Information for Pathology Sub-specialization/Fellowship

[Mordak]

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Hello all. First time posting on SDN. I am currently a 3rd year D.O. medical student. I am getting ready for my 4th year. Having spent some time mulling my future and completing an elective rotation in pathology, I am confident that I belong in no other profession. As such, I plan on pursuing a pathology residency.

My question pertains to how one can acquire the various positives and negatives for each fellowship track/sub-specialization. I view myself in the future as a community pathologist and not an academician. Thus, I desire the combined AP/CP track. I also desire sub-specialization because I find it would be a solid career move for the reason that it increases your marketability by offering a more unique skill set to your practicing group. Through conversations from various pathologists, it seems that residency training will offer much more insight into the individual differences between each separate field.

Yet, at the same time, it appears that applications for fellowship positions are happening earlier and earlier all the time. It seems that in some cases, some fellowships are applied for two years in advance.

Are there resources available that discuss the inherent positives/negatives about each sub-specialization, so that I may come to a judgement earlier?

Or is there really no good way to learn the subtleties besides immediate immersion into a residency?

I suppose the information I am looking for, in specific, would be the answers to the following groups of questions:

1. What sub-specialty of pathology has the most time intensive cases? Which one the least? What are the basic reasons for such differences?

2. Is there a large difference in the day to day working environment depending on the sub-specialty? Is this largely dependent less on sub-specialization and more on the method of employment? Which sub-specialties offer more microscope time/least? Is there a difference in the amount of frozen sections or FNAs that one sub-specialty will see versus another?

3. What is the relative competition for fellowships for such sub-specialties?
It already seems that dermatopathology appears to be the most competitive. My question is how much. Are there 100x more applicants than the next most competitive fellowship? 1000? Is it commonplace to see applicants make the decision to take another fellowship if they were not able to achieve a fellowship, only to then retry the following year? (i.e. doing a year of surgical pathology, followed by dermatopathology)

4. What is the reason some sub-specialties are more competitive than others... Is it all about money? I'm hoping there is more too it than that. If you are in a given fellowship or are a practicing physician, could you enlighten me as to why you selected your chosen sub-specialty?

I recognize my general naivety about the field as whole. Any responses to the aforementioned questions would be most appreciated. Thank you.

 

[Ombret]

Mordak, don't worry about it too much, if you are doing AP/CP you will still have 2+ years of training before you really have to apply. That is plenty of time to get a feel for the areas that interest you. To me the one exception is dermpath for which you really have to get research projects teed up early in your training in order to be competitive, unfortunately.

Your questions are all rather AP oriented and I would guess that like most humans, you are more interested in an AP career, but keep in mind that you will do a lot of CP in your training and some of the most popular pathology subspecialties fall within CP (I'm thinking of blood bank here).

To be honest your questions are very good but I think you will get more insight into all of this stuff within your first couple of months as a resident. As kind of an umbrella answer, I will say that no, the surg path subspecialties are not drastically different from one another.

 

[Circumflex]

You really will not be able to make informed decisions until you get into residency. It is kind of like choosing a residency in med school. Some fellowships are board-certified and others are not (breast, GI, GU, GYN). What your daily schedule will be like after training really depends on the practice you join. Most people who do fellowships will sign out all kinds of cases, but will be the "go-to" person for their specialty. However, some people will spend the majority of their time signing out cases from their specialty. It just depends on where you get a job. This is true for academics and private groups.

I would say to go into residency with an open mind. At the end of your first year, you will have a better idea of your interests and can narrow the choices.

 

[KCShaw]

Ditto.

1. Most subspecialties (boarded or not) have both a fast (biopsy) component and slow (complex, excision, difficult biopsy) component. The average bone marrow in heme probably takes longer than the average of most other specialties, but frankly I don't think that makes much difference to job satisfaction. The average derm or GI biopsy case is pretty quick. When you "do" it a few times you'll get a feel for whether you like it or not. Some cases take longer because of number of slides per case or number of additional studies/stains needed to come to a conclusion.

2. Day-to-day most subspecialties are similar, especially remembering that most subspecialists also sign out general surg path. A noted exception is forensic pathology, which on average is very different, with much more time on average in the autopsy room than at the microscope.

3. Derm is more competitive because you're not competing with just pathology residents, but with dermatology residents, for the fellowship. While other subspecialties technically can take individuals trained in other specialties, they rarely do. I'm not convinced the other subspecialty fellowships are significantly more or less competitive, again with the exception of forensic path which probably has a greater percentage of fellowship positions left "open" each year (though I haven't looked at those numbers comparatively). On the other hand I suspect the job market for FP's is better on average.

4. People have all sorts of reasons for going into a given subspecialty. Since the lifestyle and salaries of most of them is probably similar, I think people largely choose a subspecialty based on what they like, followed by what they think will more likely land them a "good" job.