job outlook?

[alimarie81]

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I am on my path rotation now, and am enjoying it very much. For me, this specialty is now one of serious consideration for application in the fall. However, I am feeling a bit intimidated after talking with the pathology residents. Is it true that 1) you must get a fellowship, or 2?? and 2) be a rockstar getting publications, case studies, during residency to have any chance at getting an interview, let alone a job, in a metropolitan area? I am in Chicago, and would like to stay in the midwest, and chicago-area if possible. Currently rotating in Chicago as well.
Is every "average" path resident still involved heavily in research? Where do the "less than stellar" applicants find employment?

Although I really like the field, this is a serious matter weighing on my mind. Any input will be appreciated. Esp re: to Chicago-area info. Thanks

 

[mlw03]

do a search on this topic - it's been discussed at great length.

 

[yaah]

Well, as of now most people do fellowships. I don't know if they necessarily have to, but doing some kind of area of extra training is desirable to many employers, because it gives you either more experience or expertise in an area.

Publications don't really mean squat for most jobs. They do matter for fellowships though, but you certainly don't need to have publications to get many fellowships. If you want a competitive one though, you are advised to do some work in the area either by abstract, presentation, or publication.

Every specific area of the country is different, and what is true now for the job situation is unlikely to be true when you are done. Every resident finishing our program, even the "less than stellar" ones have not had significant trouble finding jobs. None of them have looked in chicago.

No, the average path resident is not heavily involved in research. The average path resident does a project or two during their residency which usually amounts to a USCAP abstract and maybe a paper, or they do a case report. Some do nothing. Some do a lot more. I am probably the most heavily involved in my class but then again I am looking towards an academic job. What does "heavily involved" mean? I dunno - I have presented four abstracts, collaborated on two others, have two papers in press and two others in progress, and have other projects in progress or soon to start. But another resident who finished last year had a mini grant and his own lab space.

Six current fellows (One breast fellow, one cyto, two heme, one GI path, one surg path) in my program have looked for jobs this year (the others are doing a second fellowship). They all got private jobs that apparently pay well except for one staying in academics. All got a job in the exact area they were looking for (one southwest, one south, one west, one staying here, one staying in state, one in northeast).

 

[Thaitanium]

Publications don't really mean squat for most jobs. They do matter for fellowships though, but you certainly don't need to have publications to get many fellowships. If you want a competitive one though, you are advised to do some work in the area either by abstract, presentation, or publication.

Could you comment which fellowships are competitive (other than dermpath)? How about GI path or surgical path? Would you need publications if you wanted to do either of these fellowships in top tier fellowship programs?

Six current fellows (One breast fellow, one cyto, two heme, one GI path, one surg path) in my program have looked for jobs this year (the others are doing a second fellowship). They all got private jobs that apparently pay well except for one staying in academics. All got a job in the exact area they were looking for (one southwest, one south, one west, one staying here, one staying in state, one in northeast).

Could you tell us what salary offers these fellows received in your program?

Thanks for any info. You've been very informative yaah.

 

[deschutes]

Generally a (one) fellowship will suffice. But it isn't uncommon to get a job (though probably not in a metropolitan area) out of residency. The only person I know who has worked in the Chicago area had a job at Northwestern, but they graduated from there.

It's not difficult to find a small project to do during residency, and the benefit is that it often buys you a ticket to conferences like USCAP and the bigger world of pathology (not to mention rubbing elbows with fellowship directors in and outside of the fellowship fair...). If junior residents are looking to get involved in projects, they'd be well-advised to think about the timeline to presentation at a national meeting.

 

[yaah]

Could you comment which fellowships are competitive (other than dermpath)? How about GI path or surgical path? Would you need publications if you wanted to do either of these fellowships in top tier fellowship programs?

Haven't you been hanging around here awhile? You should know the answer to that. GI is probably more competitive. Unless you have an in at a program (and even if you do) it would be tough to get one without committing to it somewhat. Look at it this way: Publications are a way to separate candidates. Otherwise all they have to go on is letters of reference (which are usually flattering) and whether you're a personable individual. You don't get fellowships based on the latter.

Could you tell us what salary offers these fellows received in your program?

Nope. I know some info but that isn't for public consumption (and this is not a cue to ask in private message).

 

[LADoc00]

I am on my path rotation now, and am enjoying it very much. For me, this specialty is now one of serious consideration for application in the fall. However, I am feeling a bit intimidated after talking with the pathology residents. Is it true that 1) you must get a fellowship, or 2?? and 2) be a rockstar getting publications, case studies, during residency to have any chance at getting an interview, let alone a job, in a metropolitan area? I am in Chicago, and would like to stay in the midwest, and chicago-area if possible. Currently rotating in Chicago as well.
Is every "average" path resident still involved heavily in research? Where do the "less than stellar" applicants find employment?

Although I really like the field, this is a serious matter weighing on my mind. Any input will be appreciated. Esp re: to Chicago-area info. Thanks

I am indeed a rockstar. After spending 2 years with DIO in the 1980s shortly after the break up of Black Sabbath, I attempted to join ASIA, when I got turned down I went into pathology.

Rock on.

 

[mlw03]

here's a better question: does anyone know of a resident or fellow that graduated from their program and was not able to find a decent job? i'm not saying everyone gets their first choice in their #1 location, but rather, a fair-paying job in a liveable city. and if the answer is yes, would you chalk it up to personality reasons or the job market at the time? med students and residents love to focus on the negative, but if the overwhelming majority of graduating residents/fellows are able to find good employment that says a lot about the job market.

 

[yaah]

I have known a couple of residents with personality issues and they got good jobs too.

 

[mcfaddens]

I have known a couple of residents with personality issues and they got good jobs too.

But will they be able to keep them?

I think that the same overall message applies here, you will eventually learn the path part but the interpersonal and wisdom (as far as cases are concerned) component will lead to long term success or failure.

 

[mlw03]

But will they be able to keep them?

I think that the same overall message applies here, you will eventually learn the path part but the interpersonal and wisdom (as far as cases are concerned) component will lead to long term success or failure.

you're of course right, but whether they can keep them or not isn't a reflection of the job market. some people are just jerks, and they'll always have a hard time holding down a job. however the fact that such people are able to consistent keep finding another job speaks to the strength of the market i would think.

 

[sequela]

i find this job market/outlook talk so utterly fu**ing irritating.

there are a hundred posts about this and it is likely that none of them will apply to what path will look like in 5, 10, 20, 25+ years....

yes, there was a time (was it the late 80s or the 90s??? i can't remember) where it was especially difficult to find a job but from what we're hearing on this board and from others further along in the process, that doesn't seem to be the case these days. quite frankly, every field has had its not-so-glorious period-a time in which it was difficult to fill a program and/or find a job (rads and gas come to mind....are they suffering now?)

with regards to fellowships, look around people. it's not just pathology that is big on fellowships. rads, ortho, gen surgery, im, peds, etc.-this is the trend in medicine in general, everyone is moving towards super subspecialization. it's everywhere. esp in academics. i mean read these other specialty boards or talk to friends in other fields...i know a great handful of surgery, rads, ortho, derm, im, peds, psych and christ, even FM residents who are planning on fellowships. this is simply the reality of modern medicine.

in terms of turf wars or takeovers and all this other paranoia, it too exists in other fields. again, read these other boards...even derm, rads and gas are mouthing off about this crap and it's fair to say that as of today, they have some of the best work prospects out there.

bottom line is that things change. some times for the better and some times for the worst. no field is immune to this.

the only way to ride it out is to do what you truly like/love and perhaps more importantly, be really good at it. this should be the case for every field.

 

[yaah]

Good points - the important thing in my view to realize is that medicine is changing. Whether doctors band together or not, the time is coming when compensation and autonomy are going to continue to decrease as medicine becomes more regulated and cost containment becomes more vital. And with increasing technology and personalized medicine, subspecialization is going to be a key, although paradoxically generalists will also be important (in general medicine mostly, not so much in other branches like path). And as medicine increasingly becomes cost-conscious, the money to be made in medicine will be in administration and overseeing (i.e., things where doctors are not the primary people). Creating a niche for yourself in this world is good, but there will always be a need for doctors.

The thing I always try to tell people: If you are a good resident, work hard, train at a decent program, make reasonable contacts and good impressions on faculty, you will get a good job. "Good job" does not mean 1980s pathologist autonomy and money making opportunity. But it means you will get paid far above the national average american salary and you will get benefits. You may work hard, but isn't that expected?

Of course, that is not to say that one should sit there and take it while medicine is bought up by money managers who are siphoning off profits and leaving as little as possible to the people who have to do the actual work (i.e. mega labs). If good people reject these employment opportunities (or negotiate for what they deserve), the jobs will improve (because they likely are how things are going to be as efficiency is important).

The thing about medicine, though, is that quality is always going to be important. You can get away with cost cutting, inferior products, etc, in the retail world or in some types of industries. But you can't do it in medicine. You can try to save money by combining things, regulating certain aspects, developing more efficient ways to do things, but you can't skimp on quality. Remember this: No one wants a bad doctor. Very few people go to a doctor because they're cheaper. And when it comes to making a diagnosis, they don't want a bad pathologist making it.

 

[beary]

I have known a couple of residents with personality issues and they got good jobs too.

I have been around long enough now to know those of which you speak.

 

[pathdawg]

I am indeed a rockstar. After spending 2 years with DIO in the 1980s shortly after the break up of Black Sabbath, I attempted to join ASIA, when I got turned down I went into pathology.

Rock on.

You're better off, LA. The only meaningful contribution ASIA made was a very funny SouthPark scene (Cartman singing "Heat Of The Moment" in front of congress). Then again, if they could've had you playing synthesizer or something, maybe the band wouldn't be remembered today for being a lame 80's era joke.

btw, I too am a rock star. I just do path on the side because I love medicine so damn much.

To the OP, yeah, you're going to have to end up doing a fellowship (but not necessarily two if you don't wish). The midwest isn't as bad as urban centers in the Northeast (Boston, NYC, Philly). By the time you're finished, things will probably look different, one way or the other. I wouldn't spend alot of energy now worrying about getting a job 6 or 7 years from now. If you like path, do it.

 

[LADoc00]

here's a better question: does anyone know of a resident or fellow that graduated from their program and was not able to find a decent job? i'm not saying everyone gets their first choice in their #1 location, but rather, a fair-paying job in a liveable city. and if the answer is yes, would you chalk it up to personality reasons or the job market at the time? med students and residents love to focus on the negative, but if the overwhelming majority of graduating residents/fellows are able to find good employment that says a lot about the job market.

Yes, many many residents and fellows. Some personality, some English skills others the utter lack of any business sense. But the rosey talk of everyone from a program getting solid jobs is utter myth. 90%+ of jobs are trash.

I have known:
People with utterly stellar credentials including dermpath fellowship goin bankrupt/near bankrupt 2 years out of training.
I have seen people leaving crappy jobs to COME BACK to fellowship training after 4-5 years.
I have seen people do 4 fellowships because of the lack of reasonable job offers.
I have spoken with numerous people that are in their 50s and still havent landed partnership positions and likely never will.

I could go on ad nausem. In my experience, I know of MAYBE 5-10 total trainees that landed what I consider solid jobs.

 

[DarksideAllstar]

Yes, many many residents and fellows. Some personality, some English skills others the utter lack of any business sense. But the rosey talk of everyone from a program getting solid jobs is utter myth. 90%+ of jobs are trash.

I have known:
People with utterly stellar credentials including dermpath fellowship goin bankrupt/near bankrupt 2 years out of training.
I have seen people leaving crappy jobs to COME BACK to fellowship training after 4-5 years.
I have seen people do 4 fellowships because of the lack of reasonable job offers.
I have spoken with numerous people that are in their 50s and still havent landed partnership positions and likely never will.

I could go on ad nausem. In my experience, I know of MAYBE 5-10 total trainees that landed what I consider solid jobs.

 

[yaah]

Well, all I can say is, like I said, the graduates from here are not having trouble, even with "only" one fellowship, and they are getting jobs they want in the areas they want. I highly doubt that all of them, and this includes very good residents, are selling themselves out or are delusional. Different parts of the country are probably variable.

But there really is no excuse for going bankrupt a few years out of training with good training unless it's pretty much your own fault or circumstances in your private life that cause it. You can't really blame a job market that pays 6 figure salaries for bankruptcy. There is also no real excuse for doing four fellowships. Perhaps the reason they can't find a job is because they're doing four fellowships. Would you hire someone who did four fellowships?

The decreasing number of partnership positions is probably true. As labs are bought out by mega labs, partners are going to decrease I would imagine. "Partners" will now be people on the board (investors) who may or may not have any real connection to pathology. This is an irritating development but a necessity of a plutocratic society. I am no longer under the delusion that this is a free and democratic society. It's a plutocracy.

 

[yaah]

Here's another question: What is a "solid" job? Is it all financial? Is it all autonomy? What if the job has great benefits and gives you near total autonomy and a higher than average vacation amount but pays you $180k max? Is it a solid job if you are a partner but have innumerable adminstrative issues to deal with and don't get to do a ton of pathology? How about if it just pays really well? There are lots of tradeoffs.

 

[sequela]

that point about too many fellowships is right on....my path residency advisor at my med school explicitly told me that she thinks it's a red flag when people have done too many fellowships. in her view, it suggests that they are unable to join the work force because 1) maybe they can't handle it skills wise or 2) can't pull it off personality/interpersonal skills wise or 3) are just kinda lost souls who can't figure out what they really like/want to do and/or committ to it.

bascially, it can be seen as somewhat pathological. there comes a point when you have to give up the professional student thing and join the real world.

 

[mlw03]

Here's another question: What is a "solid" job? Is it all financial? Is it all autonomy? What if the job has great benefits and gives you near total autonomy and a higher than average vacation amount but pays you $180k max? Is it a solid job if you are a partner but have innumerable adminstrative issues to deal with and don't get to do a ton of pathology? How about if it just pays really well? There are lots of tradeoffs.

i think a "solid job" varies from person to person. i guess the way i meant it is whether people can find a job they're happy with. if someone is happy with great benefits/vacation by with a max salary of $180K, then that's solid in my perspective (and like yaah said - if someone goes bankrupt on a six-figure salary, they're doing something wrong. plenty of us grew up in households with a total income < 100 grand and turned out just fine).

the crux of my question is whether most graduates are able to find job situations they're happy with - however they choose to define happiness. and if the answer is yes, then that speaks to a good job market.

 

[DarksideAllstar]

plenty of us grew up in households with a total income < 100 grand and turned out just fine).

While your statement is inherently true, I think its misleading. Many med students have a significant amount of student loan debt which changes things. We also haven't been working since our early 20s, therefore have not been putting money into investments for retirement --which I think is the thing that bothers me most about starting a career at 28 and really getting paid a good wage 5 years later.

Back on topic, ideal job for me would include a significant amount of vacation time (ie 10-12 weeks). I'd take less salary for more vacation time any day of the week.

 

[Nilf]

I am indeed a rockstar. After spending 2 years with DIO in the 1980s shortly after the break up of Black Sabbath, I attempted to join ASIA, when I got turned down I went into pathology.

Rock on.

Dude you're too funny.

 

[LADoc00]

A "solid job" is a GESTALT concept of cash flow (not salary mind you, cash flow), llifestyle and power/leverage. Although this triangle sounds/vin diagram simple it is very difficult to fully conceptualize for many MDs.

When you look purely at the "numbers" realize this: Student loan debt nowadays is beyond absurd rapidly approaching the price of a single family home in the US. The interest rate for certain federal loans programs is also NOT capped and is at a much higher rate than home equity credit lines/home loans. Student loans are NOT dischargeable in bankruptcy like a foreclosure. They NEVER leave your credit report. Failure to pay can result a bench warrant for your arrest which INTERPOL can serve anywhere in the world. School loan officials are now involved in one of the largest kickback scandals in the history of US lending. This makes med student loans the most risky financial invest of your life, even worse than a bad marriage/divorce.

Reimbursements for Medicare are and WILL decline. The floor is not currently visible but it would be possible one day MDs make less than nurses. In fact, for some specialities it has already occurred. All payors base reimbursement off Medicare. It gets cut 20%, you are cut 20% across the board.

There is no other graduate degree program facing these obstacles, which IMO are almost insane.

There is alot more to consider than just making six figures. MD leadership in this country is horrendous. Pathology leadership is non-existent. And folks we are barrelling towards disaster at the moment. Academics, who should be storming Congress to fix these issues, are instead rearranging deck chairs on the Titantic and fiddling while Rome burns.

this is every man for himself Mad Max armageddon. Good luck. Die well.

 

[yaah]

It's true about the leadership. I went to the state pathology society, and one of the pathologists assigned to represent the group at the state capitol said that when certain laws are passed that negatively impact physicians, congresspeople barely hear a peep. But in other professions, they get inundated (like teachers' unions, labor unions, etc). Physicians just sit back and take it (or more likely hope someone else is dealing with it).

Part of the problem of course is that it costs money to access government and argue your point. What a democracy! Donate $10k to congressman X, get a private meeting! Not corrupt at all!

 

[DarksideAllstar]

It's true about the leadership. I went to the state pathology society, and one of the pathologists assigned to represent the group at the state capitol said that when certain laws are passed that negatively impact physicians, congresspeople barely hear a peep. But in other professions, they get inundated (like teachers' unions, labor unions, etc). Physicians just sit back and take it (or more likely hope someone else is dealing with it).

Part of the problem of course is that it costs money to access government and argue your point. What a democracy! Donate $10k to congressman X, get a private meeting! Not corrupt at all!

I think the other issue is that physicians do not have union representation like teachers, pipe fitters, electricians, etc, so inherently we will end up getting screwed.

 

[Myempire1]

Job outlook- Pretty good: Pathology is the base of medicine after all.

Pay outlook- Pretty bad: The senior midwest pathologists I know are pretty pessimistic about the growing practice of fee splitting. Unless I am surrounded by a disproportionate number of jaded folks, which I doubt I am, I trust their judgment. Hopefully, trends will change and lead to better times.

 

[mlw03]

Job outlook- Pretty good: Pathology is the base of medicine after all.

Pay outlook- Pretty bad: The senior midwest pathologists I know are pretty pessimistic about the growing practice of fee splitting. Unless I am surrounded by a disproportionate number of jaded folks, which I doubt I am, I trust their judgment. Hopefully, trends will change and lead to better times.

can someone please elaborate on what fee splitting means?

 

[juddson]

can someone please elaborate on what fee splitting means?

In broad strokes, it means some asshat urologist agrees to send you tissue only so long as you agree to forfeit some of your professional fee to his beach house.

Justin