Medical Specialties more w/ medicine

[ski789]

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Hi, I'm a pre-medical student and I was just curious about what specialties work most with medicine rather than physical diagnoses. For example, anesthesiologists. I am interested in the development of drugs, prescribing medicine for pain etc., but am not at all interested in anything surgical What specialties would offer something like this? (Just exploring options before med school!)

 

[mppcc]

Can you clarify further? I'm not sure what this means.

 

[ski789]

Can you clarify further? I'm not sure what this means.

Yeah, I am interested in medical fields that are more science orientated- dealing with prescribing and using drugs and medication. I am more interested in chemistry over biology if that makes sense.

 

[Medstudent 98]

Yeah, I am interested in medical fields that are more science orientated- dealing with prescribing and using drugs and medication. I am more interested in chemistry over biology if that makes sense.

I think I get what you mean. I'm a first year. We have this course, pharmacology, it's basically about drug action and elimination. Though I heard you could pursue this the via the pharmacy route, which IMO seems more practical.

 

[ski789]

I think I get what you mean. I'm a first year. We have this course, pharmacology, it's basically about drug action and elimination. Though I heard you could pursue this the via the pharmacy route, which IMO seems more practical.

I am very interested in something like pharmacology, and I understand most doctors use it just in general. Are there ant specialties that use it more though? I was thinking pain management or anesthesiology.

 

[Medstudent 98]

I am very interested in something like pharmacology, and I understand most doctors use it just in general. Are there ant specialties that use it more though? I was thinking pain management or anesthesiology.

I don't know, I'm not sure how things work in America but I suggest visiting the school you're applying to and asking around. The lecturers, professors and coordinators are usually quite helpful.😉

 

[Redpancreas]

Yeah, I am interested in medical fields that are more science orientated- dealing with prescribing and using drugs and medication. I am more interested in chemistry over biology if that makes sense.

There's no real field you're going to get deep into chemistry in my opinion, but I'm just a medical student saying this as someone who loved Organic/Gen Chem during high school and college. Anesthesiology seems like the correct general answer, but I don't know how much actual technical chemistry work is done on the job. I think if this is really what you're interested in and its your top priority, you should consider doing a PhD along with your MD to explore chemical systems of body processes. Then you can go into virtually any field.

 

[bashwell]

Hi, I'm a pre-medical student and I was just curious about what specialties work most with medicine rather than physical diagnoses. For example, anesthesiologists. I am interested in the development of drugs, prescribing medicine for pain etc., but am not at all interested in anything surgical What specialties would offer something like this? (Just exploring options before med school!)

Yeah, I am interested in medical fields that are more science orientated- dealing with prescribing and using drugs and medication. I am more interested in chemistry over biology if that makes sense.

I am very interested in something like pharmacology, and I understand most doctors use it just in general. Are there ant specialties that use it more though? I was thinking pain management or anesthesiology.

1) Given your interests, I'd recommend internal medicine, then clinical pharmacology. For example, I believe Vanderbilt has a clinical pharmacology fellowship.

2) Another good option for you could be emergency medicine, then a toxicology fellowship.

3) A worse option but one that you might be interested in is pathology and focusing on more chemical pathology. But the job market for pathologists is probably the worst there is in all of medicine.

4) Anesthesiology. Anesthesiologists are more like surgeons than physicians if you had to pick one. They do tons of procedures, very procedurally oriented. They must work alongside and collaborate with surgeons on a daily basis. However, if you aren't interested in a surgical specialty, then you might not like anesthesiology either. In my opinion, there's more overlap between those who do anesthesiology but were considering a surgical specialty than those who do anesthesiology but were considering a medical specialty -- or if the latter then more often they were considering a more "surgical" or procedurally oriented medical subspecialty like cardiology or pulm/critical care.

5) Pain. Pain is a lot more than just pharmacology. It's not all just pill mills. Pain, especially interventional pain, involves lots of procedures and is more like surgery in this respect. Also, lots of dealing with psychiatric issues. Lots of opioid addicts. Lots of diagnosing and trying to figure out what's wrong with a chronic pain patient that no other physician can or wants to deal with. Pain looks good on paper, but you have to really be able to tolerate working with chronic pain patients.

 

[ndafife]

Sounds like you want to be a pharmacist

 

[jm192]

I think you want to use medicine to help heal people.

I would say that general internal medicine, especially hospitalist will offer you that. In a day to day basis, I see a little bit of everything--GI, Cardiology, Pulmonology, Dermatology, Neurology, Infectious Disease, Nephrology.

Now the depth of which I get into pharmacokinetics? Low.

Anticoagulation will always be an issue.
Renal dosing of drugs--but I consult Pharmacy if it's not a quick/easy conversion dosing.

But if you want to dig deep into drug levels, pharmacokinetics and the like, you might be more interested in being a clinical pharmacist at a hospital.

You tell the doctors when they use the wrong dose, you watch for drug interactions, you watch blood cultures and make sure the doctors aren't using unnecessary antibiotics.

 

[Siromas]

But the job market for pathologists is probably the worst there is in all of medicine.

Could you provide a bit more information behind this statement? Just curious.

 

[jm192]

Could you provide a bit more information behind this statement? Just curious.

They don't really utiliza drugs. They are some of the smartest people in the hospital, but in terms of using drugs--nah.

 

[Siromas]

They don't really utiliza drugs. They are some of the smartest people in the hospital, but in terms of using drugs--nah.

I can see how that might deter the OP from pursuing this specialty (given their interest in chemistry), but what does that have to do with the job market for all pathologists?

 

[bashwell]

Could you provide a bit more information behind this statement? Just curious.

1) Please keep in mind I'm not a pathologist, but from what I hear unfortunately it sounds like it's pretty tough for pathologists. Just check out the path forum for example. They would be a much better resource than me.

2) However here's what I am aware of, but again take my thoughts or opinions with a grain of salt:
-Path is a 4 year residency, but doing a fellowship is all but required now since almost everyone is doing it, which effectively turns path into a 5 year residency. Some pathologists are even doing 2 fellowships so 6 years total, but I'm not sure how common doing the 2nd fellowship is.
-Path has one of the lowest or actually maybe the lowest percentage of US MDs matching into their residencies (data is available via the NRMP, see data for the 2017 Main Match). If I remember path residencies are filled with around 35% US MDs and the rest are non-US MDs and mostly IMGs. Other competitive specialties like dermatology will have over 90% US MDs matching into their residencies. The number of US MDs matching into a specialty is a rough but helpful indicator of how competitive a specialty is.
-My understanding though is that if you're a US MD, you should be able to get into a solid and even a top tier path residency. My understanding is most US MDs do find a path job eventually. I think the non-US MDs and IMGs face more difficulty finding a job for various reasons which I won't get into here.
-But starting salaries for path jobs are low. I believe around $200k/year after 5-6 years of residency. That might seem high as a pre-med, but it's among the lowest of all physicians. I think most PCPs (primary care physicians) like pediatricians and family physicians can make $200k or depending on where you live even more than that. About $250k seems average for PCPs. And PCPs are doing a 3 year residency, not 5+ years. And these salaries are low compared to other specialties, especially surgical specialties and subspecialties, and some IM subspecialties (e.g., GI, cards, pulm/critical care and heme/onc especially), as well as anesthesia and radiology, all of which will average over $350k (some well over $400k) and are more or less around the same length in training (give or take a year) as pathologists have to train for.
-In order to get a path job, even as a US MD, you will likely have to "sell" or "market" yourself a bit more. For most other specialties, especially PCP jobs, you will have people coming to you and offering you tons of options for jobs. But in path, you are more likely to be the one going out and trying to get a job. Nothing wrong with that, because that's what people in most jobs have to do, send in their CV/resume, apply to jobs, interview for jobs, etc. So in path you'll be trying to get other pathologists in your dept or university to know who you are, publish research, attend conferences and try to meet pathologists who can hire you, and so on. Just something to consider.
-Also, as a pathologist, you will most likely not have as much geographic flexibility in your job search as most other specialties would. That is, you won't be able to live wherever you want to live in the US. You have to go to where the jobs are. Jobs in popular areas where many people want to live (e.g., California, Northeast) are going to be few and far between. So you most likely won't end up there. Or if you do, you may be working for less than the average compensation or working more hours for the same compensation.
-After you get a job, if you work hard, you can eventually go from $200k to over $300k, from what I understand. But that may take a more years than in other specialties. For example, partnerships in many or maybe most other specialties tend to be around 2 years. So you will have a starting compensation, then usually a much higher compensation once you become partner. But in pathology, this is likely longer than 2 years. (However private practices are disappearing across many other specialties, but that's a separate issue).
-However if you are fine with all this, and like path, then pathology is a good choice. You do generally have a good lifestyle as an attending. Much better than a lot of other specialties.

 

[Tenk]

Toxicology.

 

[bashwell]

Toxicology.

Good choice, I mentioned it above too. 🙂

 

[getdown]

Hi, I'm a pre-medical student and I was just curious about what specialties work most with medicine rather than physical diagnoses. For example, anesthesiologists. I am interested in the development of drugs, prescribing medicine for pain etc., but am not at all interested in anything surgical What specialties would offer something like this? (Just exploring options before med school!)

1)

4) Anesthesiology. Anesthesiologists are more like surgeons than physicians if you had to pick one. They do tons of procedures, very procedurally oriented. They must work alongside and collaborate with surgeons on a daily basis. However, if you aren't interested in a surgical specialty, then you might not like anesthesiology either. In my opinion, there's more overlap between those who do anesthesiology but were considering a surgical specialty than those who do anesthesiology but were considering a medical specialty -- or if the latter then more often they were considering a more "surgical" or procedurally oriented medical subspecialty like cardiology or pulm/critical care.

5) Pain. Pain is a lot more than just pharmacology. It's not all just pill mills. Pain, especially interventional pain, involves lots of procedures and is more like surgery in this respect. Also, lots of dealing with psychiatric issues. Lots of opioid addicts. Lots of diagnosing and trying to figure out what's wrong with a chronic pain patient that no other physician can or wants to deal with. Pain looks good on paper, but you have to really be able to tolerate working with chronic pain patients.

Hi, I'm an Anesthesiologist. As a field we do work very closely with pharmacology and unlike in Internal Medicine we use medications that have very quick effects and you can see it happen in front of your eyes almost immediately. In the operating rooms we pretty much function like the ICU docs. We have to know the patient's medical problems in great detail, have a deep understanding of human physiology and the patient's pathophysiology and be able to know which medications to use the get the desired effects in addition to knowing the surgery and it's possible complications. Just today I had a patient with severe pulmonary hypertension with evidence of right ventricular strain going for a urologic procedure. In that regard I wanted to keep the patient's blood pressure around his baseline so as not to induce right ventricular failure so we did a pre-induction arterial line followed by slow induction with propofol for general anesthesia and small boluses of vasopressin to maintain systemic BP while decreasing pulmonary BP. We also tried to minimize CO2 retention and acidosis while trying to minimize muscle paralysis because he also has bad sarcoidosis and is 2L of oxygen. I bring this example up so as to illustrate the depth and breadth of the specialty and not simply as "proceduralists". We're actually often the only people who try to look at the patient's in the bigger picture of the surgery and their suitability for the surgery. Surgeons often become very focused on the actual surgery they forget to consider the other aspects of the patient's medical history. So, although we do a lot of procedures like arterial lines, central lines and regional block techniques I take slight umbrage to Anesthesiologist being called "more like surgeons than physicians" as this implies we focus more on the procedures than taking care of the patients. That being said, we do have more procedure oriented subspecialty fields like Pain where you do steroid injections and such but that's almost a whole different world than what Anesthesiologists do in the ORs.

So OP, if you are interested in solely pharmacology and drug development I think going the pharmacy route might be more of the correct option but if you are interested in seeing how the pharmacology intertwines with the phsyiology and how you can use medications to manipulate physiology then you may be interested to explore more about Anesthesia.

 

[Siromas]

1) Please keep in mind I'm not a pathologist, but from what I hear unfortunately it sounds like it's pretty tough for pathologists. Just check out the path forum for example. They would be a much better resource than me.

2) However here's what I am aware of, but again take my thoughts or opinions with a grain of salt:
-Path is a 4 year residency, but doing a fellowship is all but required now since almost everyone is doing it, which effectively turns path into a 5 year residency. Some pathologists are even doing 2 fellowships so 6 years total, but I'm not sure how common doing the 2nd fellowship is.
-Path has one of the lowest or actually maybe the lowest percentage of US MDs matching into their residencies (data is available via the NRMP, see data for the 2017 Main Match). If I remember path residencies are filled with around 35% US MDs and the rest are non-US MDs and mostly IMGs. Other competitive specialties like dermatology will have over 90% US MDs matching into their residencies. The number of US MDs matching into a specialty is a rough but helpful indicator of how competitive a specialty is.
-My understanding though is that if you're a US MD, you should be able to get into a solid and even a top tier path residency. My understanding is most US MDs do find a path job eventually. I think the non-US MDs and IMGs face more difficulty finding a job for various reasons which I won't get into here.
-But starting salaries for path jobs are low. I believe around $200k/year after 5-6 years of residency. That might seem high as a pre-med, but it's among the lowest of all physicians. I think most PCPs (primary care physicians) like pediatricians and family physicians can make $200k or depending on where you live even more than that. About $250k seems average for PCPs. And PCPs are doing a 3 year residency, not 5+ years. And these salaries are low compared to other specialties, especially surgical specialties and subspecialties, and some IM subspecialties (e.g., GI, cards, pulm/critical care and heme/onc especially), as well as anesthesia and radiology, all of which will average over $350k (some well over $400k) and are more or less around the same length in training (give or take a year) as pathologists have to train for.
-In order to get a path job, even as a US MD, you will likely have to "sell" or "market" yourself a bit more. For most other specialties, especially PCP jobs, you will have people coming to you and offering you tons of options for jobs. But in path, you are more likely to be the one going out and trying to get a job. Nothing wrong with that, because that's what people in most jobs have to do, send in their CV/resume, apply to jobs, interview for jobs, etc. So in path you'll be trying to get other pathologists in your dept or university to know who you are, publish research, attend conferences and try to meet pathologists who can hire you, and so on. Just something to consider.
-Also, as a pathologist, you will most likely not have as much geographic flexibility in your job search as most other specialties would. That is, you won't be able to live wherever you want to live in the US. You have to go to where the jobs are. Jobs in popular areas where many people want to live (e.g., California, Northeast) are going to be few and far between. So you most likely won't end up there. Or if you do, you may be working for less than the average compensation or working more hours for the same compensation.
-After you get a job, if you work hard, you can eventually go from $200k to over $300k, from what I understand. But that may take a more years than in other specialties. For example, partnerships in many or maybe most other specialties tend to be around 2 years. So you will have a starting compensation, then usually a much higher compensation once you become partner. But in pathology, this is likely longer than 2 years. (However private practices are disappearing across many other specialties, but that's a separate issue).
-However if you are fine with all this, and like path, then pathology is a good choice. You do generally have a good lifestyle as an attending. Much better than a lot of other specialties.

Holy. Thank you for your reply! I had no idea about all this.

 

[bashwell]

Hi, I'm an Anesthesiologist. As a field we do work very closely with pharmacology and unlike in Internal Medicine we use medications that have very quick effects and you can see it happen in front of your eyes almost immediately. In the operating rooms we pretty much function like the ICU docs. We have to know the patient's medical problems in great detail, have a deep understanding of human physiology and the patient's pathophysiology and be able to know which medications to use the get the desired effects in addition to knowing the surgery and it's possible complications. Just today I had a patient with severe pulmonary hypertension with evidence of right ventricular strain going for a urologic procedure. In that regard I wanted to keep the patient's blood pressure around his baseline so as not to induce right ventricular failure so we did a pre-induction arterial line followed by slow induction with propofol for general anesthesia and small boluses of vasopressin to maintain systemic BP while decreasing pulmonary BP. We also tried to minimize CO2 retention and acidosis while trying to minimize muscle paralysis because he also has bad sarcoidosis and is 2L of oxygen. I bring this example up so as to illustrate the depth and breadth of the specialty and not simply as "proceduralists". We're actually often the only people who try to look at the patient's in the bigger picture of the surgery and their suitability for the surgery. Surgeons often become very focused on the actual surgery they forget to consider the other aspects of the patient's medical history. So, although we do a lot of procedures like arterial lines, central lines and regional block techniques I take slight umbrage to Anesthesiologist being called "more like surgeons than physicians" as this implies we focus more on the procedures than taking care of the patients. That being said, we do have more procedure oriented subspecialty fields like Pain where you do steroid injections and such but that's almost a whole different world than what Anesthesiologists do in the ORs.

So OP, if you are interested in solely pharmacology and drug development I think going the pharmacy route might be more of the correct option but if you are interested in seeing how the pharmacology intertwines with the phsyiology and how you can use medications to manipulate physiology then you may be interested to explore more about Anesthesia.

Thanks good post @getdown. Just to clarify, I was only saying anesthesiologists tend to be more like surgeons in mentality or mindset than physicians if we were forced to pick one, but I actually think anesthesiologists bridge the gap between medicine and surgery (i.e., like the intensivist of the OR as you pointed out -- and I'm currently on my ICU rotation). However I was focusing on the surgical and procedural side a lot more in response to OP as I thought OP might have a slightly skewed view of anesthesiology/pain, so I just wanted to focus on "unskewing" OP's perspective at least as much as I could.

 

[bashwell]

Holy. Thank you for your reply! I had no idea about all this.

Happy to help, but again, just please keep in mind I'm not a pathologist, and it'd be best to ask a pathologist. Either way, good luck to you, and all the best to you whatever specialty you eventually decide on!

 

[Soccer171983]

toxicology, allergy and immunology, medical genetics. I would not recommend internal medicine or most subspecialties, anesthesia, er, any surgical specialty. why not just become a pharmacist or do academic medicine and be more involved with drug development and clinical trials etc. With your interests maybe just get the MD to focus on academic medicine, to be honest or become a pharmacist.

 

[getdown]

Thanks good post @getdown. Just to clarify, I was only saying anesthesiologists tend to be more like surgeons in mentality or mindset than physicians if we were forced to pick one, but I actually think anesthesiologists bridge the gap between medicine and surgery (i.e., like the intensivist of the OR as you pointed out -- and I'm currently on my ICU rotation). However I was focusing on the surgical and procedural side a lot more in response to OP as I thought OP might have a slightly skewed view of anesthesiology/pain, so I just wanted to focus on "unskewing" OP's perspective at least as much as I could.

I see no worries.

 

[ski789]

1) Given your interests, I'd recommend internal medicine, then clinical pharmacology. For example, I believe Vanderbilt has a clinical pharmacology fellowship.

2) Another good option for you could be emergency medicine, then a toxicology fellowship.

3) A worse option but one that you might be interested in is pathology and focusing on more chemical pathology. But the job market for pathologists is probably the worst there is in all of medicine.

4) Anesthesiology. Anesthesiologists are more like surgeons than physicians if you had to pick one. They do tons of procedures, very procedurally oriented. They must work alongside and collaborate with surgeons on a daily basis. However, if you aren't interested in a surgical specialty, then you might not like anesthesiology either. In my opinion, there's more overlap between those who do anesthesiology but were considering a surgical specialty than those who do anesthesiology but were considering a medical specialty -- or if the latter then more often they were considering a more "surgical" or procedurally oriented medical subspecialty like cardiology or pulm/critical care.

5) Pain. Pain is a lot more than just pharmacology. It's not all just pill mills. Pain, especially interventional pain, involves lots of procedures and is more like surgery in this respect. Also, lots of dealing with psychiatric issues. Lots of opioid addicts. Lots of diagnosing and trying to figure out what's wrong with a chronic pain patient that no other physician can or wants to deal with. Pain looks good on paper, but you have to really be able to tolerate working with chronic pain patients.

Incredibly helpful!! Thank you

 

[ski789]

Sounds like you want to be a pharmacist

I looked into that but I want to treat patients directly.

 

[ndafife]

I looked into that but I want to treat patients directly.

Like you want to prescribe? Or you physically want to give the patient their medicine?

 

[Matthew9Thirtyfive]

Second @getdown with anesthesiology. I'm not an anesthesiologist, but I do have almost a decade working with them. His experience is not unique. Every day, they are practicing applied physiology and pharmacology. It's super cool.

 

[chcash]

I shadowed a medical oncologist who had also done a fellowship in hematology. A lot of what you're looking for came up in this specialty - we definitely talked a bit of biochemistry when I asked how certain things worked, like immunotherapy drugs such as Nivolumab.

 

[ski789]

Hi, I'm an Anesthesiologist. As a field we do work very closely with pharmacology and unlike in Internal Medicine we use medications that have very quick effects and you can see it happen in front of your eyes almost immediately. In the operating rooms we pretty much function like the ICU docs. We have to know the patient's medical problems in great detail, have a deep understanding of human physiology and the patient's pathophysiology and be able to know which medications to use the get the desired effects in addition to knowing the surgery and it's possible complications. Just today I had a patient with severe pulmonary hypertension with evidence of right ventricular strain going for a urologic procedure. In that regard I wanted to keep the patient's blood pressure around his baseline so as not to induce right ventricular failure so we did a pre-induction arterial line followed by slow induction with propofol for general anesthesia and small boluses of vasopressin to maintain systemic BP while decreasing pulmonary BP. We also tried to minimize CO2 retention and acidosis while trying to minimize muscle paralysis because he also has bad sarcoidosis and is 2L of oxygen. I bring this example up so as to illustrate the depth and breadth of the specialty and not simply as "proceduralists". We're actually often the only people who try to look at the patient's in the bigger picture of the surgery and their suitability for the surgery. Surgeons often become very focused on the actual surgery they forget to consider the other aspects of the patient's medical history. So, although we do a lot of procedures like arterial lines, central lines and regional block techniques I take slight umbrage to Anesthesiologist being called "more like surgeons than physicians" as this implies we focus more on the procedures than taking care of the patients. That being said, we do have more procedure oriented subspecialty fields like Pain where you do steroid injections and such but that's almost a whole different world than what Anesthesiologists do in the ORs.

So OP, if you are interested in solely pharmacology and drug development I think going the pharmacy route might be more of the correct option but if you are interested in seeing how the pharmacology intertwines with the phsyiology and how you can use medications to manipulate physiology then you may be interested to explore more about Anesthesia.

That sounds amazing! I appreciate your response.

 

[21Rush12]

I wondered if this was @MyDogCole at first, because the first post sounded familiar.

I'd say try to do some shadowing and get a real sense of what different specialists do. Practice setting has a lot to do with the scope you'll see.


Sent from my iPhone using SDN mobile app

 

[Morichka]

1) Given your interests, I'd recommend internal medicine, then clinical pharmacology. For example, I believe Vanderbilt has a clinical pharmacology fellowship.

2) Another good option for you could be emergency medicine, then a toxicology fellowship.

3) A worse option but one that you might be interested in is pathology and focusing on more chemical pathology. But the job market for pathologists is probably the worst there is in all of medicine.

4) Anesthesiology. Anesthesiologists are more like surgeons than physicians if you had to pick one. They do tons of procedures, very procedurally oriented. They must work alongside and collaborate with surgeons on a daily basis. However, if you aren't interested in a surgical specialty, then you might not like anesthesiology either. In my opinion, there's more overlap between those who do anesthesiology but were considering a surgical specialty than those who do anesthesiology but were considering a medical specialty -- or if the latter then more often they were considering a more "surgical" or procedurally oriented medical subspecialty like cardiology or pulm/critical care.

5) Pain. Pain is a lot more than just pharmacology. It's not all just pill mills. Pain, especially interventional pain, involves lots of procedures and is more like surgery in this respect. Also, lots of dealing with psychiatric issues. Lots of opioid addicts. Lots of diagnosing and trying to figure out what's wrong with a chronic pain patient that no other physician can or wants to deal with. Pain looks good on paper, but you have to really be able to tolerate working with chronic pain patients.

I regret your statement that the job market is the worst in medicine. Please don’t comment on this. Every single pathology resident I know has multiple job offers when completing residency and fellowship. The outlook for pathologists is excellent, especially with a huge contingent of pathologists starting to retire in the next few years. Matching into pathology now will be an excellent choice as within the time of your career you will be part of the digital renaissance.

 

[ndafife]

I regret your statement that the job market is the worst in medicine. Please don’t comment on this. Every single pathology resident I know has multiple job offers when completing residency and fellowship. The outlook for pathologists is excellent, especially with a huge contingent of pathologists starting to retire in the next few years. Matching into pathology now will be an excellent choice as within the time of your career you will be part of the digital renaissance.

From the 2017 ASCP FELLOWSHIP & JOB MARKET SURVEY:
"99 PGY-3/4 residents formally applied for a job starting immediately after residency. In 2017, 69 of these residents seeking an immediate job received a job offer (44 PGY-4s and 25 PGY-3s)."

But your anecdotal evidence totally outweighs that 1/3 of pathology residents who applied to jobs, did not get one.

 

[Morichka]

1) Please keep in mind I'm not a pathologist, but from what I hear unfortunately it sounds like it's pretty tough for pathologists. Just check out the path forum for example. They would be a much better resource than me.

2) However here's what I am aware of, but again take my thoughts or opinions with a grain of salt:
-Path is a 4 year residency, but doing a fellowship is all but required now since almost everyone is doing it, which effectively turns path into a 5 year residency. Some pathologists are even doing 2 fellowships so 6 years total, but I'm not sure how common doing the 2nd fellowship is.
-Path has one of the lowest or actually maybe the lowest percentage of US MDs matching into their residencies (data is available via see data for the 2017 Main Match). If I remember path residencies are filled with around 35% US MDs and the rest are non-US MDs and mostly IMGs. Other competitive specialties like dermatology will have over 90% US MDs matching into their residencies. The number of US MDs matching into a specialty is a rough but helpful indicator of how competitive a specialty is.
-My understanding though is that if you're a US MD, you should be able to get into a solid and even a top tier path residency. My understanding is most US MDs do find a path job eventually. I think the non-US MDs and IMGs face more difficulty finding a job for various reasons which I won't get into here.
-But starting salaries for path jobs are low. I believe around $200k/year after 5-6 years of residency. That might seem high as a pre-med, but it's among the lowest of all physicians. I think most PCPs (primary care physicians) like pediatricians and family physicians can make $200k or depending on where you live even more than that. About $250k seems average for PCPs. And PCPs are doing a 3 year residency, not 5+ years. And these salaries are low compared to other specialties, especially surgical specialties and subspecialties, and some IM subspecialties (e.g., GI, cards, pulm/critical care and heme/onc especially), as well as anesthesia and radiology, all of which will average over $350k (some well over $400k) and are more or less around the same length in training (give or take a year) as pathologists have to train for.
-In order to get a path job, even as a US MD, you will likely have to "sell" or "market" yourself a bit more. For most other specialties, especially PCP jobs, you will have people coming to you and offering you tons of options for jobs. But in path, you are more likely to be the one going out and trying to get a job. Nothing wrong with that, because that's what people in most jobs have to do, send in their CV/resume, apply to jobs, interview for jobs, etc. So in path you'll be trying to get other pathologists in your dept or university to know who you are, publish research, attend conferences and try to meet pathologists who can hire you, and so on. Just something to consider.
-Also, as a pathologist, you will most likely not have as much geographic flexibility in your job search as most other specialties would. That is, you won't be able to live wherever you want to live in the US. You have to go to where the jobs are. Jobs in popular areas where many people want to live (e.g., California, Northeast) are going to be few and far between. So you most likely won't end up there. Or if you do, you may be working for less than the average compensation or working more hours for the same compensation.
-After you get a job, if you work hard, you can eventually go from $200k to over $300k, from what I understand. But that may take a more years than in other specialties. For example, partnerships in many or maybe most other specialties tend to be around 2 years. So you will have a starting compensation, then usually a much higher compensation once you become partner. But in pathology, this is likely longer than 2 years. (However private practices are disappearing across many other specialties, but that's a separate issue).
-However if you are fine with all this, and like path, then pathology is a good choice. You do generally have a good lifestyle as an attending. Much better than a lot of other specialties.

I’d like to reply to this as a current resident in pathology and having met over 100 pathologists who are currently practicing. All of them love their job, they have a decent work schedule and the salary is on par with surgery and anesthesiology. Starting salary, like most other specialties starts off lower then quickly ramps up, but is 50-80k over what you quote in the above post. Academic salaries are 70% less than private practice salaries. If you are an American medical grad, you will have your choice of residency program, and therefore your choice of good jobs. As far as the specialty goes, you are going to join a specialty that is poised to do what radiology did in the 1990s which conversion to all digital workflows. Scopes will become used less and less as the microscopy is integrated into the slide scanner and automated image analysis is added as an important feature of histologic analysis. The FDA has already approved digital for primary diagnosis.

The choice of pathology as a specialty is literally the best kept secret in medicine. If you are okay not seeing patients, there is arguably more technology, more pathology, a greater understanding of pathophysiology and biologic specimen analysis than any other medical specialty. It is incredibly intellectually stimulating. If you are considering pathology at all, do a rotation at a major medical center amd don’t worry about the job market or the salary. These have been disproven as myths.

 

[Morichka]

From the 2017 ASCP FELLOWSHIP & JOB MARKET SURVEY:
"99 PGY-3/4 residents formally applied for a job starting immediately after residency. In 2017, 69 of these residents seeking an immediate job received a job offer (44 PGY-4s and 25 PGY-3s)."

But your anecdotal evidence totally outweighs that 1/3 of pathology residents who applied to jobs, did not get one.

I would say that number is high. It is highly discouraged in pathology to look for jobs without a fellowship. In my post I said residents/fellows, which includes those who have subspecialized. Also, the ASCP fellow survey is given in the spring and job offers still have not been given, so these results are unreliable representation of how many actually get a job. In addition this only reflects fellows who are in a fellowship with a RISE In-service exam (so, does not take into account surg path and cytopath, the most common fellowships). Most common is to do a surgical pathology fellowship and go directly into practice. Also, if you are an american medical graduate, your chances of getting the job you want are much higher and they did not take that into account. Are you a pathologist? You are probably just confusing/scaring the med students.

 

[ndafife]

I would say that number is high. It is highly discouraged in pathology to look for jobs without a fellowship. In my post I said residents/fellows, which includes those who have subspecialized. Also, the ASCP fellow survey is given in the spring and job offers still have not been given, so these results are unreliable representation how how many actually get a job. In addition this only reflects fellows who are in a fellowship with a RISE In-service exam. The majority of pathologists do a surgical pathology fellowship and go directly into practice. Also, if you are an american medical graduate, your chances of getting the job you want are much higher and they did not take that into account. Are you a pathologist? You are probably just confusing/scaring the med students.

"In 2017, about 10/21 of pediatric pathology, 22/40 neuropathology, 23/48 transfusion medicine, and 53/120 hematopathology fellows had not yet received job offers."
"The job situation for pathology fellows is mixed, many receive one or more offers, but a substantial number of fellows are not finding employment right away. This later circumstance may weigh on fellows’ decisions to pursue additional fellowship training. Many fellows receive a job offer within the first three months, but some need six months to a year or more for a positive response."

I don't know how the survey is viewed by people in the industry, but it seems pretty clear that the job market for path is worse than that of the majority of other medical specialties. It isn't like law school level bad, but certainly something people should be aware of.

 

[Morichka]

"In 2017, about 10/21 of pediatric pathology, 22/40 neuropathology, 23/48 transfusion medicine, and 53/120 hematopathology fellows had not yet received job offers."
"The job situation for pathology fellows is mixed, many receive one or more offers, but a substantial number of fellows are not finding employment right away. This later circumstance may weigh on fellows’ decisions to pursue additional fellowship training. Many fellows receive a job offer within the first three months, but some need six months to a year or more for a positive response."

I don't know how the survey is viewed by people in the industry, but it seems pretty clear that the job market for path is worse than that of the majority of other medical specialties. It isn't like law school level bad, but certainly something people should be aware of.

Yes, and as I said in my previous post, the most common fellowships are cytopathology and or surgical pathology. “Most residents will seek at least 1 or 2 fellowships after residency training. The most popular first-choice fellowship was surgical pathology (26%), followed by cytopathology (16%), hematopathology (15%), gastrointestinal pathology (10%), dermatopathology (8%), and forensic pathology (5%).” (PMID: 19722750). The survey you quote didn’t even take into account the success of applicants who had done cytopath or surgical pathology, and thus are SEVERELY misleading for people interested in finding out whether there are jobs for trained pathologists. And yes, now I know you are not a pathologist. Medical students, be careful where you get your information!! Pathology is awesome!

 

[Siromas]

Yes, and as I said in my previous post, the most common fellowships are cytopathology and or surgical pathology. “Most residents will seek at least 1 or 2 fellowships after residency training. The most popular first-choice fellowship was surgical pathology (26%), followed by cytopathology (16%), hematopathology (15%), gastrointestinal pathology (10%), dermatopathology (8%), and forensic pathology (5%).” (PMID: 19722750). The survey you quote didn’t even take into account the success of applicants who had done cytopath or surgical pathology, and thus are SEVERELY misleading for people interested in finding out whether there are jobs for trained pathologists. And yes, now I know you are not a pathologist. Medical students, be careful where you get your information!! Pathology is awesome!

Where do you suggest we find credible and objective information/data from about the field?

 

[Morichka]

I would search pubmed, for one. Another source is the CAP (College of American Pathology), which conducts regular surveys on the job market. The surveys are being improved each year. APC also does surveys. As far as other objective info about the field, the CAP surveys give a breakdown of salary, and so do many other salary surveys. What other objective info are you looking for?

Last fall, a study was published (Archives of Pathology & Lab Medicine, Gratzinger et al. "The Recent Pathology Residency Graduate Job Search Experience..." in which job market surveys over 5 years were compiled, "The CAP GMEC has for 5 years followed the job search experience of first-time non-fellowship [pathology] job seekers through surveys administered near the end of the academic year. This yearly snapshot of the initial job search process reveals remarkable stability in job market indicators. Most respondents had been searching for a job for less than a year; nevertheless most respondents had accepted a position at the time of the survey, and of those, most were satisfied or very satisfied with their position," and, "Among those who had accepted a position, most (61%) reported that they had been searching for 6 months or less." This actually doesn't sound too bad to me. If you are an AMG, this should be very promising information as currently 65% of those entering residency are IMGs.

This study also is limited because it is a snapshot and does not follow all graduates as individuals to see when they end up finding a job.

But, the Association of Pathology Chairs (APC) conducts surveys, and reports, "In May of the first, second, and third year after residency graduation, 32%, 73%, and 92% (n = 124 of 388, 262 of 357, and 329 of 359) of residency graduates had begun their first pathology job." This corroborates the knowledge that 1 fellowship is recommended, and about 25% of grads do 2 fellowships. Although not everyone (apparently) has a job lined up 3-4 months before the end of fellowship, I wouldn't necessarily expect that they would. Practices are always changing, people are retiring. In fact, there is projected to be a deficit in pathologists beginning next year and extending at least a decade into the future (see figure from "Pathology Workforce in the US" by Robboy et. al.).