How hard is it to get matched somewhere in California?

[DrVan Nostrand]

My goal is to get matched somewhere in CA, which is where I'm from and where all my family is. As a reminder, we are talking:

• UCLA
• USC
• UCI
• Cedars Sinai
• Loma Linda
• UCI
• UC Davis
• UCSD
• Stanford

Most of these places are pretty competitive, right? How worried should I be worried as a current M2 about getting honors in pre-clinical and clerkships, my class ranking, publishing research, etc? My Step 1 score will be pass/fail as well, so I am not sure how that will factor into things.

I will be coming out of a lower-mid tier MD school in the midwest

Any advice/input is appreciated!

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[deleted314957]

There is really no “bar” to getting into path. Any of those institutions need grossing help. If you have observed path for any significant period of time you know it is decidedly NOT competitive. Wherever you go it is a four year tutelage WITHOUT any independent responsibility. It would be preferable to go to Little Company of Agony hospital if they allowed 4th yr independent s/o rather than USC with zero independence in my opinion.

The small # of people from your class who go into path, with rare exception, will NOT be from the “honors” crowd. They will tend toward the bottom of the class.

Sorry for the s****y but pretty accurate version of the truth.

 

[Alteran]

You will match somewhere in CA for sure. You already passed the three criteria for automatic admission into >95% of pathology residency programs:
- You're alive.
- US graduate.
- You can, by my estimation, communicate effectively in English.

There's a real problem with the pass/fail system that few if anyone thought through entirely. Right now there's no advantage to what medical school you go to as long as you do quantitatively well on STEP 1 because that's your golden ticket. Under the new system, program directors have no clue how to evaluate applicants other than letters of recommendation most of which are perfunctory puff pieces. Therefore what I envision happening is program directors are going to preferentially recruit from their own institution's medical school first and then look outside. So if you're a medical student at an institution without residency X, you're going to have a hard time getting known and into residency X elsewhere, especially if its competitive. I think its about to matter a whole lot what medical school you go to shortly.

 

[SunBakedTrash]

UCSF, Stanford and UCLA are the competitive ones in California. I bet they are as competitive as IM at those institutions. I would focus on demonstrating interest in pathology and when you get interviews, playing up your ties to the area. The rest you mentioned and the others you didn’t are not competitive at all, are primarily IMGs and have a generally poor reputation. Harbor UCLA is not affilated with UCLA and is particularly low quality. I would strongly suggest going somewhere else outside of California to train and then coming back for a fellowship or job if you can’t get residency at the first 3.

 

[Zarniwoop]

If your goal is to return to California for the next few years, then any program will take you assuming you're alive and not an immediate physical threat to the faculty and other staff.
If your goal is to be in California beyond residency, then choose another specialty or keep all of your fingers crossed and hope for the best.

 

[KeratinPearls]

Look into that UCLA Harbor program. Didn’t hear good things about the volume there. They have a surgpath fellow opening every year.

 

[KeratinPearls]

If your goal is to return to California for the next few years, then any program will take you assuming you're alive and not an immediate physical threat to the faculty and other staff.
If your goal is to be in California beyond residency, then choose another specialty or keep all of your fingers crossed and hope for the best.

LOL at “immediate physical threat”.

 

[DrVan Nostrand]

LOL at “immediate physical threat”.

literally made me laugh out loud

 

[DrVan Nostrand]

If your goal is to return to California for the next few years, then any program will take you assuming you're alive and not an immediate physical threat to the faculty and other staff.
If your goal is to be in California beyond residency, then choose another specialty or keep all of your fingers crossed and hope for the best.

what do you mean by the "beyond residency" part? lack of job opportunity? or lack of *good* job opportunity?

 

[SunBakedTrash]

what do you mean by the "beyond residency" part? lack of job opportunity? or lack of *good* job opportunity?

Both. Everyone wants to stay and many people are willing to accept crap conditions and low pay as a trade-off. There is a significant amount of underemployment and lots of revolving door positions within toxic groups with churn and burn a mentality. Be very careful taking these as a first job, they will cut you loose right before you “make partner” and cite your subpar diagnostic skills before taking the next graduating fellow for a ride. They have no qualms in destroying your reputation.

These are not unique to California, but there is plenty of this type of stuff there. The good groups hire exclusively from good programs or from the military.

there are employed positions at LabCorp and places like Kaiser. I don’t think anyone considers those good jobs, but it’s better than being fired. Academics are also prevalent if you don’t mind the pay.

 

[DrVan Nostrand]

Both. Everyone wants to stay and many people are willing to accept crap conditions and low pay as a trade-off. There is a significant amount of underemployment and lots of revolving door positions within toxic groups with churn and burn a mentality. Be very careful taking these as a first job, they will cut you loose right before you “make partner” and cite your subpar diagnostic skills before taking the next graduating fellow for a ride. They have no qualms in destroying your reputation.

These are not unique to California, but there is plenty of this type of stuff there. The good groups hire exclusively from good programs or from the military.

there are employed positions at LabCorp and places like Kaiser. I don’t think anyone considers those good jobs, but it’s better than being fired. Academics are also prevalent if you don’t mind the pay.

I see, thanks for the info.

Any thoughts on the VA? That is where I am locked in for 6 years after residency/fellowship (they paid for my tuition in return)

 

[SunBakedTrash]

I see, thanks for the info.

Any thoughts on the VA? That is where I am locked in for 6 years after residency/fellowship (they paid for my tuition in return)

If you’ve seen one, you’ve seen them all. Bread and butter stuff, good place to work if you don’t mind the slow pace and facilities. Work there, get experience and leverage it into a better job. Or alternatively work there long term, get the pension, retire early and never look back.

 

[Zarniwoop]

The main issue you raised is the notion of a geographic restriction. Regardless of place (although CA might particularly suck), pathology is not a field to enter if you have geographical restrictions.
If you feel that you'll have a high probability of landing a VA job in CA, then you should be all set - no worries. However, if the VA (or any other inside tract that you might have) doesn't work out, then landing in the region of your choice is a huge gamble in pathology.

 

[KeratinPearls]

Both. Everyone wants to stay and many people are willing to accept crap conditions and low pay as a trade-off. There is a significant amount of underemployment and lots of revolving door positions within toxic groups with churn and burn a mentality. Be very careful taking these as a first job, they will cut you loose right before you “make partner” and cite your subpar diagnostic skills before taking the next graduating fellow for a ride. They have no qualms in destroying your reputation.

These are not unique to California, but there is plenty of this type of stuff there. The good groups hire exclusively from good programs or from the military.

there are employed positions at LabCorp and places like Kaiser. I don’t think anyone considers those good jobs, but it’s better than being fired. Academics are also prevalent if you don’t mind the pay.

Thanks for keeping it real. Any further increase in residency positions will further hurt our field imo.

 

[KeratinPearls]

The main issue you raised is the notion of a geographic restriction. Regardless of place (although CA might particularly suck), pathology is not a field to enter if you have geographical restrictions.
If you feel that you'll have a high probability of landing a VA job in CA, then you should be all set - no worries. However, if the VA (or any other inside tract that you might have) doesn't work out, then landing in the region of your choice is a huge gamble in pathology.

If you want to land in cali getting into a residency position in cali is top priority. Any cities with tight job market, you got to take what you can get in Path. You might get lucky like I did.

If not be ready to move closer to Webb lmao!!

 

[WEBB PINKERTON]

I would stay away from California. Not rural enough.

 

[deleted314957]

If you’ve seen one, you’ve seen them all. Bread and butter stuff, good place to work if you don’t mind the slow pace and facilities. Work there, get experience and leverage it into a better job. Or alternatively work there long term, get the pension, retire early and never look back.

VERY well said.

 

[DrVan Nostrand]

VERY well said.

I have seen some people claim that the VA is so slow and laid back that your skills will atrophy. Such that after 6 years (what I owe to the VA), you will have a really difficult time re-adjusting to the intensity of most normal jobs. Do you think this is true at all?

 

[SunBakedTrash]

I have seen some people claim that the VA is so slow and laid back that your skills will atrophy. Such that after 6 years (what I owe to the VA), you will have a really difficult time re-adjusting to the intensity of most normal jobs. Do you think this is true at all?

That is largely dependent on the person I think. Your skills can atrophy anywhere and it’s on you to keep up with the literature and keep busy at your job. I would have no qualms hiring you from the VA if you explained your story, were more or less normal interpersonally and were willing to be a team player and cover what the group needs covered. In fact, I would see VA experience as an asset. I would bet being a left elbow pathologist in academics is more dangerous to a career than a guy who signs out old man pathology at the VA.

 

[SunBakedTrash]

To follow up on my comment, you likely won’t see much breast or gyn at the VA. Try to fill those gaps by going to conferences and focusing on those topics. By examining the bit you do receive and knowing the literature, you will be competent which is all that can be expected. This would be infinitely more useful than attending those ridiculous courses on FNA of spindle cell lesions, etc

 

[WEBB PINKERTON]

I've yet to meet a normal pathologist working at the VA and I have CAP inspected at least 5 over the years.. It would be a major red flag for me. Privatize the VA!

 

[Zarniwoop]

High volume doesn't translate all the time to great environment for maintaining and improving surg path skills. Most high volume private places are filled with high volumes of easy cases. You are much more likely to stay up to date in academia focusing on a couple of subspecialties, and then attending department conferences to stay more or less up to date on the rest.
To me the VA is perfect because you'll stay as up to date as your typical non-academic pathologist without the same stress level, and with more personal time to live your life. More time for continuing education too, if that is a priority of yours.

 

[Zarniwoop]

I've yet to meet a normal pathologist working at the VA and I have CAP inspected at least 5 over the years.. It would be a major red flag for me. Privatize the VA!

Taking a step back I have to laugh at one pathologist judging how normal another pathologist is. Look at what we do. We are all freaks.

That said, I think rural is the way to go to have your best odds in any field of medicine, and I wish that I had the courage to start a tree service, because I agree that that would be a literal gold mine, and a fantastic hedge against unstable pathology jobs, investing in collectible playing cards, crypto, and divorce.

 

[KeratinPearls]

Most high volume private places are filled with high volumes of easy cases.

Disagree high volume large tertiary care community hospitals (500+ beds) are far from easy cases.

Busy practices aren’t for everyone. You have to be cut out for it. In other words, you better have trained in a busy institution to keep up with demands. Pretty stressful.

 

[deleted314957]

As regards the VA, they usually have some affiliation with the local medical community, often formal arrangements if there are teaching hospitals. Even if it is just a local non academic hospital you can easily have a very collegial relationship because you are not competition. You may have time to help keep up thru association with them.

 

[Rosai]

Late to this thread but here's my .02:

If your priority is career and becoming the most competitive for jobs, in my OPINION, you need to train under big hitters. Plato had Socrates, Mozart had Haydn, Brady had Bellecheck, and I had your mom last night. Point is, if you want to be someone in pathology you got to train from Someone. I'm talkin all the textbook homies like Epstein, Rapini, Cibas, Hornick, Montgomery, Soslow, Justin Bishop, to name a few - non of whom work in California lol. Path is a small crowd and if you somehow get one of these big dogs to name drop you come job time you are so golden and likely will land that holy grain California pathology job. Whether or not that actually happens is up to you. Disclaimer: you do not need to be a good or even great pathologist if you don't train with these ballers. I'm just saying, name brand gives you clout and connections when it matters most and where you spend 4 years of your life sort of sets that all up. So, if you're focused on career, then shoot for the top CA schools in addition to top schools around the country. Do away rotations at as many as you can. And if you're telling yourself "i'm a nobody MS2 at a nobody med school i'd never get into jonny hopkins or harvard" for sure not with that attitude you're not. Clean up your CV and email the program about away rotations as a MS3 asap. You can make your own dreams come true. If you're open to mid west, i've heard great things about creighton, michigan, and Mayo.

There is a way to have the best of both worlds and that's to be damn sure to do your fellowship with a big name in pathology at a big institution. So you can get into a lower tier school in California but work your butt off to get into a top fellowship. This is common in Surg path. Also, if you happen to want to go into dermpath then try to go to a residency with an in house dermpath fellowship because of the competitiveness of that specialty specifically. It's like the most competitive path specialty I'm pretty sure.

Huge disclaimer: I'm a path resident and everything i said is my opinion based on conversations I've had with other residents and fellows. I have literally no actual first hand experience on anything I wrote (other than the your mom bit). Also, take what sunbaked said as truth because it is:

UCSF, Stanford and UCLA are the competitive ones in California. I bet they are as competitive as IM at those institutions. I would focus on demonstrating interest in pathology and when you get interviews, playing up your ties to the area. The rest you mentioned and the others you didn’t are not competitive at all, are primarily IMGs and have a generally poor reputation. Harbor UCLA is not affilated with UCLA and is particularly low quality. I would strongly suggest going somewhere else outside of California to train and then coming back for a fellowship or job if you can’t get residency at the first 3.

 

[caffeinegirl]

I would disagree with Rosai's assessment about training at a non-California institution. CA jobs are tight, and they favor those who have trained in CA. The practice of pathology is very different based on geography, and different geographic regions have different ways of signing things out - which is engrained by the local training institutions. Train near to where you want to practice - doesn't matter if it isn't a top program. UCLA grads have a better chance at a CA job than those from Boston.

 

[KeratinPearls]

I would disagree with Rosai's assessment about training at a non-California institution. CA jobs are tight, and they favor those who have trained in CA. The practice of pathology is very different based on geography, and different geographic regions have different ways of signing things out - which is engrained by the local training institutions. Train near to where you want to practice - doesn't matter if it isn't a top program. UCLA grads have a better chance at a CA job than those from Boston.

Speaking from someone in a tight job market I agree. You want to be in the loop. Faculty at local training programs have connections with pathologists in private practice in the area. Jobs are by word of mouth and will never get advertised. Pathologists in the area will just call someone who they trained with in residency or fellowship and ask for who they would recommend.

You want to party where the party is. You don’t want to be out of the loop unless it’s totally out of your control and you can’t match in Cali.

Unless you want to get a job in academics and someone from a program in Cali is friends with someone at your training program which is outside cali. But you are leaving that to chance and luck.

Who knows? A job may pop up in Cali and for some reason the people in the group may like you and since you are from the area, you may get the position.

 

[SunBakedTrash]

Late to this thread but here's my .02:

If your priority is career and becoming the most competitive for jobs, in my OPINION, you need to train under big hitters. Plato had Socrates, Mozart had Haydn, Brady had Bellecheck, and I had your mom last night. Point is, if you want to be someone in pathology you got to train from Someone. I'm talkin all the textbook homies like Epstein, Rapini, Cibas, Hornick, Montgomery, Soslow, Justin Bishop, to name a few - non of whom work in California lol. Path is a small crowd and if you somehow get one of these big dogs to name drop you come job time you are so golden and likely will land that holy grain California pathology job. Whether or not that actually happens is up to you. Disclaimer: you do not need to be a good or even great pathologist if you don't train with these ballers. I'm just saying, name brand gives you clout and connections when it matters most and where you spend 4 years of your life sort of sets that all up. So, if you're focused on career, then shoot for the top CA schools in addition to top schools around the country. Do away rotations at as many as you can. And if you're telling yourself "i'm a nobody MS2 at a nobody med school i'd never get into jonny hopkins or harvard" for sure not with that attitude you're not. Clean up your CV and email the program about away rotations as a MS3 asap. You can make your own dreams come true. If you're open to mid west, i've heard great things about creighton, michigan, and Mayo.

Now, if your priority is having a solid residency with very decent work hours in California, then actually Loma Linda may be your place. I'm not a LLU resident but I do have connects over there and I'll just say having the only PA school west of the Mississippi is, to quote one of the greats, Prettay, prettay, prettay, good. PD over there is pretty awesome.

There is a way to have the best of both worlds and that's to be damn sure to do your fellowship with a big name in pathology at a big institution. So you can get into a lower tier school in California but work your butt off to get into a top fellowship. This is common in Surg path. Also, if you happen to want to go into dermpath then try to go to a residency with an in house dermpath fellowship because of the competitiveness of that specialty specifically. It's like the most competitive path specialty I'm pretty sure.

Huge disclaimer: I'm a path resident and everything i said is my opinion based on conversations I've had with other residents and fellows. I have literally no actual first hand experience on anything I wrote (other than the your mom bit). Also, take what sunbaked said as truth because it is:

This is all wrong. Some geezer with a foot in the grave doesn’t give a crap about getting you a sweet private practice job. The residents and fellows a few years ahead of you are the ones hiring when you are a fellow. Geography and not being a douche go a long way in this field.

 

[Rosai]

my b my b guys. OP for sure take the advise from those here who are applying for or recently got jobs (I'm not in this group). I will say though, If you can do an away rotation with a famous pathologist that would be cool.

 

[KeratinPearls]

This is all wrong. Some geezer with a foot in the grave doesn’t give a crap about getting you a sweet private practice job. The residents and fellows a few years ahead of you are the ones hiring when you are a fellow. Geography and not being a douche go a long way in this field.

Agree so important for the people in the group to like you. When you work with them especially as a young pathologist, you will have to work so closely with them. It’s really like living in the same house. If you do not get along with the people in a group, it can be like living in the same house as your ex spouse!!!!!!

 

[LADoc00]

Yah man not sure on this one... "I hoping for any residency in California" sounds an awful lot like "I hope I can get a lap dance at the Spearmint Rhino." You will, dont worry young padwan. The journey of a 1000 miles begins with one step.

There are low bars and then are lower bars you never thought was a thing until SDN came into being.