Let's talk pathology...

[Mindy]

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Hey all! It's been a little bit since we've had a fruitful pathology chat, so I'm getting a little itchy. I propose this topic:

Many path departments have been upheaving recently (like those famous Boston ones.) How can one tell (based on interviews, etc.) how stable a department is? Does anyone have any inside scoops? What attracts/interests applicants to certain programs?

Okay, I tossed the ball in...

Yours truly,
Mindy

 

[Magree]

Hi:

What's been going on in Boston? As to being comfortable with stability - I think that's a great question and kind of tough. Me-thinks that maybe contacting the residents is the best way to gauge. If there was one you particularly liked when interviewing or felt was "frank" about things then email him/her. Just an idea..

M-

 

[Mindy]

Rumor has it that the Harvard programs, particular MGH, have recently underwent some rapid faculty turnover and have been experiencing financial difficulties (i.e. not living up to the normal high Harvard standards.) Anyone know if this is fact, exaggeration, or downright falsehood?

Good idea regarding contacting residents, Magee...

Mindy

 

[brownman]

Mindy,

Path...great choice. Good field, and one of the last great pieces of detective work in medicine. Some of the smartest people I know go into path, including my sister and her husband who are both residents at Stanford in path.

Ok, so here is the breakdown:

FOR SURG PATH: there is no better program than stanford. If you want to make cash in surg path, or an/clin for that matter...Stanford is the place to go. There is no other place that will offer those kinds of opportunities.

For Heme path: Brigham (MGH is a possibility too, but that program is very resident driven and the fellows don't really do that much).

For Derm path: There are a lot of good programs. It really depends what in the end you are looking for in your education when it comes to derm path.

The harvard programs are actually ok...they've merged their practices, renegotiated rates with insurance providers, and are actually offering enough cash to mediate many attendings staying. With that said however, nothing is easy anywhere. The two things I have heard is that:

a) MGH: resident heavy: you will work like a dog. The read out so many slides, that it almost sounds inhuman. But the fellowships there are nice.

b) Brigham: exactly the opposite.

My personal recommendation is that you come to Stanford. Outside of getting great training, and a respectable salary...my sister and her husband each get an 8,000 dollar per year housing allowance. It's the greatest deal ever. They pocket cash every month, and they take two to three nice vacations every year (we should all be so lucky, huh?). Anyway, that's one man's perspective. Good luck...

 

[Firebird]

so I have this really stupid question that doesn't really have anything to do with this topic...other than it's a path question

Do pathologists wear white lab coats? I just thought this up the other day and was wondering...

 

[Magree]

Hi:

Interesting stuff on the Boston programs. I've basically heard that no matter what the state of those programs - you can "write your own ticket" when your done. Those people know virtually EVERYONE in path and can get you a job or fellowship whereever you want. Stanford is probaby similar. I think the lifestyle of Brownman's sister is somewhat reflective of having a spouse also making money. Palo Alto ( and the rest of the Bay Area ) is incredibly expensive to live in. Most of the residents I've met live pretty frugal lives - especially if they are trying to make a dent in their loans.

M-

 

[Mindy]

Firebird: Pathologists in our program (SUNY Upstate) occasionally wear lab coats...but only when they are cold 🙂 The clinical pathologists wear their lab coats more frequently than the surg. pathologists.

Magree: I've definitely heard the "write your own ticket" theory too. I think U of Penn can be added to that list.

Brownman: I'm an east coast gal...but open-minded, what's your response to Magree's comment?

Finally: anyone know anything about Wake Forest? Their clinical pathology training includes a dedicated six months of medical technologist training (literally taking the same course as med tech students.) Any thoughts?

Mindy

 

[Magree]

Hi:

Wow - I didn't know about Wake Forest's Clin path program. I think that sounds cool. Don't know much about the path program - most of what I've heard about other programs is impressive (people rave about anesthetics there) and most seem to like the area. Are there many path programs that have dedicated med tech teaching? Thanks.

M-

 

[GreatPumpkin]

Wake has awesome facilities and what seems like a friendly group of residents and staff. It is always one of the programs I recommend to people to check out. They do trememdous numbers of autopsies as residents so if that is not your thing be aware.

The clinical path program there is interesting, personally as a resident I wouldn't want to spend six months as a lab tech in training. That is not really needed as a pathologist you will really not need to know step by step the complete details of performing the tests, more important is the understanding of how the equipment works and the interpretation of the test. For example if I did 2 months of blood bank this year I spent maybe 4 days sitting as a tech. And, I have to say that was enough I think I would have been bored if I had to do more. Instead I spent my time going on patient consults for abnormal antibodies, transfusion reactions and apheresis. I went to blood utilization meetings and management meetings. These are the things that path docs do during clinical path. Make sure the cp program has a good molecular program.

As for evaluation of a program, I would say the most important thing to try to evaluate is whether or not the residents are happy. If they are the program itself is likely fine. The thing you don't want to do is go to a program where the residents are miserable because you will be as well.

Going to any of the larger well known schools will write your ticket. The program directors and staff will have numerous contacts in the community to help with your job search. Many will have nationwide contacts.

Firebird, I only wear my labcoat when going to see patients. Or if I am wearing scrubs and going to the main patient areas like the cafeteria.

 

[guardian]

First year medical student entering 😀 !
I have a dumb question, what exactly do pathologists do? What are the subspecialties of pathology?

Mindy, I go to Upstate too. You have some really helpful classmates who TAed anatomy 😀 .

 

[GreatPumpkin]

For info about what a pathologist does check this out.

<a href="http://asip.uthscsa.edu/PATH_CAREER/ASIP_BROCHURE.html" target="_blank">http://asip.uthscsa.edu/PATH_CAREER/ASIP_BROCHURE.html</a>

subspecialties include

Derm path
Cytopath
Molecular
All sorts of surgical path subs
Transfusion medicine
Forensics
etc....

 

[Mindy]

As always G.P. you have terrific advice...

But since you :wink: brought it up...what programs would you recommend a prospective pathologist check out?

Mindy

 

[MBK2003]

I have a question about the NIH anatomical path residency program. My interest is definitely experimental path and my faculty advisor is steering me towards NIH. Has anyone heard anything about the program or even interviewed there?

Thanks!!
MBK2003

 

[GreatPumpkin]

I know the most about Southeast coast schools. The ones I have heard good things about are:

Wake Forest
UVA
MCV (hehe self promotion)
Duke
Emory
UNC

Other schools I have heard good things about:
Univ of New Mexico
Stanford
Univ of Washington

Of course I know the most about my program, but I interviewed at UVA, Wake, Univ of Tenn and MCV. If there are any questions about these places.

Mindy, do you go to SUNY Albany? I know one of the first year path residents there, Donna Vincenti. I am sure she would give you the lowdown of the places she looked into as well.

 

[dbiddy]

Path people............I have a question. I am in the match for radiology, and at my #2 ranked program I have the opportunity to spend 4 months of my intern year in another department and I am thinking of path. I am sure that this would be worthwhile, but I am wondering what I would spend this time doing? I've never done any pathology rotations. I'm thinking path because I can learn about rare diseases and the subtle differences between different types of malignancies and also because the schedule would be alot more humane than doing something like surgery. Any thoughts? Comments? Suggestions? Thanks.

 

[Magree]

Hi:

Wow - I thought that radiology required a clinical internship. I never realized that some programs would let you "opt" out. Path would be a great place to spend time. I would assume that anatomical path would be the most beneficial to you as a radiologist :wink: - so you could end up on the autopsy service or maybe doing some surg path (cutting in and signing out biopsies etc.). There's an amazing amount to learn and you'd get first hand exposure to the lesions etc. you'd be identifying radiologically. Good luck! I'm sure GP could give you more info.

M-

 

[GreatPumpkin]

Cytopath, surgical path and autopsy would be the best rotations for you. You will learn a ton and probably have a lot of fun. What a great deal to be able to do this during your intern year. And, if you can compare the actual gross findings to x-ray findings on patients it will be awesome.

 

[Voxel]

To sit for the radiology boards you need to fulfill the following requirements (straight from the American Board of Radiology website)

"The other year must be accredited clinical training in Internal Medicine, Pediatrics, Surgery or surgical specialties, Obstetrics & Gynecology, Neurology, Family Practice, Emergency Medicine, or any combination of these. This clinical year will usually be the first postgraduate year. No more than a total of three months may be spent in Radiology, Radiation Oncology, and or Pathology. All clinical training must be in an ACGME, AOA, RCPSC or equivalent approved program."

So you can't do 4 months of pathology and still sit for the radiology boards. Be careful, I would not want that little thing stopping me from taking my boards.

 

[mcphuguy]

Hey GP,

I know that a faculty member at my school (not in path), who makes a lot of money trying out equipment for surgical procedures for the companies that make them. Is there any chance to do this in path when one is out in the real world (either private practice or academics)? Could one try out cutting edge technology for company x and get paid for it? Or do other things on the side?

Thanks

 

[trixnjoks]

To all of you in Path residency and beyond...
I remember reading something (at medschool.com) about how non-whites have a hard time getting desireable positions after residency. What is your opinion on this? Is this true? Is this statement valid nationwide? Can a non-white pathologist make $200,000 a year? Thanks
Also, how does this situation applies for whites IMG's versus nonwhite AMG's?

 

[Mindy]

Guardian: Good to see a fellow Upstater! I hope you are having a pleasant time... (though honestly first year was anything but pleasant!)

GP: Thanks for your list. I am not terribly shocked by your choices though it does confirm that I have at least some idea of the desirable programs. I suppose you can guess that I have finally made the plunge, disregarded any paranoia I have regarding the path job situation, and have dedicated myself to a lifetime of glass slides! 😀 Two more questions: 1) What do you plan on doing with yourself once you "graduate"? 2)What would you say to a potential MCV applicant (my husband's fond of Virginia/N.C. area)

Trix: I think that foreign pathologists may find a resistant job market, but I do not(or am unwilling to) believe that non-white american applicants have a disadvantage compared to white americans. Though even as I write this, I am sure that there is plenty of anectdotal and second-hand evidence to show that discrimination against american non-whites and women exists.

Magree: Have you decided pathology too?

Look forward to all of your replies, like always!

Mindy

 

[Mindy]

Oops, one more question to all:

Anyone going to the AIMCL (automated information management in the clinical laboratory) 20th annual symposium in Ann Arbor?

Just checking!

Mindy

 

[GreatPumpkin]

mcphuguy, no idea on that one.

trixnjoks, are you talking FMG or non-white? FMGs do have a tougher time in path just like they do in almost all specialties where they need to join a group. Tougher, but they will find a job. Non-white american grad I guess it is likely that some old boy network groups still exist, but that is not the norm. I do not have any real world examples either way though or any statistics. We have a black resident who will graduate in two years I will have to let you know. 🙂 She certainly has not had any problems within our residency program, she will be one of our chiefs next year.

Mindy, I will likely do general surgical path practice in a group in a small to medium sized hospital. I am not planning on a fellowship right now, but that might change. I have four more years to think about it. It is great you are going path and it is great to hear that you might apply to MCV it really is a wonderful program. Good mix of surgical and clinical path during all the years, very friendly work enviornment and staff has lots of contacts to help with the job search. The director of Anatomic Path will by the national president of the cytology association next year or the year after one. So we have our fair share of famous docs, if that matters. And, we are moving in to a brand new building this April. So we will have super facilities. Hours are fair, little call really and it is from home.

If anyone has other questions fire away.

 

[dbiddy]

The four month thing is part of the transitional program at the hospital. The rankings for the transitional year are tied into the radiology program. I guess that I'd have to do only three months of path. Their program is probably not set up specifically for people going into radiology. They have four elective months and give you the option of doing all four in a sponsoring department or choosing two electives and having two assigned by the PD.

 

[Magree]

Hi Mindy:

Yeah, I've pretty much decided on path. I enjoy clinical work a lot so its been a tough decision to not have much patient contact. But I have really enjoyed my path rotations and, to me, its a lot of fun. Its definitely not a field for everyone but I think it works well for me. What about you - are you path for sure?

M-

 

[Mindy]

Hey Magree! Yep, despite all my hard work trying to convince myself not to go into pathology, the bottom line is I love it. I definitely can empathize with your concerns about patient contact--it feels almost sacrilegious not to be a clinician. Though honestly, I'm to the point where I cannot wait to start a pathology residency (I think its separation anxiety from the microscope!)

BTW, G.P. I am actually out of SUNY Upstate Syracuse. How many years have you got left? Planning on practicing in/around Virginia? What do you think the most important features in a residency are (happiness asides!)

Mindy

(I'm going to keep this post alive until no one responds :wink: )

 

[jargon124]

I'd like to pick the brain of Great Pumpkin and other Pathology buffs:

-What impact do you think future advances in medicine - things like molecular medicine, gene therapy, genetic screening, etc - have on the demand for and role of pathologists? Are these things so far off that its not worth worrying about? I ask because I am in incoming med student who is exploring all specialties and think I might have an interest in path. My biggest fear, though, is choosing a specialty that becomes obsolete (as a worst case scenario) or else sees its role dininished as advances are made in technology/science.

-Along the same lines, what is the demand situation like currently? Is there a glut/shortage of pathologists?

-What is the pay like for fellowship trained pathologists - I am interested in Cytopath. Derm Path and Neuropath in particular. I know that pay always varies by location and whatnot - but I'm looking for a general idea and wondering if it's worthwhile, financially, to spend the extra 1-2 years in fellowship training.

Thanks in advance for the imput!

 

[jargon124]

One more thing - are pathologists strictly diagnosticians (e.g. diagnostic radiologists) or do they serve as consultants with respect to course of treatment in certain cases as well?

 

[guardian]

Even though it's really premature, I think I'd be interested in pathology. From what I here there's all sorts of research routes in pathology. I think I'd be interested in clinical research with a basis in basic science research. Thanks for the link Great Pumpkin 🙂 .

Hey Mindy? Are you at Binghamton now? Do you have any advice going into physiology and histo? 😀 .

 

[GreatPumpkin]

jargon124:
-What impact do you think future advances in medicine - things like molecular medicine, gene therapy, genetic screening, etc - have on the demand for and role of pathologists?

In the short term these things are hot subspecialties that pathologists can participate in. Most of these techniques are in the early stages. And, very expensive.

In the long term, I would say at least 20 years off, there might be more of a shift toward the clinical pathology part of the job and less need for the surgical path part. But, likely even then these tests will just be something that is used in conjunction with the normal surgical path histo exam. Kind of like how immunochemistry is used today.

Are these things so far off that its not worth worrying about?

Yep, shouldn't worry actually the pathologists that embrace this technology will be in the greatest need.

I ask because I am in incoming med student who is exploring all specialties and think I might have an interest in path. My biggest fear, though, is choosing a specialty that becomes obsolete (as a worst case scenario) or else sees its role dininished as advances are made in technology/science.

Not likely, esp. considering that pathology is the one that controls most of these technologys anyway.

-Along the same lines, what is the demand situation like currently? Is there a glut/shortage of pathologists?

Not a glut or shortage. But, I have no real data to support my feelings. Just my observations and stories from the people leaving here.

-What is the pay like for fellowship trained pathologists - I am interested in
Cytopath (1yr) in demand easily start over 200+
Derm Path (1yr)in SUPER demand easily start over 300+
Neuropath (2yrs)not sure about this one. Seems that the field is shrinking but the job market should be increasing so who knows.

And, yes in some instances we are consultants esp. in apheresis and cytology.

Good luck

 

[mcphuguy]

Hi again GP,

What about pediatric path?? Jobs, $$, future, etc.

Thanks

 

[GreatPumpkin]

Sorry don't know much about ped path either we don't have a fellowship in ped path.

 

[Firebird]

What type of opportunities are there for a fellowship trained pathologist in a semi-rural setting. I'm specifically talking about in and around Huntington, WV which is where I plan to live and practice. The city is approximately 60k in population, and is one of the two largest cities within 2.5 hour's drive.

Do rural areas typically employ derm path or some other type of specialized pathologist?

 

[GreatPumpkin]

Firebird,

General surg path and clinical path would be fine for a rural area. There would be no real need to specialize any anything in particular. Though they would gladly take a fellowship trained pathologist.

The area you mentioned has a med school and a regional hospital so there would jobs for specialized pathologists. I wouldn't really classify that as rural.

 

[Mindy]

Hey Jargon! I'm certainly not going to go into it again (for reasons that will be become clear if you choose to pursue this next bit of advice). Use the search engine on this forum and use the keyword "pathology." We have had raging and extensive debates concerning the pathology job market. I've decided to stop fretting over it.

Though, I just read another thread on this forum linking to an AP article talking about a surgeon shortage. If this is perceived as real, which I am somewhat skeptical about in the first place, does anyone think it would affect surgical pathologists? (...the sky is falling...the sky is falling!)

Regards,

Mindy

 

[Firebird]

•••quote:•••Originally posted by Mindy:
•Though, I just read another thread on this forum linking to an AP article talking about a surgeon shortage. If this is perceived as real, which I am somewhat skeptical about in the first place,...•••••It is real...come to West Virginia...