Lifestyle job vs mentally stimulating: your preference?

[coroner]

I recently had a colleague e-mail me about a job. I may consider it, but I’m interested to know other perspectives. If you had two jobs to choose from, and are about 20-25 years away from retirement with no geographic restrictions keeping you from moving, what would you prefer based on the following differences:

Job 1: Busy, large hospital with complex cases and enough volume to support a residency program (not happening). 10 total pathologists (including part-timers/per diem) covering 4 hospitals, private practice.

• Average work week: ~45 hrs. Routinely everybody starts at 8am.
• Signing out: 5,200 cases/yr per pathologist (many big cancer resections), 100 bone marrows/yr. per pathologist
• Procedures: Frozens: 1-2/wk per pathologist. FNA adequacies (ROSE): 3-4 FNA/wk per pathologist.
• Grossing: About 1X/wk at one of the satellite smaller hospitals for about 2-3 hrs/d (PA’s at main hospital). Plus, when on call 7-8 weekends/yr, about 4-5 hrs each of those weekends, and when the PA is off. Yearly hours grossing ~150 hrs (including 7-8 weekends/yr).
• Call: 7-8 weekend calls/yr (with grossing as mentioned above), an additional 6 weekends/yr on backup call (almost never get called but you cannot leave town in case something happens to the 1st call pathologist).
• Other: Tumor conferences: 1-2 /mo per pathologist. No admin or CP duties (excluding CP call).
• Time off: 7 weeks. Harder to schedule time off because of coordinating schedules with other pathologists in the same hospital/practice.

Job 2: Small hospital, solo pathology, employed. Low complexity (~60% bxs., no high complexity cancer cases, they’re operated on at larger hospitals) Recently absorbed by a larger healthcare conglomerate with 5-6 hospitals under their belt.

• Average work week: 30hrs. Flexible start time, can start at 9-9:30.
• Signing out: 2200 cases/yr (occasional breast or colon for resection about once/mo.), ~10 bone marrows/yr
• Procedures: Frozens: 1 every other month = 6/yr (yes, only 6 per year). FNA adequacies: None. Radiology just sends them for permanents.
• Grossing: Every day about 30 min. - 1 hr (no PA). Never on weekends. Yearly hours grossing ~150 hrs (no weekends)
• Call: Always on. Never involves coming in, let alone grossing. If anything, there might have been one time in the last 5 years a pathologist was contacted on a weekend, but didn’t require coming in.
• Other: 1 quarterly med staff meeting, maybe another random committee meeting. No tumor conferences. = 3-6 total meetings per year.
• Time off: 11 weeks. Can schedule time off whenever without planning weeks/months in advance or worrying about backup/scheduling conflicts with other pathologists. This is because during the time off, there's always regional pathologists in the healthcare network who will get the cases shipped to them via courier when you're off.

The pay is almost identical. Job 1 is private practice and Job 2 is employed; however, the income comes out to roughly the same. However, with the average hours per week (due to lower caseload) being significantly less at Job 2, the hourly wage breakdown has Job 2 earning a whopping 64% more per hour than Job 1, and a 42% lower annual caseload.

Even though the pay is roughly the same, the cushy lifestyle and 1 month/4 weeks more of vacation of Job B means significantly less time behind the scope freeing up the ability to do other things in life. The cost of living is similar and the cities are not much of an upgrade/downgrade i.e. same geographic region and size. So it’s not like going from South Beach, Florida to Valentine, Nebraska. Besides the volume & lifestyle, all other major criteria about a job are more or less equal or close.

Which brings me to one of the main differences of the two jobs would be the degree of mental challenge. The busy hospital (Job 1) has more interesting cases on a regular basis as a result of being higher volume. Job 2, is solo and very much run-of-the-mill, small town pathology i.e. gallbladders, hernia sacs, GI/Gyn biopsies, etc. There is no curbside consult like knocking on your colleague’s door for a quick reply, only sending to local pathologists via courier for a 2nd opinion the next day. In this type of environment, my concern is my skills might gradually erode over time; or, if the hosptal closed and I had to take a "big league" job again stepping up from the "minor league".

So, the question is which would you take? Job 1: busy, more frequently interesting & challenging cases and colleagues to bounce ideas off. Job 2: cushy, way better lifestyle, more vacay, but you're solo and skillset isn’t really broadening.

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[deleted314957]

Job 2. But, it sure would be nice to get that 2,200 up to min 8,000 thru outreach but i guess that ain’t gonna happen. Also, place 2 sounds ripe to be “absorbed “ by some entity.

 

[coroner]

Job 2. But, it sure would be nice to get that 2,200 up to min 8,000 thru outreach but i guess that ain’t gonna happen. Also, place 2 sounds ripe to be “absorbed “ by some entity.

Already happened. It was independent years ago, the absorption is under a financially stable healthcare system with 5 or 6 hospitals. They want boots on the ground at Job 2 because that's what they've always had in the past and clinician's want to keep it that way. And this healthcare system can afford it...

 

[KeratinPearls]

Job 2 for me. Depends on your current experience and how long you plan to stay with job 2.

Job 1 would be good for experience if you don’t have as much experience as you would like or want to get better. You can always go to a Job 2 later on.

If you feel your diagnostic skills are just fine and you can see yourself never going to a busy practice again then Job 2 it is. It might be hard to transition to a Job 1 after being at Job 2 for so many years.

 

[caffeinegirl]

What are your skills worth?
"the hourly wage breakdown has Job 2 earning a whopping 64% more per hour than Job 1."

I would suggest that Job 1 is definitely underpaid for the amount of work going into it.

 

[deleted314957]

Already happened. It was independent years ago, the absorption is under a financially stable healthcare system with 5 or 6 hospitals. They want boots on the ground at Job 2 because that's what they've always had in the past and clinician's want to keep it that way. And this healthcare system can afford it...

In that case, job 2. And let the medical staff know thru words and deeds that you are THEIR pathologist. Nobody will be able to get you out of there with a shoehorn.

 

[HeyDalaron]

Job 2 sounds better. If you have subspecialty expertise you could market yourself as the local or regional expert and try to get more complex cases of that system sent your way.

 

[Med Director New England]

Does job 2 also entail clia / medical director for all hospital labs ?

If so although you may feel your AP skills May erode - you’ll likely get much better at CP (I.e picking up and mastering things like running a small blood bank).

So my answer depends on if job 2 has CP component.

I also don’t think your going to forget how to handle things like staging a lung cancer or whatever even if you switch to job 2. You likely will still see every diagnosis you normally would just less of them and some only on small biopsy.

 

[coroner]

Does job 2 also entail clia / medical director for all hospital labs ?

Yes. And it does involve a small extra stipend for medical directorship. I included that in total comp. when comparing jobs. I have covered a small solo hospital before and you are correct. When you're the only pathologist there, you're much more abreast of what goes on in CP vs a larger hospital with 8-10 pathologists and there's one medical director and one blood banker who get all the inquiries and everyone else is focused on signing out.

If you feel your diagnostic skills are just fine and you can see yourself never going to a busy practice again then Job 2 it is.

I also don’t think your going to forget how to handle things like staging a lung cancer or whatever even if you switch to job 2. You likely will still see every diagnosis you normally would just less of them and some only on small biopsy.

Good points. Yeah, I've been out for almost 10 years. I think in any field of medicine, after awhile, stuff starts to repeat. Sure, there's always a zebra even an academic pathologist might say they've only seen once in 20+ years, but that's why they're zebras. But, if you're in this field long enough (or any field in medicine), you'll eventually see most of what's out there to see. Not necessarily everything; but, stuff starts to repeat...

 

[shikimate]

I'd take job 2 without a blink.
"intellectual stimulation" is such a BS trap for wanna be gunners. It's akin to buying "premium quality" trinkets at the flea market.
But you know what, there are hoards of people who'd buy "premium quality" trinkets at the flea market, so mark my word, some sucker out there will take it.

 

[TrojanRaggy]

I'd take job 2 without a blink.
"intellectual stimulation" is such a BS trap for wanna be gunners. It's akin to buying "premium quality" trinkets at the flea market.
But you know what, there are hoards of people who'd buy "premium quality" trinkets at the flea market, so mark my word, some sucker out there will take it.

Off topic but do similar different choices for jobs exist in Canada? Since the pay is more or less uniform, what type of setting should a new pathologist join?

 

[Dave CX]

Gonna die someday. Job 2. All about bucks and the effort required. The rest is just conversation. Let others pursue sainthood.

 

[Med Director New England]

Yes. And it does involve a small extra stipend for medical directorship. I included that in total comp. when comparing jobs. I have covered a small solo hospital before and you are correct. When you're the only pathologist there, you're much more abreast of what goes on in CP vs a larger hospital with 8-10 pathologists and there's one medical director and one blood banker who get all the inquiries and everyone else is focused on signing out.




Good points. Yeah, I've been out for almost 10 years. I think in any field of medicine, after awhile, stuff starts to repeat. Sure, there's always a zebra even an academic pathologist might say they've only seen once in 20+ years, but that's why they're zebras. Most of the other stuff you eventually see when you do this long enough...

I would take job 2

Also you will in the end find likely find job 2 more stimulating and challenging but in different ways. The path at the larger hospital works up a rare AP tumor gets satisfaction from nailing the diagnosis, waxing poetic later about it at some teaching conference…

In job 2 you’ll be helping make decisions in the CP world that really impact your hospital services and quality. Your CEO needs a solution for running surveillance Covid testing for your hospital staff, your ED docs or critical care docs need the lab services to pivot in some way, etc. hospitals this size with ****ty lab services are ****ed. You’ll be appreciated and challenged daily

 

[Allegri]

Is it possible that in job 2 there will be some administrator with an online MBA managing your output and telling you what to do in annoying ways? Who exactly are you employed by?

 

[WEBB PINKERTON]

Go to the google maps website and take the job most rural. Although both sound like they suck.

 

[octopusprime]

Job #2.
Why would anyone take job #1? There are forms of mental stimulation outside the pathology office, and if you take job #1 you'll almost certainly never discover any of them (and you'll burn out).

Job #2 offers pay closer to revenue generation.
Job #2 offers more vacation. That ALONE is incentive enough.

There's absolutely no reason someone should take job #1, but it's alot easier to find job #1 than job #2.

 

[Dave CX]

Is it possible that in job 2 there will be some administrator with an online MBA managing your output and telling you what to do in annoying ways? Who exactly are you employed by?

In my experience, smaller 1 pathologist hospitals have less annoying administration characteristics. I believe thats because the smaller hospitals have a bit of a chip on their shoulder, docs and administrators alike. So they are all on the same team in a way.

 

[coroner]

Is it possible that in job 2 there will be some administrator with an online MBA managing your output and telling you what to do in annoying ways? Who exactly are you employed by?

I met the CEO, and it just seemed like a routine meet-and-greet. And, when I asked the path office secretaries and histotechs, they said the prior pathologist was never bothered by or complained about admin being overbearing.

Job #2.
Why would anyone take job #1? There are forms of mental stimulation outside the pathology office, and if you take job #1 you'll almost certainly never discover any of them (and you'll burn out).

Job #2 offers pay closer to revenue generation.
Job #2 offers more vacation. That ALONE is incentive enough.

That was a huge factor I considered. More time in life to pursue other activites besides slapping glass.

There's absolutely no reason someone should take job #1, but it's alot easier to find job #1 than job #2.

👆This. I've been on dozens of interviews. Job #1's where you're grinding it out in a private group are a dime a dozen, so when interviewing for these kinds of jobs, it usually comes down to:
a) geography - being in a city you really like, close to family, don't want to uproot/move across the country
b) lack of other options - the job isn't a home run (how many are though?); but, it's the least subpar out of your other options.

 

[shikimate]

Off topic but do similar different choices for jobs exist in Canada? Since the pay is more or less uniform, what type of setting should a new pathologist join?

There are huge differences between different hospitals/jobs in Canada. Since pay is more or less uniform, it becomes very important to pick your job carefully. I will list 4 examples and you can make a judgement yourself.

It was well known that in the past, This major academic center A did not have a slide limit, which resulted in mountains of slides for everyone, and turnover was very high. Then they instituted a 200/day limit, and turnover is a bit less now. Nonetheless, they seem to recruit people all the time. The residents there are constantly pressured to do research and be "academic", even though sometimes it seems unnecessary. In the last few years resident attrition rate has increased.

Another prestigious teaching hospital B gets difficult consults from within the country and even outside the country. Foreign trained fellows are used heavily to help out with the workload. Unfortunately staff turnover is still prevalent. But many staff are hyper-specialized. Aka if you are a GI pathologist you'll never see a skin tag. This retains some people as they are so hyper specialized they cannot do general practice anymore.

One small community hospital C is in a town with somewhat of a "rust belt" reputation. It is a 2 person crew. Most specimen are biopsies with occasional large resection (eg melanoma, colon cancer). Usually work starts at 9am and finish by 4pm, with time to browse Amazon and go for strolls at lunchtime. Some pathologists at the nearby prestigious academic center secretly makes jokes about this small hospital, but the 2 pathologists there don't seem to care much about it.

A medium sized community hospital D has about 8 FTE pathologists. Most are internationally trained. While the workload isn't high, some complex resections and difficult cases are done there. Because of culturally and historical reasons, or maybe because there isn't that much work, office politics gets very interesting there. It seems even though a few of the pathologists there came from the same country, they came from different regions and different social class, and brought their prejudice against others with them.

 

[deleted314957]

In my experience, smaller 1 pathologist hospitals have less annoying administration characteristics. I believe thats because the smaller hospitals have a bit of a chip on their shoulder, docs and administrators alike. So they are all on the same team in a way.

That was kinda my situation. All of our (good) long-standing medical staff and the admin would stridently support one another.

 

[AZpath]

That was kinda my situation. All of our (good) long-standing medical staff and the admin would stridently support one another.

I am at a small hospital and have always had great interactions with Admin. That said. Hospitals can change services on a dime if they want to.
Smaller independent hospitals might do this a little less than big ones.

 

[TrojanRaggy]

There are huge differences between different hospitals/jobs in Canada. Since pay is more or less uniform, it becomes very important to pick your job carefully. I will list 4 examples and you can make a judgement yourself.

It was well known that in the past, This major academic center A did not have a slide limit, which resulted in mountains of slides for everyone, and turnover was very high. Then they instituted a 200/day limit, and turnover is a bit less now. Nonetheless, they seem to recruit people all the time. The residents there are constantly pressured to do research and be "academic", even though sometimes it seems unnecessary. In the last few years resident attrition rate has increased.

Another prestigious teaching hospital B gets difficult consults from within the country and even outside the country. Foreign trained fellows are used heavily to help out with the workload. Unfortunately staff turnover is still prevalent. But many staff are hyper-specialized. Aka if you are a GI pathologist you'll never see a skin tag. This retains some people as they are so hyper specialized they cannot do general practice anymore.

One small community hospital C is in a town with somewhat of a "rust belt" reputation. It is a 2 person crew. Most specimen are biopsies with occasional large resection (eg melanoma, colon cancer). Usually work starts at 9am and finish by 4pm, with time to browse Amazon and go for strolls at lunchtime. Some pathologists at the nearby prestigious academic center secretly makes jokes about this small hospital, but the 2 pathologists there don't seem to care much about it.

A medium sized community hospital D has about 8 FTE pathologists. Most are internationally trained. While the workload isn't high, some complex resections and difficult cases are done there. Because of culturally and historical reasons, or maybe because there isn't that much work, office politics gets very interesting there. It seems even though a few of the pathologists there came from the same country, they came from different regions and different social class, and brought their prejudice against others with them.

A. U. Ottawa
B. U. Toronto
C. Windsor
D. Sudbury
??
All of them sound bad!

 

[path_spouse]

As everyone says, Job B, but I'll add the perspective of a spouse (we are dual career with kids).

When my husband had Job A, the schedule left me holding the bag on nearly everything related to our kids. He had a lot of leave, but rarely when it was needed. So at random times I'd be home trying to work, and he'd be hovering around wanting to tell me random things like that he was seeing a prevalence of TB comparable to the developing world at his hospital and wasn't it unbelievable. But when I had the flu or surgery or whatever, I had to solo parent our little kids anyway because he hadn't put in for leave a year ahead of time. It was kind of uncool...I get that residency and fellowship are inflexible but I expected it to end at some point.

Job A also started very early in the morning, leaving me fully responsible every single morning for getting two little kids ready and dropping them off at two different schools before work. It's a slog to deal with screaming, barfing, whatever for a couple of hours and then be on game for your 8:30 am meeting--and it's tough to do that every weekday forever and know there's no backup, ever. None of my colleagues had that problem, which made things worse. I also had to cover all of our kids' sick days, random school holidays, etc. This had a negative impact on my career, sanity, and also salary.

The good part of Job A--and maybe this is something to consider--is that my husband met a lot of people, which led him to the next job.

So from my POV, Job B all the way. Find something to do in your free time--I think Webb suggests doggie day cares or tree removal.

 

[deleted314957]

As everyone says, Job B, but I'll add the perspective of a spouse (we are dual career with kids).

When my husband had Job A, the schedule left me holding the bag on nearly everything related to our kids. He had a lot of leave, but rarely when it was needed. So at random times I'd be home trying to work, and he'd be hovering around wanting to tell me random things like that he was seeing a prevalence of TB comparable to the developing world at his hospital and wasn't it unbelievable. But when I had the flu or surgery or whatever, I had to solo parent our little kids anyway because he hadn't put in for leave a year ahead of time. It was kind of uncool...I get that residency and fellowship are inflexible but I expected it to end at some point.

Job A also started very early in the morning, leaving me fully responsible every single morning for getting two little kids ready and dropping them off at two different schools before work. It's a slog to deal with screaming, barfing, whatever for a couple of hours and then be on game for your 8:30 am meeting--and it's tough to do that every weekday forever and know there's no backup, ever. None of my colleagues had that problem, which made things worse. I also had to cover all of our kids' sick days, random school holidays, etc. This had a negative impact on my career, sanity, and also salary.

The good part of Job A--and maybe this is something to consider--is that my husband met a lot of people, which led him to the next job.

So from my POV, Job B all the way. Find something to do in your free time--I think Webb suggests doggie day cares or tree removal.

My hat is off to you for the struggles you have faced in your situation. I am retired now but we have 2 kids who grew up through my career. There is NO WAY my wife could have held down a full time job either from home or more traditionally at an office. I pretty much had to be the only breadwinner but, fortunately, my wife was very fulfilled and busy. But, in those days, my salary was ~1M/yr and the financial incentive for her to NEED to work for income was zero. Medicine, any specialty, can be a killer for 2 career couples.
Good on ya!