M4 Considering Pathology

[Ditzel]

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Hey guys, sorry to start one of these threads but I’d really like some help.

I’m just about to start M4 and am still having a hard time deciding what I want to do when I grow up. All year I assumed if I didn’t find anything I liked I’d just go into radiology. Well now I’m at the end and I can’t see myself doing any core M3 specialty. I think I could do radiology and might be happy but lately I’ve been strongly considering path. Ideally I would do a rotation in each but my school ends 3^rd year late and I won’t be able to start either until the end of August which is already getting late for LOR and I haven’t been exposed to the day to day life of either field enough to know if I would truly enjoy them.

Sure I’ve considered path all along but I heard the job market is terrible and kind of discounted it , but I don’t think that shouldn’t be a reason to rule it out. I like that pathologists really get to understand disease a deeper level than any other physician and make definitive diagnoses. Whenever I look up one thing in Robbins I find myself reading extra pages just because I find it interesting. Also compared to radiology I’d rather look at colorful cells under a microscope than read films in the dark and prefer histology over anatomy.

Also, this shouldn’t be a deciding factor but would going to a highly ranked residency help secure a fellowship/job? and would I be competitive?
Step 1 – 269
M3 grades – H in (Peds, FM, Neuro, Psych) HP in (IM, OB), surg is pending
No juinor AOA, possible senior AOA, no research
As of now I still have rads scheduled in that block and would need to change in the next 2 weeks. Any advice? Thanks.

 

[scienceguy19]

Based on the stats you provided, you should be able to get into the majority of pathology residency programs. The reputation of the residency program does matter for getting into the most competitive fellowship programs like dermpath. Then again, you can make that up by being a star and doing more research at a less stellar program. Also it would help to go to a residency program which has a fellowship in the area you are interested in, assuming they prefer in-house residents and none of your classmates are aiming for the same fellowship. A good residency program/fellowship is important for jobs (especially in this job market) but maybe more importantly is getting a fellowship in the area where you intend on practicing because pathologists tend to know each other in a specific locale.

Realize that the job market is very different for radiology and pathology. Graduating radiologists should be able to easily find jobs irrespective of what program they were trained at or how they rank compared to their peers. Jobs are readily available in most locations in the USA.

Pathology residents and fellows have fewer options. I noticed that of the job openings available, many are in less desirable locations away from metropolitan areas. There seems to be an increasing trend for residents to do multiple fellowships. From my observation, a good proportion of these fellowship originally intended on practicing but due to the poor job market, had little choice but to complete another fellowship. Also understand that pathology is changing. Molecular pathology will play an increasing role in the future and there may be less an emphasis on traditional morphology. It may become less of a visual field in the future.

Anyone I hope you use your own judgment and weigh the pros and cons. I feel the same that pathology is more interesting than radiology. But I do feel mislead that as a 4th year medical student, I was told that there were plenty of jobs in pathology.

Hey guys, sorry to start one of these threads but I’d really like some help.

I’m just about to start M4 and am still having a hard time deciding what I want to do when I grow up. All year I assumed if I didn’t find anything I liked I’d just go into radiology. Well now I’m at the end and I can’t see myself doing any core M3 specialty. I think I could do radiology and might be happy but lately I’ve been strongly considering path. Ideally I would do a rotation in each but my school ends 3^rd year late and I won’t be able to start either until the end of August which is already getting late for LOR and I haven’t been exposed to the day to day life of either field enough to know if I would truly enjoy them.

Sure I’ve considered path all along but I heard the job market is terrible and kind of discounted it , but I don’t think that shouldn’t be a reason to rule it out. I like that pathologists really get to understand disease a deeper level than any other physician and make definitive diagnoses. Whenever I look up one thing in Robbins I find myself reading extra pages just because I find it interesting. Also compared to radiology I’d rather look at colorful cells under a microscope than read films in the dark and prefer histology over anatomy.

Also, this shouldn’t be a deciding factor but would going to a highly ranked residency help secure a fellowship/job? and would I be competitive?
Step 1 – 269
M3 grades – H in (Peds, FM, Neuro, Psych) HP in (IM, OB), surg is pending
No juinor AOA, possible senior AOA, no research
As of now I still have rads scheduled in that block and would need to change in the next 2 weeks. Any advice? Thanks.

 

[AngryTesticle]

I think you should have little problems getting interviews at most or all of the programs you apply to. Do not worry too much about having too little research experience. There are enough strong programs apart from the touted "research" programs. That being said, do not underestimate the interview. We have chosen not to rank people who have similar stats who bombed the interview.

 

[BU Pathology]

Hey guys, sorry to start one of these threads but I’d really like some help.

I’m just about to start M4 and am still having a hard time deciding what I want to do when I grow up. All year I assumed if I didn’t find anything I liked I’d just go into radiology. Well now I’m at the end and I can’t see myself doing any core M3 specialty. I think I could do radiology and might be happy but lately I’ve been strongly considering path. Ideally I would do a rotation in each but my school ends 3^rd year late and I won’t be able to start either until the end of August which is already getting late for LOR and I haven’t been exposed to the day to day life of either field enough to know if I would truly enjoy them.

Sure I’ve considered path all along but I heard the job market is terrible and kind of discounted it , but I don’t think that shouldn’t be a reason to rule it out. I like that pathologists really get to understand disease a deeper level than any other physician and make definitive diagnoses. Whenever I look up one thing in Robbins I find myself reading extra pages just because I find it interesting. Also compared to radiology I’d rather look at colorful cells under a microscope than read films in the dark and prefer histology over anatomy.

Also, this shouldn’t be a deciding factor but would going to a highly ranked residency help secure a fellowship/job? and would I be competitive?
Step 1 – 269
M3 grades – H in (Peds, FM, Neuro, Psych) HP in (IM, OB), surg is pending
No juinor AOA, possible senior AOA, no research
As of now I still have rads scheduled in that block and would need to change in the next 2 weeks. Any advice? Thanks.

Pathology is a great career and you should have little trouble given your posted credentials. I would suggest that you do a pathology rotation as soon as possible, so that you can experience the day to day life of a pathologist.

Not having a research component as part of your portfolio will not be a significant detractor, unless you plan to have a career as a basic scientist with subspecialty signout.

Pathology is a small field in terms of numbers of practioners compared to other specialties such as radiology. There are total fewer openings for pathologists, but everyone gets a job. The pathology leadership is actually worried about not having sufficient numbers of trainees to meet the demands of our field in about 3 to 4 years. Do not be worried by anonymous postings on the internet about no jobs.

If you like Robbins, consider applying for residency at Boston Medical Center, home of the Mallory Institute of Pathology. Dr. Robbins wrote the first edition while he was the Chair of Pathology here.

Daniel Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston University and Boston Medical Center

 

[sbp]

as a recent grad and someone who just started at a new position I have to say that people on this site may have some ajenda or unrealistic expectations...

I went to a middle of the road residency program and did a fellowship in surgpath at an ivy league type program. I had 5 interviews for jobs and got 1.5 offers... (a long story)

my point is the market isn't great... you may not get the city or even state that you want however if you are flexible you will most likely get a job. So the market isn't as doom and gloom as some may like to post but it isn't as roses and peaches as some other say....

in the future we don't know what is going to happen.. people like to predict this huge mass retirement... I will believe it when I see it.. I would keep on working making a decent salary as long as I can.. being that you are only better as you get more experienced and the work is not that physicaly challenging..

I think the uncerntanty of medicine plays a role in the market, but more so is that we have to many people training. When path became a 4 year not five year residency the spots were not cut, so we now have for the past 7 or 8 years 1/5 more graduating residents per year looking for a job... so spots should be cut..

anyway.. radiology doesn't have a great job market now either, don't believe what people tell you that you will have 5 offers making bucko bucks... it is hard for them as well for some of the similar reasons to path...

at the end of the day you should do what you like and at the best institution that is reasonable for you to get...

 

[scienceguy19]

Yes talk to pathologists at your med school to get a good idea of the field. Also talk to community pathologists if that's what your goal is.
Make sure you also talk to young and middle age pathologists.

as a recent grad and someone who just started at a new position I have to say that people on this site may have some ajenda or unrealistic expectations...

I went to a middle of the road residency program and did a fellowship in surgpath at an ivy league type program. I had 5 interviews for jobs and got 1.5 offers... (a long story)

my point is the market isn't great... you may not get the city or even state that you want however if you are flexible you will most likely get a job. So the market isn't as doom and gloom as some may like to post but it isn't as roses and peaches as some other say....

in the future we don't know what is going to happen.. people like to predict this huge mass retirement... I will believe it when I see it.. I would keep on working making a decent salary as long as I can.. being that you are only better as you get more experienced and the work is not that physicaly challenging..

I think the uncerntanty of medicine plays a role in the market, but more so is that we have to many people training. When path became a 4 year not five year residency the spots were not cut, so we now have for the past 7 or 8 years 1/5 more graduating residents per year looking for a job... so spots should be cut..

anyway.. radiology doesn't have a great job market now either, don't believe what people tell you that you will have 5 offers making bucko bucks... it is hard for them as well for some of the similar reasons to path...

at the end of the day you should do what you like and at the best institution that is reasonable for you to get...

 

[WEBB PINKERTON]

Go into pathology at your own risk. I cannot recommend it to anyone. It is way too consolidated at this point and you will be a slave to labcorp, quest etc. If in office pathology labs take over you will also be a slave to physicians. It is a no win situation. And eventually technology is gonna replace biopsies. Interventional pathology may have a future.

 

[Nilf]

Go into pathology at your own risk. I cannot recommend it to anyone. It is way too consolidated at this point and you will be a slave to labcorp, quest etc. If in office pathology labs take over you will also be a slave to physicians. It is a no win situation.

I agree with this assessment. Main threats are large laboratories, and in-office labs, owned and operated by clinicians, who also do the billing.

Don't do pathology unless you have a particular interest in the field. It's very interesting, but there are huge cons to pathology as a career. There are much better options for you.

 

[scienceguy19]

I don't get the feeling that many pathologists are 'winning' but maybe you know some.

 

[DIce3]

Pathology is by far the absolute worst specialty to enter at this time. The current supply of pathologists looking for a semi-decent job far exceeds the number of even borderline acceptable jobs available. I personally know many pathologists who are unemployed, underemployed, or work at a slave mill. Reasonable small hospital pathology groups are selling out at an epidemic pace. Expect to graduate only to find your only option is employment at a slave mill.

A three year residency in FP or IM will grant you a dramatic increase in job security and at least an equal income per hour worked. The supply/demand curves have only worsened in the past decade and as I see it, will only get worse. I am in private practice and see the pathology job market purely from a community doctor perspective. As a result, the above may not apply if you are planning on staying in academics/research.

 

[KeratinPearls]

Pathology is by far the absolute worst specialty to enter at this time. The current supply of pathologists looking for a semi-decent job far exceeds the number of even borderline acceptable jobs available. I personally know many pathologists who are unemployed, underemployed, or work at a slave mill. Reasonable small hospital pathology groups are selling out at an epidemic pace. Expect to graduate only to find your only option is employment at a slave mill.

A three year residency in FP or IM will grant you a dramatic increase in job security and at least an equal income per hour worked. The supply/demand curves have only worsened in the past decade and as I see it, will only get worse. I am in private practice and see the pathology job market purely from a community doctor perspective. As a result, the above may not apply if you are planning on staying in academics/research.

That's depressing. Is there an icon with a gun to the head?

 

[yaah]

A three year residency in FP or IM will grant you a dramatic increase in job security and at least an equal income per hour worked. The supply/demand curves have only worsened in the past decade and as I see it, will only get worse. I am in private practice and see the pathology job market purely from a community doctor perspective. As a result, the above may not apply if you are planning on staying in academics/research.

Are you serious? The average income of a pathologist outside academia is twice that of an FP. And FPs work longer hours and take more call. So your point about job security is valid but "equal income per hour worked" is farcical. This is why there is so much in the press these days about primary care physicians being underpaid compared to specialists. Pathologists are specialists and are paid like specialists.

 

[DIce3]

I am not here to stir the pot. I am a solo internist. My wife is a pathologist. I see the raw numbers and think my prior statement is valid. You make a good point about national survey polls. A PCP seeing 20 patients in an office that is not tightly managed with no hospital patients, procedures, or ancillaries is not going to fare well. A self employed PCP who is more hands-on and keeps a low overhead can net an amount that is not reflected in national survey polls.

 

[Enkidu]

Pathology is a small field in terms of numbers of practioners compared to other specialties such as radiology. There are total fewer openings for pathologists, but everyone gets a job. The pathology leadership is actually worried about not having sufficient numbers of trainees to meet the demands of our field in about 3 to 4 years. Do not be worried by anonymous postings on the internet about no jobs.

Do you think that the pathology leadership is right to worry about a shortage of pathologists? What evidence is there that such a shortage is coming? I want to believe in this, but it seems dubious.

 

[Sir James Bond]

It would be helpful to hear from an unemployed pathologist, since apparently there are so many. We welcome your contribution to this discussion.

Out of curiosity, what factors exist that are currently preventing the outsourcing of pathology?

What prevents complete automation of reading pathology images in the future by machines?

To that end, with the advent of molecular screening and gene discovery, why do we need to read pathology images if certain malignancies have very distinct gene profiles? (I understand there's a whole spectrum of pathology that must take into account tissue architecture and doesn't fall under this umbrella)

 

[Nilf]

It would be helpful to hear from an unemployed pathologist, since apparently there are so many. We welcome your contribution to this discussion.

Out of curiosity, what factors exist that are currently preventing the outsourcing of pathology?

What prevents complete automation of reading pathology images in the future by machines?

To that end, with the advent of molecular screening and gene discovery, why do we need to read pathology images if certain malignancies have very distinct gene profiles? (I understand there's a whole spectrum of pathology that must take into account tissue architecture and doesn't fall under this umbrella)

It's not machines, outsourcing, or molecular screening that is doing us in.

It's the fact that there are too many of us, and that clinicians and corporations figured out how to take advantage of that.

Pathology has undergone tremendous changes in past decade. Expect things to continue going south, especially for young trainees.

If you are a young pathologist... If you can, make your money now, and then GTFO. After you save some dough, get a nice academic synecure, and then you can smugly comment on how great things are in pathology.

If you can't... well you've been punked.

 

[scienceguy19]

They've been predicting a shortage of pathologists for many years. I don't believe there was a single time in the past 30 years where there was a shortage of pathologists in the USA.

So I don't know how much to trust the statement that there will be a shortage of pathologists in 5 years.

 

[yaah]

Pathology has undergone tremendous changes in past decade. Expect things to continue going south, especially for young trainees.
.

OK, but to be fair, name a profession about which this hasn't been said recently. Medical and non-medical. I haven't talked to any medical profession (save maybe private-pay only cosmetic surgeons) which doesn't have members saying this. And in non-medical fields, Lawyers are complaining because legal tasks are being outsourced and compensation is declining (except for at the top). MBAs are complaining because jobs are not secure and compensation is all being routed to the top levels. This is the way the US and global economies are going. Everything is shifting to the top and efficiency and consolidation are key. One has to be prepared to deal with it and adjust.

Unless you have your own idea like Groupon or Linked in and can take it all the way, you're getting punked.

 

[pathstudent]

OK, but to be fair, name a profession about which this hasn't been said recently. Medical and non-medical. I haven't talked to any medical profession (save maybe private-pay only cosmetic surgeons) which doesn't have members saying this. And in non-medical fields, Lawyers are complaining because legal tasks are being outsourced and compensation is declining (except for at the top). MBAs are complaining because jobs are not secure and compensation is all being routed to the top levels. This is the way the US and global economies are going. Everything is shifting to the top and efficiency and consolidation are key. One has to be prepared to deal with it and adjust.

Unless you have your own idea like Groupon or Linked in and can take it all the way, you're getting punked.

Pathologists have been commodotized more so than any other medical field. Subspecialty surgeons have some gripes which pathologists share but gastroenterologists aren't hiring ENTs and billing for their work and then giving the ENTs 25%.

 

[pathdoc68]

I repeat I love pathology, but I would not recommend the specialty to any med-school student. The ROI is too small, 4-5 years training after med school only to find a brutal market. Run...run away! If you like path I would consider med-onc or rad-onc.

 

[scienceguy19]

If you do radiology, the average starting salary is twice as much as pathology. Since there are fewer radiologists relative to overall supply, they can demand higher salaries.

 

[KeratinPearls]

If you do radiology, the average starting salary is twice as much as pathology. Since there are fewer radiologists relative to overall supply, they can demand higher salaries.

Wow, there is so much negativity on this forum! I'm not saying the path market is great but it seems like there is one user with multiple accounts since every post nowadays is ultra-negative! Seriously, in the last 4 years that I have been following this forum, I've heard of maybe 5 firsthand stories from ppl that cannot find a job vs. hundreds of posts just complaining and complaining. Seriously, if you are complaining about path, like pathdoc68 (who looks like is an attending and therefore has a job), why are you guys/gals so bitter? Then there is scienceguy19, who are you (attending or resident) and why are you so bitter as well? There are all these usernames who come out of the woodworks and start complaining. I seriously wonder who these ppl are and do they have a job. If so, then why are you all so bitter? Pathstudent and yaah, seem to be the only sensical posters on here! Did you guys have trouble finding a job? Something happen in private practice that is making ou hate your life?

This forum is turning out to be a place where ppl vent their frustration and anger and is completely nonproductive.

 

[Thrombus]

Something happen in private practice that is making ou hate your life?

Things that have happened to my practice or others I know in the past year:

Most practices I know of have lost specimens to specialists who are now employing pathologists for pennies on the dollar. This takes a big chunk of revenue away and with more regulatory costs associated with running a business, really puts the collar on us. When you lose the most profitable parts of your business, and you already are at the bottom dollar with the hospitals for the nonprofitable work just so you can sign out a few specimens at a low negotiated price, you are starting to hurt.

Some practices I know have had to cut junior pathologists.

Every practice I know has to bend over backwards to sooth their clients -- many times at the expense of the pathologists or the patient -- many times practicing bad medicine as a result -- if you don't you lose your clients and your risk losing your business. Instead of being on somewhat equal footing with other doctors, we are being marginalized and it is not healthy at all. This whole CrAP Transformational garbage fails to mention any of this for some reason.

These and others are the reasons you hear all this negativity. There is not much positive to be said right now with rampant exploitation.

 

[scienceguy19]

I am a resident from a respectable institution who personally knows several individuals who have had difficulty finding jobs and thus had to resort to doing multiple fellowships. When it comes time to apply for jobs, I will also post on my experience as well.

 

[BU Pathology]

Do you think that the pathology leadership is right to worry about a shortage of pathologists? What evidence is there that such a shortage is coming? I want to believe in this, but it seems dubious.

It is always difficult to predict the future. The College of American Pathologists, and the AAMC, both have projections indicating that there will be an upcoming shortage of trained pathologists. The projection by CAP was calculated based on the impact of aging and gender, healthcare reform, and economic growth over the next several years. The appropriate pages are extracted from the full report:

http://www.cap.org/apps/docs/pathology_residents/pdf/full_slides_022611.pdf

The AAMC data is in the attached report, which shows that pathologists are the third most elderly group of practicing physicians. Only preventative medicine and psychiatry have an older profession.

My professional view is that in the year 2011 we have enough pathologists for the current volume of work, but we are facing a significant shortage in the next 5 to 10 years. Just about the time that I need someone to read my biopsy, there will be a shortage.

Daniel Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston University School of Medicine, Boston Medical Center