Highest paying pathology subs?

[ElementMD]

I have been looking at path fellowships. Is degree of competitiveness necessarily correlated with salary?

What are the highest paying pathology subspecialties?

Is it possible to moonlight on top of full time job as pathologist? Medical director? Reading slides per-diem?


For example I know derm is highly competitive.
What about molecular?
GI?
GU?

Is there somewhere I can go that has a good primer on this sort of thing?

TYIA

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[LADoc00]

I have been looking at path fellowships. Is degree of competitiveness necessarily correlated with salary?

What are the highest paying pathology subspecialties?

Is it possible to moonlight on top of full time job as pathologist? Medical director? Reading slides per-diem?


For example I know derm is highly competitive.
What about molecular?
GI?
GU?

Is there somewhere I can go that has a good primer on this sort of thing?

TYIA

Success in Pathology in terms of financial metrics is binary: our world is divided roughly into 2 groups, those WITH service contracts held in their name and those WITHOUT service contracts. Those without are by necessity reliant on those with.

Having a contract in your name requires only 2 things: Board certification in AP AND CP.

Therefore "highest paying subspecialities" in Path is very very different than say Ortho or other surgical subs.

My gut feeling with anecdotal evidence only is that there is no real correlation between your subspec anymore and your pay level.

That being said, these are fairly useless:
Molecular Genetics (unless connected to a general surgical path year)
Blood Banking
Med Micro
Chemical Pathology
Forensics
Pediatrics
Neuropath
Informatics

GI and GU are NOT boarded subspec fields in this discipline. So I would call those more of a surgical path fellowship with concentration in X.

Top subspec fields for board certification:
Hemepath
Dermpath
Cytopath (although questionable now given paradigm shift)

Top post-residency surgpath concentrations:
Breast/Gyn
GU
GI

Too niche to consider:
Soft tissue/bone
Endocrine
Perinatal
Pulmonary
Liver
Renal

There you go.

 

[ElementMD]

Thanks so much for the detailed and quick reply.

I understood about 90% of it.

To simplify or paraphrase your answer it sounds like you are saying, in terms of monetary reward, the best fields are
dermpath and hempath.

Followed by surgical path and its' concentrations (breast/GYN, GI and GU)

Did I get that?

Molecular (which interests me, it fairly useless from earning standpoint)?

The beginning part about service contracts I am not sure I understood.

Are you saying for those who own a private path lab, the value is in obtaining service contracts?
Don't most pathologist go and work for a group or hospital?

Thanks again for the help with this.

 

[LADoc00]

uh you sort of got it.

Anytime you do further medical education in your late 20s you need to determine what the Opportunity Cost is precisely.

Scenario:
If you have a job offer for $200,000 (take home amount, for simplicity sake) for general pathology and the opportunity to do a fellowship in Derm, realize that some groups will only marginally pay more a DP boarded pathologist, lets say its a $15,000 premium.

If you lived like a resident that first year after training and took the $200,000 lived off 50 of it and spent another 100 or so towards accumulated debt, the last 50 you put in a 7% investment vehicle.

Over a 25 year career, that extra year of work produces $271,000 from that 50K and saves you around $140,000 in student debt interest from the quicker repayment than the DP scenario. Net, that is $411,000. That is the cumulative difference of the DP "premium pay" added for TWENTY SEVEN years. But the math is even rougher.

If the premium pay pack is an "attractant" as it almost always is for a potential partner, then you really experience it for a 2-3 years before pay equalizes, meaning you will never ever EVER actually win in a financial scenario doing a DP fellowship IF you already have a solid job offer.

In reality it is more complex than this because boarded fellowships are a "foot in the door" for many groups, but I would counter that connections, individual personality factors and educational pedigree are FAR FAR greater in this regard.

Good luck.

 

[deleted314957]

I’ll simplify it for you Element. LaDoc alluded to it but I think you
are missing the forest.

You can be either a 1. Chief
2. Indian
The former typically makes lots of money. The latter usually makes
a comfortable salary.
Fellowship has no effect on Chief or Indian status.

 

[LADoc00]

I’ll simplify it for you Element. LaDoc alluded to it but I think you
are missing the forest.

You can be either a 1. Chief
2. Indian
The former typically makes lots of money. The latter usually makes
a comfortable salary.
Fellowship has no effect on Chief or Indian status.

essentially this.

You know if you are a chief or an indian. You know if you are a submissive or a dom. Doing 5 fellowships will simply not change you unless you yourself choose to embark on a "vision quest" and become a "tier 1 operator."

 

[coroner]

Seems like your initial fellowship recommendations over a decade ago are pretty consistent in today's market for the most part. Breast/Gyn got an upgrade which is understandable. Plus, you once mentioned BB/TM is a well kept secret for a lifestyle gig if someone oversees multiple hospitals.

Imo, Cyto just as useful now as it was a decade ago, because even though the Pap has not gone with universal HPV screening, an increase in ROSE by Pulmono., Surg., ENT, and [mainly] IR has kept it in demand for medium/busy practices

No, for a number of reasons. For one, there are a TON of cyto fellowship positions, probably 2x as many that are needed. And this is nowhere near as marketable as it used to be given that breast FNAs are being replaced by cores from radiology. Pap smears too hopefully will go away with universal HPV screening. So move that down the list.

Now GYN in my opinion is near worthless, gynpath is bread and butter stuff you can get in any solid surg path year. Competition for these fellowships is limited to academic geek types who fantasize about large ovarian masses and endometrial polyps...move that down.

GI is HUGE and up-n-coming. How many solid GI fellowships are there? Maybe MAYBE 6 in the whole US: Odze at Brigham being no1, MGH, BID, UCLA (but their big guy left), Cleveland, Hopkins...the list is slim. And dont bring up UCSF please, that fellowship is 80% liver. Move that one WAY up.

GU is interesting b/c out of the blue this is hugely marketable. Okay realize Im saying "marketable" NOT useful. I can dx anything that someone who spent a year with Epstein can but in terms of marketing myself to urologists I dont have the same leverage, move this way up, there are less GU fellowship slots than GI!!

Overall my list:
1.) Derm, still king
2.) GI
3.) GU
4.) Heme
5.) Cyto
6.) Forensics (can be very competitive at the best places: NM and MiamiDade)
7.) Blood bankTM
8.) BoneSoftTissues
9.) Gyn
10.) general surg path
11.) Lung
12.) Liver (near worthless)

We have a serious communication disconnect here....Im not saying Molecular diagnostics is worthless, Im saying the fellowship in its current form is. You will likely not develop a single assay during your 12 month stint there. The point of the fellowship is not 'assay development', that is translation type research that predominantly occurs in biotech. Why not spend 12 months in biotech if that is your goal??

Watch: We use LOTS and lots of formalin in pathology too, but people dont do a formalin fellowship, right? We use lots of antibodies in immunohistochemistry all the time, but how many people do an IHC fellowship??

Do a rotation in mol path, I have, in fact Ive done one at 4 different hospitals. You know what? There is only so many times I can read a quant PCR protocol and watch a tech pipet nucleotides before I scratch my eyes out.

Doing a mol path fellowship will not give you any street credentials for academics unless you publish, and publish MIGHTILY during that year.

Do not do mol path. That is my opinion, take it as one's man perspective. Ask people who have done it, see how much of it they use year 1 after, year 5 afterward...

LADOC's WATCH OUT LIST of fellowships
mol path
forensics
chemistry
medical micro
pulmonary
gyn
soft tissue/bone
pediatrics
IHC
neuro
transplant
renal
oncologic
cytogenetics

dont do these unless you have a very very clear idea of what you want out of em...

LADOC's nobrainer fellowships
Derm
Cyto
Heme
GI
GU
General Surg path

those will be good almost anywhere you land, its a nobrainer you arent going to be totally wasting a year of opportunity cost (which after 30 years is anywhere between 1-4 million dollars) on.

 

[LADoc00]

Awesome post to keep me honest.

I would say in the last 10 years:
1.) Cytopath paradigm shift has dropped this field considerably
2.) BB consolidation into massive geographic area based blood banks that actually offer on-call services even has eliminated many slots in this subspec and dropped it significantly in my rankings
3.) Cancer centers started slowly pushing for a pathologist with dedicated post residency training in Gyn oncology. This has NO cognitive or logical basis, it is SJW/3rd Wave Feminism attempt to alter gender make up of all male pathology groups as most gyn fellows are women. and plays into the overall fake narrative that "only women can truly care about female disease..." b.s.

 

[Pathbusiness]

Fellowship is the price of entry into the club(Group). Your real learning happens once you start working. Initially they train you. After that it all depends what you bring as in value to the group. There are way more things you can shine in addition to your fellowship, especially in private setting. Those qualities are of real value in long term.

 

[ElementMD]

Thank you for your answer... how does one bring value to the group?
Bring in contracts? Business?

 

[ElementMD]

wow. I am 0 for 3 on this thread. I think I get the picture.

 

[Pathbusiness]

wow. I am 0 for 3 on this thread. I think I get the picture.

In that case you can be a team player, pleasant, demonstrate leadership skills, etc..