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suckerfree

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Hi,

So as my M3 goes by I am realizing more and more all the time that I love the disease, I don't like the day to day management/treatment of the disease. I also don't think I care as much about direct patient contact. Don't get me wrong, I care about the patients, but I know that what they really want from me is effectiveness in helping fix them, just as I want only to cure them; being their friend or really getting to know them is not a true priority for me. I also miss pathology more and more all the time. The other week, I had the pleasure of following a patient on my peds rotation with hemophagocytic lymphohistiocytosis, and when I went to the path lab to look for the hemophagocytes in the bone marrow biopsy, I was very excited. Pathology seems a lot like when I did astronomy in college...its like there is a whole separate world that you see through pictures and then you do your calculations and assessments to figure out what you are looking at.

I was curious:

1) How dynamic is the field's knowledge base? How much do you study? I love heme/onc a lot, but I wasn't as crazy about the prospect of always reading about the latest chemotherapeutic trials all the time for the rest of my life, I am much too interested in the pathology, not enough in the pharmacology I guess. Is the knowledge base in pathology like anatomy, where the knowledge is relatively static but current developments for learning consist in new ways of looking at the same thing? What do you read on a daily basis once you finish residency?

2) I was discussing with a few of my friends and no one seemed to be able to figure out...why is radiology so competitive but path is not equally competitive? Both are very similar in terms of high income potential, good hours, daily activity of looking at scans/images most of the day. Yet it is largely expected one must be AOA to enter rads now, and yet path is not as competitive.

Thanks!
 

DarksideAllstar

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1) How dynamic is the field's knowledge base? How much do you study? I love heme/onc a lot, but I wasn't as crazy about the prospect of always reading about the latest chemotherapeutic trials all the time for the rest of my life, I am much too interested in the pathology, not enough in the pharmacology I guess. Is the knowledge base in pathology like anatomy, where the knowledge is relatively static but current developments for learning consist in new ways of looking at the same thing? What do you read on a daily basis once you finish residency?

I'm an M4 who did a PJF, but I would say that you have do to a fair amount to keep with new diagnostic criteria or re-classifications. A lot of what I saw consisted of an attending say, "Well, they changed the criteria for _____ last year, let's look it up to see what we need to diagnose it." Things will always be classified and re-classified, new markers will be discovered, etc so I think that you have to do a fair amount of reading to be good at what you do, just like most other fields.

suckerfree said:
2) I was discussing with a few of my friends and no one seemed to be able to figure out...why is radiology so competitive but path is not equally competitive? Both are very similar in terms of high income potential, good hours, daily activity of looking at scans/images most of the day. Yet it is largely expected one must be AOA to enter rads now, and yet path is not as competitive.

Again, take my opinion with a grain of salt. I think the perception is that both the job market and salaries for radiology surpass that of pathology. It is seen by some med students as interesting because of the technology and a larger variety of practice opportunities (ie. interventional or diagnostics) and offers a myriad of fellowships (similar to path in this regard). From what I understand (from reading AuntMinnie) is that a few years ago it is was not competitive at all, and recently (?? coinciding with the improvement in the job market and salaries) with people realizing that they achieved more satisfaction from their jobs in a consultant's role, it become more competitive. The hours in rads are not as good as one is led to believe, depending on what type of practice you do. There are still a large number of >50 yr old rads attendings doing overnight call in private practice. I had 4 friends in my class last year match into Rads who were not AOA, so while helpful, it is not necessary. Overall, I think med students get a lot of exposure to rads and are more likely to explore the field, while simultaneously not getting any exposure to path and basically not even considering it based on their experience with their med school path course. I was seriously considering radiology at the end of my third year, but had had enough experiences in path as an MS3 that I thought about it, and ended up taking a year off to see what the hell went on in pathology (and for other reasons, as well).
 

danaphosaurus

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I prefer to live my life in color- I considered rads but I knew that I would just fall asleep looking at things in black and white all day in the dark- Path is prettier-
 
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path-hopeful

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Path is prettier. I decided against rads because I don't think I could sit in a dark room day after day.

Also, path is getting more and more competitive every year. I wouldn't pass it off as something that's easy to get into.
 

mlw03

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There's a few issues:
a - radiology has some sub-specialties that involve patient interaction, path really doesn't. rads is a chance to be a diagnostician without totally giving up patient contact, which some people simply don't want to do.
b - rads has a lot more procedural opportunities - there's a lot of image-guided procedures that radiologists perform. this gets back to a also in terms of getting some patient contact.
c - radiologists don't have to/get to do autopsies. some people just aren't comfortable with this, and while many pathologists don't do autopsies day to do, it is a part of residency.

i'm sure there are other factors at play, but this is what i can think of off hand.

Hi,

2) I was discussing with a few of my friends and no one seemed to be able to figure out...why is radiology so competitive but path is not equally competitive? Both are very similar in terms of high income potential, good hours, daily activity of looking at scans/images most of the day. Yet it is largely expected one must be AOA to enter rads now, and yet path is not as competitive.

Thanks!
 

suckerfree

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I have been thinking for the last year, and have realized that although I have always been interested in heme onc, after doing a heme onc elective the most interesting part was looking under the scope, and I really didn't like the type of stuff you have to read on a continual basis. I am very passionate about learning and understanding the heme onc disease entities, but the management of the treatment is absolutely not the side that I want to be on. Half way through the 3rd year now with only surgery and OB and Family remaining...all 3 I feel I have effectively ruled out on the basis of lifestyle issues (no matter how much I might love surgery, I really don't want to go through that kind of a residency or live that lifestyle). I think hematopathology is the way for me to go!!!:idea:
 

fun8stuff

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I have been thinking for the last year, and have realized that although I have always been interested in heme onc, after doing a heme onc elective the most interesting part was looking under the scope, and I really didn't like the type of stuff you have to read on a continual basis. I am very passionate about learning and understanding the heme onc disease entities, but the management of the treatment is absolutely not the side that I want to be on. Half way through the 3rd year now with only surgery and OB and Family remaining...all 3 I feel I have effectively ruled out on the basis of lifestyle issues (no matter how much I might love surgery, I really don't want to go through that kind of a residency or live that lifestyle). I think hematopathology is the way for me to go!!!:idea:

interesting. i have pretty much the same feelings and experiences as you. i started med school with an interest in heme/onc, but have slowly been drawn toward path...
 

suckerfree

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My best friend has his heart set on heme/onc. For him, there is great fascination in the idea of the drugs targeting and destroying the cancer cells. For me, I find it much more fascinating to picture the cells reproducing and tearing everything apart, and then seeing what they look like under a scope or on a computer screen. I think one of the most important criteria for deciding on a career in medicine is what do you want to read for the rest of your life. I like the pictures in path, having the story already...i don't like the chemotherapy in clinical heme/onc. Cheers!
 

Neddy

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Hey suckerfree, I'm a 4th year going into path after considering IM/Heme-Onc. One of the things I realized after doing a heme-onc elective is that most of your time is spent managing side effects of chemo, rather than puzzling out what the best agent would be for someone based on the biology of their disease. Most of the chemo regimens are pretty much standardized. Plus they generally only see the patient when the tumor is already a) removed or b) incurable.

I still think heme-onc is an incredible field, but in path you get to actually SEE cancer at every stage, and as a field we've got our work cut out for us figuring out how to get clinically useful molecular data out of tumors (in addition to using the good ol' scope). So I think path is gonna be a pretty cool field over the next few decades, especially in the academic setting.
 
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