Job Market in Major US Cities

[KeratinPearls]

Now I’ve been looking at online job ads for jobs in major US cities like LA, Chicago, Boston, NYC.

I haven’t seen many at all online. I’ve been seeing some jobs in the Bronx, Brooklyn and NJ area via email from recruiters. There may be some job ads I may have missed. I’ve been looking at job ads for the past year. To me, I’m not seeing that many jobs that I think I should be seeing.

If anyone is training in these cities, where do the graduates from your programs find jobs? Is it thru some type of secret underground network or something? I mean there are at least 20-30 grads a year in these cities. Where do your graduates go?

I contacted a pathologist in LA once and she mentioned that people do somehow find jobs there but looking online, it paints a different story since I’m not seeing many ads.

While looking for jobs in my city, I talked to a few places where they fill by contacting local programs/local connections looking for the best candidate and the job is never advertised.

Im thinking this is what’s happening in cities with a tighter market. Im wondering if the number of jobs on pathoutlines may not accurately predict the number of jobs out there. I’ve always been curious to how many jobs may be by word of mouth and that no one who is NOT in the loop hears about it.

Am I right?

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[Spaziergängerin]

I think you're definitely right. I got 1 of ten interviews from an online posting. The other 9 were word of mouth only and not posted. In the big markets it's basically the only way to get a decent job. I personally find this terrible and very unfair to everyone involved.

 

[KeratinPearls]

I think you're definitely right. I got 1 of ten interviews from an online posting. The other 9 were word of mouth only and not posted. In the big markets it's basically the only way to get a decent job. I personally find this terrible and very unfair to everyone involved.

Thanks for the post.

Wow you got 10 interviews? So I’m guessing there are jobs out there that aren’t accounted for in Pathoutlines. Were the interviews in a major city or did you apply broadly across the US?

im thinking it’s because most employers don’t feel like they have to advertise to get a candidate especially in tighter job markets where the demand is high to go there. Also with the variability in candidates (some great, some good, some poor) why would you want to put a job ad and get flooded with CVs when you can call up your local path academic training program and ask someone you trust for a great candidate?

The jobs I heard of via word of mouth were eventually posted on pathoutlines.

 

[deleted314957]

Keratin, did you ever jump on that job with the crappy vacation I told you to take about 1 1/2 years ago?

 

[KeratinPearls]

Keratin, did you ever jump on that job with the crappy vacation I told you to take about 1 1/2 years ago?

Yes I took that job. Thanks for the advice. I managed to squeak out/negotiate 4 weeks vacation. I do most prostate work and some low complexity path specimens enough to keep me busy. I feel like I’m losing my skills though but a job is a job for now.

Decent pay and good hours.

 

[deleted314957]

Yes I took that job. Thanks for the advice. I managed to squeak out/negotiate 4 weeks vacation. I do most prostate work and some low complexity path specimens enough to keep me busy. I feel like I’m losing my skills though but a job is a job for now.

Decent pay and good hours.

Plus, now you have INDEPENDENT SIGN OUT EXPERIENCE which trumps the type of cases you are looking at. Continue to gain experience and get ready to move up/on if and when you can.

 

[KeratinPearls]

Plus, now you have INDEPENDENT SIGN OUT EXPERIENCE which trumps the type of cases you are looking at. Continue to gain experience and get ready to move up/on if and when you can.

Thanks. I like my job but I am keeping an eye out for better job opportunities down the road. Maybe start some LADoc00/Webb Pinkerton level business.

 

[path_spouse]

Due to my job, we live in a major coastal city that lots of us non-doctors need to live in for work.

Unfortunately for pathologists (and even across healthcare generally) this place is a shark tank. There are quite a few local fellowship programs, and that means a relatively large cohort of fellows graduate every year. Experienced pathologists who had to move away after fellowship also want to return.

We certainly ran across word of mouth openings, but I doubt there is a huge submerged underground network of jobs just because pretty much all the fellows we knew ended up in advertised positions. If pathoutlines is showing two jobs available in the area, maybe there are really four--but I doubt there are ten.

Back when my husband was a fellow we spent time looking at where other alumni of his program had gone. It looked to me like they did one of a few things...

1) Flee! Those who were open to going elsewhere usually did. The good news is that often they went to other equally or more desirable cities on the same coast.
1a) Boomerang--some people who fled tried to come back in a few years when they had more signout experience.

2) Move to Pluto. Some folks went to exurbs 1-2 hours away from the city center, where some ultimately ended up building minor pathology empires.

3) Pinball. Some hung around bouncing to second (or third) fellowships or instructorships until a job opened.

4) Settle. Some took suboptimal local jobs and built signout experience. By suboptimal I mean there are local groups where if you look on LinkedIn you will realize that the last few pathologists all left within a year or two, and if you do some Google searches you find lawsuits. Unfortunately even jobs like that are competitive here.

So anyway that's my $0.02. If you were really determined to stay here after training you could, but probably you had to do some combination of the above.

 

[WEBB PINKERTON]

Still boggles my mind why anyone would even use pathoutlines to advertise a job. We just call up people and slot them in. And that has been my experience when I was looking for a job.

Networking is essential for this field and if you don't do it, you are going to end up in some really sh*tty jobs for your whole career.

 

[Spaziergängerin]

Thanks for the post.

Wow you got 10 interviews? So I’m guessing there are jobs out there that aren’t accounted for in Pathoutlines. Were the interviews in a major city or did you apply broadly across the US?

im thinking it’s because most employers don’t feel like they have to advertise to get a candidate especially in tighter job markets where the demand is high to go there. Also with the variability in candidates (some great, some good, some poor) why would you want to put a job ad and get flooded with CVs when you can call up your local path academic training program and ask someone you trust for a great candidate?

The jobs I heard of via word of mouth were eventually posted on pathoutlines.

I wanted to stay close to family so it was really just in the major northeast cities.

 

[KeratinPearls]

Still boggles my mind why anyone would even use pathoutlines to advertise a job. We just call up people Still boggles my mind why anyone would even use pathoutlines to advertise a job. We just call up people and slot them in. And that has been my experience when I was looking for a job.

Networking is essential for this field and if you don't do it, you are going to end up in some really sh*tty jobs for your whole career.

Ask LA why he advertised using pathoutlines.

Sometimes it can be from wanting the best candidate possible. Sometimes personal contacts don’t yield any candidates who are interested. Sometimes you interview candidates and you don’t think they would be a good fit with the group for various reasons.

 

[medgator]

Still boggles my mind why anyone would even use pathoutlines to advertise a job. We just call up people and slot them in. And that has been my experience when I was looking for a job.

Networking is essential for this field and if you don't do it, you are going to end up in some really sh*tty jobs for your whole career.

Sounds like rad onc these days....

 

[KeratinPearls]

Sounds like rad onc these days....

You’re in rad onc? How’s it with you guys? Heard the market was bad in the past. Improving at all?

 

[medgator]

You’re in rad onc? How’s it with you guys? Heard the market was bad in the past. Improving at all?

Used to be 2/3 (job satisfaction/quality, location and $$$) was a reasonable goal during peak rad Onc a decade or so ago... Now it's more 0-1/3 is considered successful.

ASTRO (specialty society) president basically came out and said any job you get should be considered a success.

Many of us are in good positions who matched during the competitive era earlier in the century, but now we can't lateral easily either.

My current sweet gig was obtained word of mouth and we will do the same if and when we need to hire again. Don't even need to look at new grads because there are enough experienced BC ROs looking for permanent employment, honestly worried that 2025+ residency grads will be unemployable.... It's really been a fast and furious change of fortune to the specialty, but that's what happens when you double slots in a short period of time without a growth in demand (quite the opposite, hypo-fractionation allows many existing docs to treat more patients).

 

[KeratinPearls]

Used to be 2/3 (job satisfaction/quality, location and $$$) was a reasonable goal during peak rad Onc a decade or so ago... Now it's more 0-1/3 is considered successful.

ASTRO (specialty society) president basically came out and said any job you get should be considered a success.

Many of us are in good positions who matched during the competitive era earlier in the century, but now we can't lateral easily either.

My current sweet gig was obtained word of mouth and will do the same if and when we need to hire again. Don't even need to look at new grads because there are enough experienced BC ROs looking for permanent employment

Sounds like Pathology but I think it was worse before (like 10 years ago).

 

[deleted314957]

Used to be 2/3 (job satisfaction/quality, location and $$$) was a reasonable goal during peak rad Onc a decade or so ago... Now it's more 0-1/3 is considered successful.

ASTRO (specialty society) president basically came out and said any job you get should be considered a success.

Many of us are in good positions who matched during the competitive era earlier in the century, but now we can't lateral easily either.

My current sweet gig was obtained word of mouth and we will do the same if and when we need to hire again. Don't even need to look at new grads because there are enough experienced BC ROs looking for permanent employment, honestly worried that 2025+ residency grads will be unemployable.... It's really been a fast and furious change of fortune to the specialty, but that's what happens when you double slots in a short period of time without a growth in demand (quite the opposite, hypo-fractionation allows many existing docs to treat more patients).

Sound to me like hypofractionation has really nailed you guys. I had INVOLUNTARY hypofractionation. Was supposed to get 7000 rads in 35 days. Had to stop at 5800
because it damned near killed me.

I understand lots of what y’all do is now 5 or so fractions. Big difference in $.

 

[medgator]

Sound to me like hypofractionation has really nailed you guys. I had INVOLUNTARY hypofractionation. Was supposed to get 7000 rads in 35 days. Had to stop at 5800
because it damned near killed me.

I understand lots of what y’all do is now 5 or so fractions. Big difference in $.

Those 5 fractions each bill higher than a normal fraction but you get the idea.. many of us advocated for case-based reimbursement years ago but it fell on deaf ears. Was idiotic to hitch our reimbursement to one based on fractions

 

[Med Director New England]

Used to be 2/3 (job satisfaction/quality, location and $$$) was a reasonable goal during peak rad Onc a decade or so ago... Now it's more 0-1/3 is considered successful.

ASTRO (specialty society) president basically came out and said any job you get should be considered a success.

Many of us are in good positions who matched during the competitive era earlier in the century, but now we can't lateral easily either.

My current sweet gig was obtained word of mouth and we will do the same if and when we need to hire again. Don't even need to look at new grads because there are enough experienced BC ROs looking for permanent employment, honestly worried that 2025+ residency grads will be unemployable.... It's really been a fast and furious change of fortune to the specialty, but that's what happens when you double slots in a short period of time without a growth in demand (quite the opposite, hypo-fractionation allows many existing docs to treat more patients).

Rad oncs who I know around me say exactly what you wrote

TY for chiming in here - I think path can learn a lot from Rad Onc. You guys overall are a smaller sub specialty and would feel the pain of overtraining much quicker than pathology

 

[deleted314957]

Those 5 fractions each bill higher than a normal fraction but you get the idea.. many of us advocated for case-based reimbursement years ago but it fell on deaf ears. Was idiotic to hitch our reimbursement to one based on fractions

Just curious but does hypofractionation nail your radiation physicists too?

 

[medgator]

Just curious but does hypofractionation nail your radiation physicists too?

Yes, everyone gets paid from the same fees

 

[eulAEgy]

Still boggles my mind why anyone would even use pathoutlines to advertise a job. We just call up people and slot them in. And that has been my experience when I was looking for a job.

Networking is essential for this field and if you don't do it, you are going to end up in some really sh*tty jobs for your whole career.

Is doing out of state networking a realistic thing, or does it really have to be local/in state?

 

[AZpath]

Networking out of state is more challenging. You might make contacts at a CME meeting near by the target city.
Perhaps one of your professors knows a pathologist in the area etc.

Often a pathology group from that state calls up a professor or the program director and asks who are your favorite residents.
I know people at my local university program. I don't know anyone in the next state over. That's why local networking is easier.

 

[deleted314957]

I would re- emphasize LADoc’s comment re your own senior residents. They can be excellent job sources if you impress them. I had two job offers from prior seniors who were in PP when I was in the market.

 

[KeratinPearls]

Networking out of state is more challenging. You might make contacts at a CME meeting near by the target city.
Perhaps one of your professors knows a pathologist in the area etc.

Often a pathology group from that state calls up a professor or the program director and asks who are your favorite residents.
I know people at my local university program. I don't know anyone in the next state over. That's why local networking is easier.

Train in the place you want to work so you get as much leverage in this job market.

 

[Zarniwoop]

Train in the place you want to work so you get as much leverage in this job market.

Smart advice for a better career, but that makes choosing the "best" programs a "bad" choice, because even with connections it is near impossible to get good jobs in Boston, SF, Baltimore suburbs, etc.

 

[ReedSternburg]

When I was looking for a job (10+ years ago), my east coast program director (top 10 residency program) called his buddy program director (top 10 residency program) in the Midwest metro I was particularly interested in. His buddy was kind enough to meet with me in person and give me local job market insights. Ended up taking a job that was advertised, but was alerted to several other positions that I would not have known about otherwise.

 

[Med Director New England]

Agree with Zarn above ^^
Some markets are “supersaturated”.

I’ve attached a link to a recent zoom round table that happened in the rad onc world. The panel is a mixture of private practice and academics. It is worth listening too but I will summarize. The private group is raising concerns of the expansion of training programs that doesn’t match the need for jobs & downstream effect including diminishing interest from US grads, difficulty finding jobs, etc (sound familiar).

the impact of the voices on SDN and Twitter have basically forced rad onc leadership to reconsider the expansion of training spots and a couple of programs have actually decreased spots in the last few years.

i would like to see something similar happen in pathology.

 

[HeyDalaron]

Agree with Zarn above ^^
Some markets are “supersaturated”.

I’ve attached a link to a recent zoom round table that happened in the rad onc world. The panel is a mixture of private practice and academics. It is worth listening too but I will summarize. The private group is raising concerns of the expansion of training programs that doesn’t match the need for jobs & downstream effect including diminishing interest from US grads, difficulty finding jobs, etc (sound familiar).

the impact of the voices on SDN and Twitter have basically forced rad onc leadership to reconsider the expansion of training spots and a couple of programs have actually decreased spots in the last few years.

i would like to see something similar happen in pathology.

I don't think it will happen because pathology is already compromised by private equity and publicly traded corporations (e.g. Quest, Labcorp). Rad onc doesn't have that problem yet.

I have always been disappointed that the consistently poor showing of pathology in residency matches has been accepted as the status quo and is unquestioned. Why aren't we doing better?

 

[AZpath]

It will take a big effort by residents in pathology and younger pathologists to effect change.

Program chairs have been telling us the status quo is fine for 20 years

 

[AZpath]

How much % did rad onc cut from residency positions?
I remember around 1999-2003 there was small amount of cuts in Pathology.
It was not much of a % and did not last.

 

[AZpath]

I don't think it will happen because pathology is already compromised by private equity and publicly traded corporations (e.g. Quest, Labcorp). Rad onc doesn't have that problem yet.

I have always been disappointed that the consistently poor showing of pathology in residency matches has been accepted as the status quo and is unquestioned. Why aren't we doing better?

There has been a big shift to corporation lab owners ( this includes more than just LC and Quest labs) and other specialists as lab owners over the last 20 years.
Unfortunately, cheaper labor is nice when you trying to gain business on lower price. The other specialists are going keep what ever they can too.
An employers job market works for these business models.

I see private equity buy other specialties too. Right now most are trying to leverage higher payments rather than cutting prices to gain business. I am not sure they are dropping salaries average salaries right now.

This dynamic will change if there are excess professionals in the field.

 

[Med Director New England]

I didn’t say that ^^ how’s my name attached

 

[KeratinPearls]

I didn’t say that ^^ how’s my name attached

Deleted.

 

[deleted314957]

There has been a big shift to corporation lab owners ( this includes more than just LC and Quest labs) and other specialists as lab owners over the last 20 years.
Unfortunately, cheaper labor is nice when you trying to gain business on lower price. The other specialists are going keep what ever they can too.
An employers job market works for these business models.

I see private equity buy other specialties too. Right now most are trying to leverage higher payments rather than cutting prices to gain business. I am not sure they are dropping salaries average salaries right now.

This dynamic will change if there are excess professionals in the field.

They WILL drop salaries, particularly if the bottom line is suffering. Of that I can assure you.

 

[deleted314957]

It will take a big effort by residents in pathology and younger pathologists to effect change.

Program chairs have been telling us the status quo is fine for 20 years

One of the first things they can do is restore the required 1 year of internship. AND I would not allow some bs back door way to get around it. This would sift out lots of dead wood. It would deter people with s****y communication skills and it would provide just a bit of street cred among our clinical colleagues. Right now, most of you have NONE.

 

[octopusprime]

One of the first things they can do is restore the required 1 year of internship. AND I would not allow some bs back door way to get around it. This would sift out lots of dead wood. It would deter people with s****y communication skills and it would provide just a bit of street cred among our clinical colleagues. Right now, most of you have NONE.

So ... a year of general medicine internship on top of 4 years of residency and another 1-2 of fellowship?
That's not a way to sift out "dead wood", but certainly a deterrent to some people who think 6 yrs is absurdly long compared to other specialties and decidedly the least viable option. (People with s****y communication skills still do internships, and it doesn't make them better at communicating).
I understand that's the salty-dog ex-military in you mike, but from a practical standpoint it's moot.

 

[Med Director New England]

How much % did rad onc cut from residency positions?
I remember around 1999-2003 there was small amount of cuts in Pathology.
It was not much of a % and did not last.

It wasn’t many for rad onc but
Md Anderson cut a couple of spots apparently. Rad - onc have at least now stopped program expansion.
We could learn a lot from them...

 

[HeyDalaron]

So ... a year of general medicine internship on top of 4 years of residency and another 1-2 of fellowship?
That's not a way to sift out "dead wood", but certainly a deterrent to some people who think 6 yrs is absurdly long compared to other specialties and decidedly the least viable option. (People with s****y communication skills still do internships, and it doesn't make them better at communicating).
I understand that's the salty-dog ex-military in you mike, but from a practical standpoint it's moot.

I did a rotating internship ten years ago in Canada and consider it a formative year that I benefited greatly from.

If all programs were high quality and recruits were bright and motivated, fellowships would be the exception, not the norm.

 

[AZpath]

It wasn’t many for rad onc but
Md Anderson cut a couple of spots apparently. Rad - onc have at least now stopped program expansion.
We could learn a lot from them...

There residency slots grew about 80-100% over the last 10 years.
The number of rad onc procedures has dropped too.

It takes meaningful cuts that last a while (more than stopping expansion).
They are talking starting salaries now @ 350 K.
They will be joining the mid 200s in no time.

 

[octopusprime]

I did a rotating internship ten years ago in Canada and consider it a formative year that I benefited greatly from.

If all programs were high quality and recruits were bright and motivated, fellowships would be the exception, not the norm.

I'm happy for the folks that spent a formative "5th year of medical school" honing their clinical skills and not maximizing their income & retirement savings, but there's absolutely no relevance or need. I spent 15 years in the Army and it was extremely formative, but I'm not out there pushing for compulsory military service.
[in that same vein...direct commissions in the military (eg. lawyers, doctors) generally require a ~2 week OBC to learn the ropes as opposed to the full 10 week basic training & several more weeks / months of AIT. Don't get me wrong, I thought basic & AIT were formative as hell but I don't see the point in requiring lawyers and doctors to do it, just as I don't see pathologists (or psychiatrists, or some others) to spend a year doing something they'll definitively forget in a few years--you don't use it, you lose it.]

 

[Med Director New England]

There residency slots grew about 80-100% over the last 10 years.
The number of rad onc procedures has dropped too.

It takes meaningful cuts that last a while (more than stopping expansion).
They are talking starting salaries now @ 350 K.
They will be joining the mid 200s in no time.

Totally agree

My point is practicing rad oncs has thru social media, mostly SDN and Twitter, managed to stop expansion and lately get a few programs to contract.

path should continue to speak up
It matters

 

[KeratinPearls]

Totally agree

My point is practicing rad oncs has thru social media, mostly SDN and Twitter, managed to stop expansion and lately get a few programs to contract.

path should continue to speak up
It matters

Just like those redditors who squeezed GameStop and caused hedge funds to lose billions, SDNers, en masse, can create change in our field.

We are living in an age of social media ladies and gentlemen.

 

[fecalith]

Just like those redditors who squeezed GameStop and caused hedge funds to lose billions, SDNers, en masse, can create change in our field.

We are living in an age of social media ladies and gentlemen.

Every time you mention GME, I die a little bit inside...

 

[KeratinPearls]

Every time you mention GME, I die a little bit inside...

I apologize. Just hodl lol.

 

[LADoc00]

I'm happy for the folks that spent a formative "5th year of medical school" honing their clinical skills and not maximizing their income & retirement savings, but there's absolutely no relevance or need. I spent 15 years in the Army and it was extremely formative, but I'm not out there pushing for compulsory military service.
[in that same vein...direct commissions in the military (eg. lawyers, doctors) generally require a ~2 week OBC to learn the ropes as opposed to the full 10 week basic training & several more weeks / months of AIT. Don't get me wrong, I thought basic & AIT were formative as hell but I don't see the point in requiring lawyers and doctors to do it, just as I don't see pathologists (or psychiatrists, or some others) to spend a year doing something they'll definitively forget in a few years--you don't use it, you lose it.]

My brother and I laughed over drinks when he was at RTC Great Lakes. He said all chaplains, doctors and nurses were pissed they even had to go through what amounted to high school PE classes.

Every single American should have to go through USMC boot IMO, everyone...even disabled kids. And not this millennial approved boot either, old school Cold War boot.

Voting should be a reward for low crawling over a mountain of corpses as you make your way up the legendary Reaper. The hot Las Pulgas sun will make all the dead bodies smell like total hell adding to the experience.

So yah I am pushing for compulsive military service.

 

[gbwillner]

My brother and I laughed over drinks when he was at RTC Great Lakes. He said all chaplains, doctors and nurses were pissed they even had to go through what amounted to high school PE classes.

Every single American should have to go through USMC boot IMO, everyone...even disabled kids. And not this millennial approved boot either, old school Cold War boot.

Voting should be a reward for low crawling over a mountain of corpses as you make your way up the legendary Reaper. The hot Las Pulgas sun will make all the dead bodies smell like total hell adding to the experience.

So yah I am pushing for compulsive military service.

So you are saying "Service Guarantees Citizenship"?

Would you like to know more?

 

[octopusprime]

My brother and I laughed over drinks when he was at RTC Great Lakes. He said all chaplains, doctors and nurses were pissed they even had to go through what amounted to high school PE classes.

Every single American should have to go through USMC boot IMO, everyone...even disabled kids. And not this millennial approved boot either, old school Cold War boot.

Voting should be a reward for low crawling over a mountain of corpses as you make your way up the legendary Reaper. The hot Las Pulgas sun will make all the dead bodies smell like total hell adding to the experience.

If it would turn your avg joe into Tom Hanks Saving Private Ryan-steel resolve-GSD machines, yeah, sounds great; but as it is, I wouldn't trust 9 of 10 avg citizens with a loaded weapon, my life or my mission. Too many people who know absolutely nothing already vote; let's not make it worse.

 

[WEBB PINKERTON]

So you are saying "Service Guarantees Citizenship"?

Would you like to know more?

I remember going to see that movie back in the late 90s with low expectations but it wasn't half bad. Dina Meyer 😉

 

[octopusprime]

I remember going to see that movie back in the late 90s with low expectations but it wasn't half bad. Dina Meyer 😉

and denise richards

 

[Napoleon1801]

So you are saying "Service Guarantees Citizenship"?

Would you like to know more?