Is path right for me + next steps?

[PathNeuroIMorFM]

M3 in the middle of 3rd year thinking about the future + stressed about 4th year schedule.

Q1: Is Path right for me?

I fell in love with path while shadowing in premed and haven't been able to shake it, despite lots of paths saying the field is going downhill. I think slides/stains are beautiful, I love diagnostics way more than therapeutics, I like the leadership component of lab management, I LOVE LOVE LOVE all my path preceptors/teachers. It's the only place I feel at home and respected. My only gripe is I always wanted to help underserved populations (still do), but that doesn't really mesh with path. I genuinely tried to like other things. I really did, but nothing sticks.

Inpatient medicine/peds: I like talking with other clinicians + consults and the slower pace, but I really strongly dislike rounding. Community setting was unstimulating with too much of the same diagnoses (HF, MI, pneumonia, etc), academic setting seemed to refer to other (sub)specialties to the more interesting things.
Outpatient medicine/peds: It's a fun setting/pace and (not to brag) I'm really, really good with patients, but I can tell I would get very bored of it before residency was over or soon after. The social work sucks, but I have always been okay with administrative work.
Peds: Liked it more than I thought, but I still never ever want to work with kids.
EM: Acute care settings were never for me. I don't like the stress and the rotating door of "we need to move patients as quickly as possible". Frustrating patient population.
OB/GYN: Liked it more than I thought, especially gyn, and felt like I was making a difference, but don't want to work with just women. Also didn't like OR.
OR: Always knew it wasn't for me. High pressure, I don't like the lifestyle or working with my hands all day. Anesthesia looks great on paper, but boring IRL.
Lifestyle + money: I want the best lifestyle possible during and after residency. Medicine is great, but I will always love my hobbies, my wife, traveling, and free time more than medicine. If I can pull more than 300k one day that would be great, but I'll be happy to pay off my loans sooner-rather-than-later and make more than the average peds.

I've taken every rotation except neuro, FM, psych, and additional medicine subspecialty rotations. Unless neuro/psych absolutely blows me away in a big, big way, I am not sure I will go for it. I feel positive that FM is off the table.

No preclinical failures, but bottom third of my class because performance wasn't stellar. AOA/GHHS is a "boys club" at my school anyway and I wouldn't make it. Passed Step 1 first try. Doing well in rotations, strong MSPE comments so far. All HP, with 1 honors in surg and 1 pass in EM. Did a research year in a neuropath lab and also really loved it, gave me very strong research presentations/pubs in both neuro and path and two strong research LORs. I think I can craft a strong personal statement.

Q2: How should I schedule my away rotations?

Assuming I do go for path, I have absolutely no path LORs. My research year was with a path PhD, not MD, so no letters there. I think I can grab a decent letter from an extremely prominent pathologist in his subspecialty if I do well on his away rotation. I can also maybe grab a good letter from my pathology PD if I shake the right hands and kiss the right butts, but no guarentees. He is aware of me and we have a cordial relationship. He helped coordinate my path research year, but otherwise not too much contact with him.

I also moved across the country for school and desperately want to move back to my home region (my home state does not have a pathology residency). Will I need to do an away at my top programs/a program in my region to be competitive?

I am required to complete an ICU rotation, an inpatient sub-I, and an outpatient sub-I before the end of the year. 4 weeks each, 12 weeks total. Sub-I can be in medicine, FM, peds, surg, or OBGYN, but I will probably opt for medicine. I think doing most/all of these after ERAS is due is probably the best move. My schedule is due in January and 4th year begins roughly April, depending on when I take Step 2.

Thanks in advance for the advice

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[mike-sheree]

You are already quite competitive for pathology with what you have already done. Additional pathology rotation is just icing on the cake.

 

[PathNeuroIMorFM]

You are already quite competitive for pathology with what you have already done. Additional pathology rotation is just icing on the cake.

Thanks for the input!

I know I sound very neurotic, it's just due to family reasons I'm just extremely geographically restricted to the Northwest, which has like... five very small and fairly competitive programs (Univ of Washington, OHSU, U of Colorado, Nevada-Reno, U of Utah), so I want to be as competitive as possible. Being originally from Idaho (no path programs) and going to school on the East coast is not doing me any favors.

If you know of any ways to get some additional icing on this application cake, I'd love to hear it.

 

[Dave CX]

I pretty much hated all my rotations too. If it wasn't path, it would have been RadOnc. Might think about that one also.

 

[HeyDalaron]

Why not radiology?

 

[Zendo]

I pretty much hated all my rotations too. If it wasn't path, it would have been RadOnc. Might think about that one also.

Do you agree with the doom and gloom surrounding pathology, or do you recommend the field to current students?

 

[SunBakedTrash]

My friends in rad onc told me the speciality is a dying one-trick pony, propped up by waste, which will die by a thousand cuts from declining reimbursement, technological innovation and clinical obsolescence.

Sounds quite a bit like pathology!

 

[Dave CX]

Do you agree with the doom and gloom surrounding pathology, or do you recommend the field to current students?

A bit yes, but that goes with a long secular decline in the quality of anything hospital based. Some of the IM specialties like oncology, cardiology and med onc are sweet spots in medicine, might be worth sucking it up for 3 years of IM residence. Optho is good too. But I wouldn't avoid Path if you really like it. You can still have a decent career especially if you have geographic flexibility.

 

[PathNeuroIMorFM]

Why not radiology?

Lots of reasons, but I can summarize it down to i just don't like it. I'm aware the pay and job market and so on are better and the working conditions can be similar. I just like the workflow and options of pathology. I like slides more than imaging. The lower competitiveness and greater ability to stay within my region of interest is a nice bonus.

 

[MetroPath]

Pathology is here to stay. Pathology ain’t going to die cmon man. The issue is whether the field will continue to be degraded or not.

There will always be biopsies and resections. Someone needs to read them. Even with AI, pathologists will still need to push that sign out button. There may be less need for pathologists because pathologists are able to do more work with the help of AI but nobody knows.

If anything the field will continue to be unattractive to US med students (which it already is) and will attract more and more FMGs that want a job in America.

To make the situation worse, there’s a lot of subpar programs churning out subpar pathologists. It’s my impression that some grads graduate deficient in areas and then struggle in their first job.

Some groups give slide tests and from what I’ve heard, some people who go to interview for jobs just completely bomb a 10 slide exam.

Like I was told by a senior pathologist…”It’s not hard to find A pathologist. It’s hard to FIND A GOOD COMPETENT, WELL ROUNDED PATHOLOGIST.”

Job market is still crappy regionally in areas. I know of one grad who only got two job offers, who was geographically restricted, both of which were academic jobs. One of the jobs was a low ball offer, like around 200K.

It’s kind of ironic. These academic places employ cheap labor residents and then when they graduate continue to lowball grads with low pay or even worse an “instructorship” position before paying them as an attending.

Don’t get me wrong. There are jobs. There are groups looking but if you are geographically restricted you MAY have to take what you can get when it comes to a job.