

 

[path or no path]

Um yeah, well if the deciding factor on whether you want to be a pathologist is some anonymous blather on an internet forum where people say the job market isn't great I think that is a sign that you should not be a pathologist. If your deciding factor was anonymous blather saying the job market is great that is also a sign you shouldn't be a pathologist.

Main point: Don't let job market rumors and complaints sway your decision because frankly they should be essentially irrelevant to you. Whatever problems the job market in pathology has it is still vastly better than the majority of professions in this country. What are you going to do, go to law school? Unless you go to harvard/yale you are looking at a 50% unemployment rate. MBA? Unless you have connections or something to recommend you you are looking at the same jobs as thousands of others, many of whom are willing to work 120 hours a week for little pay just to get a potential better opportunity later on. The unemployment rate for COMPETENT pathologists is essentially 0%. What, you say jobs aren't as good as they used to be? Join the club for every single career in the world except for things associated with professional athletics or creating an internet business that someone can buy.

Dude above says he is going to be a farmer. OK buddy. Let us know how that works out. You can have a great life as a farmer if you own several of them as part of a corporation. You gonna own a family farm and work it? Enjoy your 20 hours days. The ONLY way to be a successful small farmer these days is to somehow manage to grow something illegal without authorities finding out or to make some bull**** herbal product that everyone thinks they can cure cancer by taking. And if it's the latter, your subsistence only exists based on the gullability of others.

So I think a little perspective is in order.

That's what I am here for

 

[Tissue issue]

Path or no path- Your geographic restriction is important for our specialty. It's hard to give you advice without prying more into how restricted you are. If you can't move past a 50 mile radius or something you're going to really limit your odds.
I think this quote from mlw03 sums it up best: "The OP said finding a job in the location of their choosing is high priority to him, and if that's the case, how can anyone in good faith recommend they do pathology over primary care? "

 

[path or no path]

Path or no path- Your geographic restriction is important for our specialty. It's hard to give you advice without prying more into how restricted you are. If you can't move past a 50 mile radius or something you're going to really limit your odds.
I think this quote from mlw03 sums it up best: "The OP said finding a job in the location of their choosing is high priority to him, and if that's the case, how can anyone in good faith recommend they do pathology over primary care? "

I guess Southern California is well over 50 mile radius

 

[Tissue issue]

I guess Southern California is well over 50 mile radius

Well, Southern California is actually pretty restrictive for pathology. I'd feel better if you said something like the South or the Midwest. You seem to be deciding between medicine (with possible specialty fellowship) and pathology. Go with medicine unless you decide you really want to do pathology and wouldn't be happy otherwise.

 

[2121115]

I guess Southern California is well over 50 mile radius

Southern California may be the tightest and most cut throat pathology job market in the US, and that is saying something. You certainly don't have to take my advice, but look elsewhere. Pathology is not for you.

 

[DIce3]

The initial post says, "cons: JOB MARKET JOB MARKET JOB MARKET. The idea of spending 5+ years in residency and not being able to find a good job in the location of my choosing really scares me. One resident I've spoken with said that it is mostly FMGs who are struggling due to language or cultural issues."

It continues to amaze me how MS4s realize this and still attempt to match into pathology as opposed to say internal medicine. Internal medicine= great jobs in any city at any time. Remember, solo internist can hang out a shingle anywhere and do really well. Pathology= move every 2-3 years from slave job to slave job. There are no good jobs anymore unless you have an inside connection. Forget about opening your own lab in 2012.

Path or no Path... your post is not just some words on a screen. The market is worse than what you wrote. You will have no options. Things are not going to get better. Pathologists are not going to retire en mass. You will be stuck in slavery for the rest of your professional career, while your classmates in other specialties have lots of freedoms: both economically and politically. Would you play with the barrel of a loaded gun up to your head? Read what you wrote above. Stop thinking about pathology and move on.

 

[KeratinPearls]

Internal medicine and pathology are two totally different fields. Do rotations in both and see what you like. BTW, not all pathologists do autopsies when they go out to practice. Internal medicine has options to do fellowships (although competitive, it will land you a very good job if you get into one: gastro, cardio, allergy immunology) and a better job market. But you got to do what you love and the only way for you to know is to do rotations. I could never do internal medicine even if I knew pathology did not have a good job market.

I briefly looked at the CONS you wrote for internal medicine. It seems like you would be unhappy in internal medicine given what you wrote. Pathology is also a jack of all trades master of none field. There is surgpath, hemepath, cytopath, all fields in clinical pathology....just a FYI

My brother is a cardiologist and just made partner. He was able to choose where he wanted to work and is making a GREAT living. I just hope I can choose where I'd like to live.

 

[KeratinPearls]

. The market is worse than what you wrote. You will have no options. Things are not going to get better. Pathologists are not going to retire en mass. You will be stuck in slavery for the rest of your professional career, while your classmates in other specialties have lots of freedoms: both economically and politically. Would you play with the barrel of a loaded gun up to your head? Read what you wrote above. Stop thinking about pathology and move on.

Would you like to elaborate on your situation? What is making you so bitter? Did you have a lot of problems finding a job? Slavery? Why do you say so? You seem unhappy with your job. Why so?

I ask because I am wondering if ppl come on these boards because they are in general unhappy and bitter ppl or do they really have a reason to be bitter. I am not saying the market it great and from what Ive been hearing ppl do get jobs although not the greatest in cases.

If you give me a good reasons to support your comments, that would be great to hear.