MS3 thinking pathology but hesitant to commit...

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Mamba824

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Hey everyone,

I'm an MS3 at a top 50 MD program. I absolutely loved my pathology rotation a few weeks ago. I've enjoyed every rotation thus far but pathology is exactly what I'm looking for. The intellectual stimulation. Being a diagnostician and the doctor's doctor. The architectural patterns in histology. The lifestyle. I feel its a perfect fit for my goals and talents.

My path mentor at school said that with my scores (Step 1 ~250, all Honors thus far in 3rd year including IM and Surgery with possible AOA, and 5 publications and 4 posters with first authorships in both), I have a solid shot at top programs. My plan is to do some Away rotations at these top places to solidify my interest.

Every attending I've talked to (at my institution, at top academic programs and private practices) has told me that pathology is a wonderful specialty. None of them regret going into it. They all emphasized that the doom and gloom talk just isn't true and that the pay is very good (one attending at my institution mentioned average of 300K and someone in PP mentioned his salary is 500K). The fellows at my school all got good jobs with solid pay. The director at my school also emphasized that since I'll likely be able to go to a top residency program, I will have no problems finding a job in 6-7 years.

Now, this is the COMPLETE OPPOSITE of what I have read on here. I struggle to find ONE person on here who isn't completely crapping on the specialty aside from Yaah. So naturally I'm confused.

My questions are: what gives? why the difference? Are these people lying to my face? I can't imagine EVERYONE lying to me. Whats the real story? What's with the salary discrepancies on here (some people have said mid 150s and low 200s), Doximity (avg 300k), and medscape 2017 (260k)? I have yet to meet a "real" pathologist telling me to stay away from the specialty. Anesthesiology is the only other specialty I'm considering at this point but its a distant 2nd.

I would appreciate the feedback as I'm ready to make an important decision. Thanks!
 
I'm an MS4 and I too was deciding between anesthesia and pathology but so far I'm glad I picked path. People are negative on here because message boards these days in general tend to draw a negative crowd. At every residency I interviewed with all the graduates have gotten a jobs, and most places provide lists of where their residents go for fellowship and first jobs. Seriously if it's your passion go for it, especially with your stats you will get interviews to every top program and you will have your pick of the litter.
 
The issue is knowing how to stratify these "opinions" properly. You have academic pathologists who are shielded from effects of the free market, much more so than "regular physicians" that work in a hospital or private practice. You have private practice pathologists who own path labs and employ dozens of CLS workers who can probably only be compared to nephrologists who own dialysis centers. Then you have other extreme physician outliers like the forensic pathologists who work in the legal realm almost as much as medicine. It is highly likely that the "ivory tower" pathologists are describing a world that only a fraction of all new pathologists can ever enter due to how long it takes professors to retire compared to surgeons and whatnot.

If you are very entrepreneurial and know how to navigate leveraged buyouts and how to finance the ridiculous overhead of the average pathologist (equipment is expensive) compared to something like psychiatry (a basic office), pathology is perfectly fine to go into.
 
Mamba824 said:
Now, this is the COMPLETE OPPOSITE of what I have read on here. I struggle to find ONE person on here who isn't completely crapping on the specialty aside from Yaah. So naturally I'm confused.
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My advice would be to trust the people you speak to in person and not rely on the opinions of an anonymous forum to guide an important life choice. But then I suppose if you followed my advice, I guess you'd also be ignoring it...

Let's face it: pathology isn't a competitive speciality, and probably some fraction of pathologists have trouble finding positions, or positions they think they deserve. Medicine is changing, and the changes do not favor physicians. Pathology has its own threats; practicing pathologists have had to deal with these threats and see that the future will likely not be as good as the past. If you want to kill it salary-wise, pathology is probably not the best choice. If you have to live in San Diego and only San Diego, pathology is probably not the best choice. But if you want to make slightly better $$ than primary care and have a lot more time to spend it, pathology is still an attractive choice - but nothing is for certain over the long term.
 
Go into Path. It is a great field. Academics pay is usually crap but community and private pay is really good. Lifestyle is nice. Job is fun. There are a lot of peeps without jobs but Path also is a field with a lot of peeps who don’t know or have good social skills.
 
You're probably ok if you go to a well-regarded program and do a fellowship that's in demand.

path isn't something i'd recommend anyone do if they have to go average or below, but for the upper echelons its probably fine
 
Pathology is a great career if you are interested in the pathogenesis of disease and enjoy working hard to improve patient care. One should not be discouraged by disgruntled postings on an internet forum.

Daniel Remick, M.D.
Chair and Professor of Pathology and Laboratory Medicine
Boston University School of Medicine and Boston Medical Center
 
Mamba824 said:
My questions are: what gives? why the difference? Are these people lying to my face? I can't imagine EVERYONE lying to me. Whats the real story? What's with the salary discrepancies on here (some people have said mid 150s and low 200s), Doximity (avg 300k), and medscape 2017 (260k)? I have yet to meet a "real" pathologist telling me to stay away from the specialty. Anesthesiology is the only other specialty I'm considering at this point but its a distant 2nd.

I would appreciate the feedback as I'm ready to make an important decision. Thanks!
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This board advocates using sexual history/preference as a tool to decide if you're right for pathology. Pretty much all you need to know. Good people do well in pathology, the rest come here to whine.
 
No doubt there are lucrative and rewarding positions in pathology. Those who have the skills to get those positions are encouraging you on this board. But there is only one chair at BU - the rest of his faculty are being hired in as instructors at $115K, hoping one day to land a PP job and enjoying that someone else is now grossing for them. And although discussion boards do attract more negativity, you should not dismiss that negativity out of hand. The real evidence is out there, independent of this board. Look at the number of positions posted at any physician recruitment website, and compare path with any specialty other than nuclear medicine. Or call a physician recruiter and ask about their path openings. No one wants you, or if they do, they don't want to pay you. Your service is viewed as a commodity by hospital administrators and other physicians. Patients think their surgeon is making the diagnosis. Results come back "from the lab," with no mention of the consultation or tumor board or your contribution. But if you have financial/business skills, or do a dermpath fellowship, you can likely arrange for a good future. So get your MBA while in training, or make sure you do a high demand fellowship.

I send my kids to piano lessons, but I don't want them to go into music. There aren't that many Lang Langs out there - most professional musicians are teaching kids or doing music therapy. Rewarding work, perhaps, but often not the original goal for these folks.

You will be limiting your future income and choices by going into pathology. There are other well-compensated, good lifestyle specialities that you can (and should) pursue.
 
Consider more options than Path or Gas. Those are the two I would definitely avoid, along with rads. All three are in the same boat being commoditized.

I hate that expression "the doctor's doctor". In real life you are the doctor's piggy bank as you will be exploited by many physicians.
 
Thank you everyone for your responses! I'm def more confused now lol but I think I'm gonna go ahead and listen to some of you and trust the people I've spoken to in real life. Not random online posts. Its interesting though that every attending I've talked to has never even HEARD of SDN. My path mentor at school specifically told me to stay away from it...
 
Pathology is a great field but it has its pros and cons. There are relatively fewer jobs as compared to other specialties but essentially everyone finds a job if they are not geographically restricted. If you are restricted to a specific geographical area than its definitely a drawback as compared to specialties like IM, Psych, FP etc. Money is pretty decent and you can do financially well if you end up in private practice, definitely more than IM, FP, Psych, Peds, Neurology, ID etc but not at the level of Derm, Ortho, ENT and other surgical specialties. Lifestyle is pretty cushy too and low stress. Another positive is intellectual satisfaction. The negatives are being dependent on referrals as you can imagine volume is controlled by clinicians. A patient cannot travel 200 miles to see another specialist but a biopsy can...That being said, if you are entrepreneurial type, have an easy going personality and train at a decent place, you will do just fine. If you like the field and willing to relocate for first job go for it.
 
I’m a current pathology resident. I’ve decided on leaving and going to primary care. Not trying to persuade you either way, but want to give you my perspective just as something to think on.

I also went into path for the reasons you stated: thought it was interesting, challenging, good lifestyle, pay, etc.

Why I want out:

-The work (while interesting) at least in residency at MY PROGRAM is making me miserable. Microscopes and sitting all day have caused me to develop migraines. (I’ve left the surgical lab, thrown up, and gone back to complete my work)
-On the clinical rotations (while super relaxed) I just feel as if I’m wasting my time. (Again, MY PROGRAM) no attending really cares what you do. Not much guidance.
-Autopsy months are depressing
-I found when it comes to actually handling the specimens (which I didn’t much do as a student), I don’t enjoy it. Mostly because it’s potentially infectious and/or smelly.
-Grossing here is every day. The schedule is a 1 day schedule (sign out in the AM, gross in PM). I feel drained after grossing and find it very difficult to make myself study (which, again, you have to do a lot)
-As a med student I was burnt out with reading text books. Path is a lot more of this. (Thought you’d learn more at the scope etc I guess...didn’t anticipate the amount of work and self discipline it requires)
-Finally, I realized I do want to be able to practice near my family. Path has relatively fewer opportunities for jobs.

That said:
If you truly like the microscope (and I mean you need to stare through it for several hours in a day to know) and you don’t mind the sedentary, isolated nature of the work. It is a fascinating field in many ways. For me it just doesn’t outweigh the misery of the day to day practice of pathology. Again this is my opinion based on my experience. YMMV. I find that I do well with long hours as long as I’m busy and don’t hate the task I’m working on. I pondered family medicine vs pathology for a long time. Ultimately now, I realize I made the wrong choice for myself.

Hope whatever you choose works out and you enjoy it.
 
You’ve been lied to.

Only the TOP 15 programs make the cut.
Lol at you thinking your peasant status stood a chance. Smh.
 
mario2010 said:
Pathology is a great field but it has its pros and cons. There are relatively fewer jobs as compared to other specialties but essentially everyone finds a job if they are not geographically restricted. If you are restricted to a specific geographical area than its definitely a drawback as compared to specialties like IM, Psych, FP etc. Money is pretty decent and you can do financially well if you end up in private practice, definitely more than IM, FP, Psych, Peds, Neurology, ID etc but not at the level of Derm, Ortho, ENT and other surgical specialties. Lifestyle is pretty cushy too and low stress. Another positive is intellectual satisfaction. The negatives are being dependent on referrals as you can imagine volume is controlled by clinicians. A patient cannot travel 200 miles to see another specialist but a biopsy can...That being said, if you are entrepreneurial type, have an easy going personality and train at a decent place, you will do just fine. If you like the field and willing to relocate for first job go for it.
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very helpful. thank you!
 
Patho_logical said:
I’m a current pathology resident. I’ve decided on leaving and going to primary care. Not trying to persuade you either way, but want to give you my perspective just as something to think on.

I also went into path for the reasons you stated: thought it was interesting, challenging, good lifestyle, pay, etc.

Why I want out:

-The work (while interesting) at least in residency at MY PROGRAM is making me miserable. Microscopes and sitting all day have caused me to develop migraines. (I’ve left the surgical lab, thrown up, and gone back to complete my work)
-On the clinical rotations (while super relaxed) I just feel as if I’m wasting my time. (Again, MY PROGRAM) no attending really cares what you do. Not much guidance.
-Autopsy months are depressing
-I found when it comes to actually handling the specimens (which I didn’t much do as a student), I don’t enjoy it. Mostly because it’s potentially infectious and/or smelly.
-Grossing here is every day. The schedule is a 1 day schedule (sign out in the AM, gross in PM). I feel drained after grossing and find it very difficult to make myself study (which, again, you have to do a lot)
-As a med student I was burnt out with reading text books. Path is a lot more of this. (Thought you’d learn more at the scope etc I guess...didn’t anticipate the amount of work and self discipline it requires)
-Finally, I realized I do want to be able to practice near my family. Path has relatively fewer opportunities for jobs.

That said:
If you truly like the microscope (and I mean you need to stare through it for several hours in a day to know) and you don’t mind the sedentary, isolated nature of the work. It is a fascinating field in many ways. For me it just doesn’t outweigh the misery of the day to day practice of pathology. Again this is my opinion based on my experience. YMMV. I find that I do well with long hours as long as I’m busy and don’t hate the task I’m working on. I pondered family medicine vs pathology for a long time. Ultimately now, I realize I made the wrong choice for myself.

Hope whatever you choose works out and you enjoy it.
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Thats great to know. Thanks for your input!
 
Most of medicine sucks. I've met very few happy Nephrologists, pulmonologists, PC's, ER docs or general surgeons. In my opinion, there are several oases in a sea of suckness...ENT, RAD-ONC, Optho, ortho are among the few. Pathology is not quite there, but its way better than most. Getting into a top notch program will help limit the negatives.
 
Recent graduate, American IMG, in this year's match who only applied to pathology.

I don't know why there are so many negative comments on here about this specialty. I went to medical school with the sole purpose of becoming a pathologist, and almost all the pathologists I have spoken to love their jobs and would never trade it for the world. Yes laboratories are becoming computerized, but the best thing about pathology is having so many options. Hematopathology, Molecular pathology, cytopathology, breast path, GU path, GI path, Neuro path, Pediatric path, Forensic path, you name it theres a pathology subspecialty. So people saying we are a ''dying'' specialty don't know us too well. In pathology your fellowship is the best dictator of your job, and for those who say that you won't succeed unless you are in a highly ranked program really don't know what they are talking about. Ie I interviewed at a community program that had a resident get into DERM path (highly competitive since Derm residents compete for the same fellowship), while at a top program their chief resident did not get their desired derm path residency. Success is dependent on your ability to network and work hard, period. The reason why you saw the wide salary range is because of the subspecialty. Forensic path (my career choice) starts at the low end i.e. $150K range while I know derm path people who start at $275K and my mentor who is the Director of a laboratory makes $533K. Salary is dependent on where you did your fellowship, specialty, and what part of the country you live in.

At the end of the day never let some stranger on the internet sway your career choice. Become a member of CAP (College of American Pathologists), go out and talk to pathologists and explore the subspecialties within path. Its a great field and there is absolutely nothing that could sway me to change specialties. Best of luck to you and if you love path go for it!
 
myshka310 said:
Recent graduate, American IMG, in this year's match who only applied to pathology.

I don't know why there are so many negative comments on here about this specialty. I went to medical school with the sole purpose of becoming a pathologist, and almost all the pathologists I have spoken to love their jobs and would never trade it for the world. Yes laboratories are becoming computerized, but the best thing about pathology is having so many options. Hematopathology, Molecular pathology, cytopathology, breast path, GU path, GI path, Neuro path, Pediatric path, Forensic path, you name it theres a pathology subspecialty. So people saying we are a ''dying'' specialty don't know us too well. In pathology your fellowship is the best dictator of your job, and for those who say that you won't succeed unless you are in a highly ranked program really don't know what they are talking about. Ie I interviewed at a community program that had a resident get into DERM path (highly competitive since Derm residents compete for the same fellowship), while at a top program their chief resident did not get their desired derm path residency. Success is dependent on your ability to network and work hard, period. The reason why you saw the wide salary range is because of the subspecialty. Forensic path (my career choice) starts at the low end i.e. $150K range while I know derm path people who start at $275K and my mentor who is the Director of a laboratory makes $533K. Salary is dependent on where you did your fellowship, specialty, and what part of the country you live in.

At the end of the day never let some stranger on the internet sway your career choice. Become a member of CAP (College of American Pathologists), go out and talk to pathologists and explore the subspecialties within path. Its a great field and there is absolutely nothing that could sway me to change specialties. Best of luck to you and if you love path go for it!
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This is awesome to hear. Thanks for sharing!
 
There are happy and unhappy people in every medical specialty; ultimately you have to do what your gut tells you, but few medical students (save a few with family experience or a childhood dream) truly know what they're getting into when applying to their specialty...
Job markets fluctuate, but as a general rule, the job market for path is arguably much more rough than most other specialties and unless you're willing to make peanuts working long hours (relatively speaking) in academia, you have to be willing to apply & move to where the job is, if you can find it. Best jobs = small markets, midwest, least sexy places to live, and (usually) avail word-of-mouth.

And while we tell ourselves our decisions are based on ideals or altruism, they require considering what you want your LIFE to be like in 10, 20 and 30 yrs in terms of stress, burnout, physical vs mental demand, financial security, not simply "what is interesting to you" in the here and now...i think it's very hard as a medical student to appreciate the full extent of a career in some specialties...you think "Surgery, ugh, no way", but ENT is a fantastic specialty, high demand, high pay, and usually forgiving hours; most ENTS are extremely happy. What I view as a 'great career specialty' now vs as a med student is different, partly because I was naive and partly because i had a LOT more energy, enthusiasm, and altruism, and while i told people i chose path because it had the most potential for research or higher scientific endeavors, it came down to the low burnout rates, hours, intellectual rigor, introverted nature of the work, autonomy, and not having to see patients...in retrospect, several other specialties offer similar "pros" minus the "not having to see patients" part, and all of them offer VASTLY greater job markets and higher average pay, and i'm sure I would have been content in them as well.

There are happy people in pathology, but they are much fewer in number than specialties like rad onc, ENT, anestiesia. If you're willing to take the risk, best of luck. Otherwise, get into the most competitive specialty your scores will allow (ophtho, rad onc, ENT, etc).
 
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octopusprime said:
There are happy and unhappy people in every medical specialty; ultimately you have to do what your gut tells you, but few medical students (save a few with family experience or a childhood dream) truly know what they're getting into when applying to their specialty...
Job markets fluctuate, but as a general rule, the job market for path is arguably much more rough than most other specialties and unless you're willing to make peanuts working long hours (relatively speaking) in academia, you have to be willing to apply & move to where the job is, if you can find it. Best jobs = small markets, midwest, least sexy places to live, and (usually) avail word-of-mouth.

And while we tell ourselves our decisions are based on ideals or altruism, they require considering what you want your LIFE to be like in 10, 20 and 30 yrs in terms of stress, burnout, physical vs mental demand, financial security, not simply "what is interesting to you" in the here and now...i think it's very hard as a medical student to appreciate the full extent of a career in some specialties...you think "Surgery, ugh, no way", but ENT is a fantastic specialty, high demand, high pay, and usually forgiving hours; most ENTS are extremely happy. What I view as a 'great career specialty' now vs as a med student is different, partly because I was naive and partly because i had a LOT more energy, enthusiasm, and altruism, and while i told people i chose path because it had the most potential for research or higher scientific endeavors, it came down to the low burnout rates, hours, intellectual rigor, introverted nature of the work, autonomy, and not having to see patients...in retrospect, several other specialties offer similar "pros" minus the "not having to see patients" part, and all of them offer VASTLY greater job markets and higher average pay, and i'm sure I would have been content in them as well.

There are happy people in pathology, but they are much fewer in number than specialties like rad onc, ENT, anestiesia. If you're willing to take the risk, best of luck. Otherwise, get into the most competitive specialty your scores will allow (ophtho, rad onc, ENT, etc).
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I think this is very solid advice. “It takes all kinds,” as they say. The tough part (especially for path) is trying to pin down exactly what the day to day is like and what effect it will have on you. Prior to actually practicing (as a resident) pathology it’s very hard to know. If you do end up liking it, it’s definitely a comfy set up. Attendings here often arrive well after me (1-2 hours) and leave before me. And my hours aren’t bad at all.

As mentioned though, it’s academia, idk what pay range they’re in but according to numbers I’ve seen it’s not great. And if they wanted to move somewhere, they’d just about have to know someone to get a job. Whereas with something like family medicine, people practically beg you to work for them in any location.

It’s all a give and take. Figuring out what you’re willing to give in order to take what you want is the tricky part.
 
Patho_logical said:
I think this is very solid advice. “It takes all kinds,” as they say. The tough part (especially for path) is trying to pin down exactly what the day to day is like and what effect it will have on you. Prior to actually practicing (as a resident) pathology it’s very hard to know. If you do end up liking it, it’s definitely a comfy set up. Attendings here often arrive well after me (1-2 hours) and leave before me. And my hours aren’t bad at all.

As mentioned though, it’s academia, idk what pay range they’re in but according to numbers I’ve seen it’s not great. And if they wanted to move somewhere, they’d just about have to know someone to get a job. Whereas with something like family medicine, people practically beg you to work for them in any location.

It’s all a give and take. Figuring out what you’re willing to give in order to take what you want is the tricky part.
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Thanks for the input. Resident life and work is different than community/PP attending life no? I don't plan on doing Academia. Seems like alot of what you are saying is based on your feelings in residency which will end at some point. But I could be mistaken. I guess the looking through a microscope part will always be there...
 
Like has been said before, you need to try to think long term about what you are looking for in life and what your skills and interests are. Sure there are lots of options open if you have good board scores/AOA/etc...but if you are miserable looking up people's noses, then it doesn't matter that ENT is good for lifestyle and $$$ if you are miserable for 80+ hours a week for 5 years and thereafter for the rest of your life. I've only been in PP for 1.5 years or so, but love it and couldn't imagine being very happy in another field.

Yeah, the job market is not like FP where they are banging down your door (to see those 28.3 patients per day, or whatever metric the Overlords have deemed appropriate for an FP doc). Going to a top program is important, and with your stats that looks pretty doable. Even the sub-par people I knew who went to top programs ended up with decent gigs (with one or two exceptions). Like pretty much other field (IT/business/etc...) word of mouth is important. Maintaining good relationships with co-residents and attendings is important (5 people in my group have a residency connection (not all from the same place)). But you may have to ultimately be flexible in terms of job options.

One thing that helped me with specialty selection is the realization that if you don't like it, you can change. People come into path from other specialties. People (more rarely) leave path for other specialties. Sure, it is not optimal, but that realization at least takes off some of the pressure.

Good luck with your decision.
 
Great CV, but enter pathology and you are throwing it away. Commodity, just like the rest of us. A lot of your career decisions will now be made by other people. You can still be happy, but that is the reality of pathology. Commodity. No leverage. No security. Easily replaced.
 
chooks said:
Like has been said before, you need to try to think long term about what you are looking for in life and what your skills and interests are. Sure there are lots of options open if you have good board scores/AOA/etc...but if you are miserable looking up people's noses, then it doesn't matter that ENT is good for lifestyle and $$$ if you are miserable for 80+ hours a week for 5 years and thereafter for the rest of your life. I've only been in PP for 1.5 years or so, but love it and couldn't imagine being very happy in another field.

Yeah, the job market is not like FP where they are banging down your door (to see those 28.3 patients per day, or whatever metric the Overlords have deemed appropriate for an FP doc). Going to a top program is important, and with your stats that looks pretty doable. Even the sub-par people I knew who went to top programs ended up with decent gigs (with one or two exceptions). Like pretty much other field (IT/business/etc...) word of mouth is important. Maintaining good relationships with co-residents and attendings is important (5 people in my group have a residency connection (not all from the same place)). But you may have to ultimately be flexible in terms of job options.

One thing that helped me with specialty selection is the realization that if you don't like it, you can change. People come into path from other specialties. People (more rarely) leave path for other specialties. Sure, it is not optimal, but that realization at least takes off some of the pressure.

Good luck with your decision.
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Two things:
1. most med students have absolutely no more of a notion that they "dislike ENT" than they do a notion that they "like pathology"... "if you are miserable [looking through a microscope] than it doesn't matter that [pathology] is good..." ...fill in the blank with most specialties. [FWIW 'looking in noses' in a minor component of ENT...that's akin to the ignorant masses' bewilderment that someone would 'like' doing autopsies, as if that's all we do...i despise autopsies FWIW...] Point being that every specialty has it's mundane, monotonous, less-than-sexy aspects, but some specialties are WAY better at affording a happy life OUTSIDE medicine...and --based on the odds--have a greater likelihood of placing you in a position that will be high pay, good vacation and better hours...ENT is one of those fields, Path is not.

2. Going to a top program is not the most important. Going to a program with adequate volume to expose you to what you need to see is. I could care less that someone went to MGH or WashU for path...sure there are some bottom-of-the-barrel programs i would avoid, but the expanse of country between the coasts is filled with mid range programs that will train you adequately--and likely afford you more job prospects of the kind that are highly coveted. Beyond the basic requirement of volume & exposure, path residency is very self driven.
 
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Mamba824 said:
Thanks for the input. Resident life and work is different than community/PP attending life no? I don't plan on doing Academia. Seems like alot of what you are saying is based on your feelings in residency which will end at some point. But I could be mistaken. I guess the looking through a microscope part will always be there...
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No I think you’re right. Much of it would end after residency depending on your plan. I would (ideally) be working in a pretty rural area which is somewhat underserved. Possibly I could still be required to do my own grossing in that setting.

Microscope work will always be there unless you go CP/blood bank. Then I guess it’s a smaller portion of your work as you end up doing lots of administrative work I think. Forensics would avoid a good bit. But it would be traded for autopsy. There are definitely ways to tailor a career in path to your desires to some degree. I unfortunately find most of those options uninteresting.

To be fair, I can’t say with a lot of certainty what attending life is like. I assume better than resident life. But maybe not. Definitely better compensated for the drudgery.
 
path24 said:
Great CV, but enter pathology and you are throwing it away. Commodity, just like the rest of us. A lot of your career decisions will now be made by other people. You can still be happy, but that is the reality of pathology. Commodity. No leverage. No security. Easily replaced.
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That has not been my experience.

Many of us lead our groups, laboratories and medical staffs. If I ask administration for a new gadget, it will literally be there on my desk the next day. Nobody makes decisions in isolation. Those individuals who provide value, time and commitment to an organization, its goals and people will always have leverage, security and respect.

Be kind to others. Don't think its all about your ability....its not.
 
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My experience has also been that pathologists are critical components of the leadership within the hospital and physician groups. I know several pathologists who have been elected to lead the finance groups of the physician groups, e.g. all of the physicians at the institution. Perhaps I have just been fortunate to work with intelligent, assertive pathologists, but my experience is that we are fairly compensated for our professional work.
 
BU Pathology said:
My experience has also been that pathologists are critical components of the leadership within the hospital and physician groups. I know several pathologists who have been elected to lead the finance groups of the physician groups, e.g. all of the physicians at the institution. Perhaps I have just been fortunate to work with intelligent, assertive pathologists, but my experience is that we are fairly compensated for our professional work.
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lets not be too flowery here.
maybe you have been fortunate.
ive seen both sides. wealthy private owner pathologists who are happy with their autonomy, and academic/corporate drones who are underpaid and certainly not respected. ive also met intelligent pathologists, and dumb pathologists. hospitals that respect their pathologists, and hospitals that wont even hire a PA for the employed group and depend on foreign pathology labor from pakistan because they dont complain about the conditions.
 
BU Pathology said:
My experience has also been that pathologists are critical components of the leadership within the hospital and physician groups. I know several pathologists who have been elected to lead the finance groups of the physician groups, e.g. all of the physicians at the institution. Perhaps I have just been fortunate to work with intelligent, assertive pathologists, but my experience is that we are fairly compensated for our professional work.
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Says the guy in charge (who is likely the best compensated). What % of your faculty's professional fees is used toward their compensation? What is the ratio of BU pathology's compensation to his lowest full time faculty member? I would guess 5:1, or something on that scale. Does that level of exploitation happen in private practice? Is BU Path signing out 5 times what this junior faculty member is signing out? My guess is the instructor is signing out more than he is. Though it is anecdotal, I have heard that some of the worst abusers of junior pathologists are senior pathologists.
No doubt some pathologists participate in and contribute to hospital leadership teams. But these are the exception - don't count on this level of respect or influence as an ordinary pathologist, and don't believe that it translates to better compensation.
 
jupiterianvibe said:
lets not be too flowery here.
maybe you have been fortunate.
ive seen both sides. wealthy private owner pathologists who are happy with their autonomy, and academic/corporate drones who are underpaid and certainly not respected. ive also met intelligent pathologists, and dumb pathologists. hospitals that respect their pathologists, and hospitals that wont even hire a PA for the employed group and depend on foreign pathology labor from pakistan because they dont complain about the conditions.
Click to expand...

I think there is a lot of truth here. This basic topic has been kicked around here for years. You can end up with a very satisfying, prestigious, and
lucrative professional career or you can end up "otherwise". Sadly, all
the trends, pretty much since TEFRA in the early 80's, have made the former
much less frequent and the latter a sad reality for too many. This has
happened throughout medicine, but has disproportionally affected
pathology. So, BU's viewpoint is valid and so is Granular's. It all
depends on the window you are looking out of.
 
I have no regrets about going into path. I am primarily hemepath at Wake Forest and we see A LOT of leukemia, lymphoma, MDS, etc. I am also 1/2 administrative (Assoc Dean of Admissions) and the flexibility of the clinical practice is a perfect fit with the admin duties. I have a lot of contact with the oncologists and the hematologist, so that is rewarding. I don't mind that they get "credit" for making the diagnosis. If that bothers you, you should rethink medicine.
 
Granular said:
Says the guy in charge (who is likely the best compensated). What % of your faculty's professional fees is used toward their compensation? What is the ratio of BU pathology's compensation to his lowest full time faculty member? I would guess 5:1, or something on that scale. Does that level of exploitation happen in private practice? Is BU Path signing out 5 times what this junior faculty member is signing out? My guess is the instructor is signing out more than he is. Though it is anecdotal, I have heard that some of the worst abusers of junior pathologists are senior pathologists.
No doubt some pathologists participate in and contribute to hospital leadership teams. But these are the exception - don't count on this level of respect or influence as an ordinary pathologist, and don't believe that it translates to better compensation.
Click to expand...

This sort of comment irks me to no end and I often see this quoted on this forum. This sort of comment usually comes from pathologists who have never held any sort of administrative position in their life. A group's income stream is determined by how they bill and how effective they are at collecting payments. Yes, you need pathologists who can sign cases out. The more you sign out, the more you can bill for, etc. That's just one facet of how the business runs. There's also the administrative arm, which you seem to completely ignore and blow off as if it's something that isn't necessary.

While you're signing out your 30th tubular adenoma, I bet BU Pathology is making the rounds to different hospital committees, meeting with other doctors who provide the pathology group specimens (aka $$), answering phone calls and emails about a variety of issues that require his urgent attention, managing ancillary support staff, etc. All of that takes time and there is only so many hours in the day. If you neglect these duties, the entire system falls apart.

If you want respect, you have to earn it. Competent junior pathologists don't stay in that position forever. It is completely INCORRECT to assume that the person who is "signing out 5 times" the volume as their boss is actually doing more work. Perhaps one day you'll understand this concept. If you don't, you'll just be some disgruntled worker bee who never gets to where they want to be in life. If that's the case, I recommend therapy.
 
The Path sucks because "sitting all day" thing has significant real scientific merit now. You absolutely HAVE TO GET REGULAR EXERCISE if you are gonna do Path. Like 60+ minutes in the gym, which can be hard if the idiot cabal of modern medicine is having you spend 10 hours a day hunched over pericolic fat looking for 12+ nodes....
 
That's where we are... pathology sucks because you can't exercise enough if you're in it. I can't imagine a more resounding endorsement for a specialty than reaching THAT far down, even if that was said half in jest.

So to recap, one of the most respected (by the other trolls) posters on this board has said in the last month(ish):

You won't be good at pathology if you're ever a bottom in the bedroom.
Pathology sucks because you can't exercise enough.
 
BrainPathology said:
That's where we are... pathology sucks because you can't exercise enough if you're in it. I can't imagine a more resounding endorsement for a specialty than reaching THAT far down, even if that was said half in jest.

So to recap, one of the most respected (by the other trolls) posters on this board has said in the last month(ish):

You won't be good at pathology if you're ever a bottom in the bedroom.
Pathology sucks because you can't exercise enough.
Click to expand...

Yes that is the current state of affairs. Excellent concise summation for potential applicants.

REF:
Mayo Clin Proc. 2010 Dec; 85(12): 1138–1141.
Sedentary Behavior: Emerging Evidence for a New Health Risk

Kumar, Ashwin. (2003). What is the relationship between physical exercise and sexual desirability?. Social inquiry. 13.
 
Last edited:
Trying to accurately assess the job market in pathology is like screaming into a void and hoping for an answer. If you talk to a bunch of people, you will get a bunch of different answers, most of which are anecdote-based or biased in some way. Like Ferris Bueller - "My best friend's sister's boyfriend's brother's girlfriend heard from this guy who knows this kid who's going with the girl" who knows several unemployed pathologists. But ask them their experience with the job market, and they might respond, "It wasn't as bad as I thought, I had several good prospects and took a great job. I guess I was lucky." I know people I trained with who were amazing and had trouble finding a great job right away - but most found a great job after taking a less desirable job for a year or two. I also know people I trained with who I would not want to work with AT ALL who had multiple job offers and make a lot of $.

I would much more trust the opinion of a residency program director than I would the anonymous ranting of someone who tells you it sucks. The problem with residency directors is that some of them absolutely do NOT keep track of where their graduates end up. They all know where they go year 1 out of residency, but that is almost always a fellowship and once that happens some seem to lose interest in tracking movements.

We have put out job ads recently. The quality of applicants we receive is more variable than anything I have ever seen. Some candidates I would not hire to plow my driveway. There are a lot of these candidates. They have such glowing things on their resume like:
  1. Listing as references people who badmouth the applicant when you call them.
  2. Multiple fellowships in multiple unrelated specialties, but little competence in any of them
  3. Horrible grammar
  4. Gloating about how wonderful they are (seriously - one applicant we had once said other people would refer to him as God's Gift to Pathology).
  5. Their "hobbies" section is longer than anything else on their resume (seriously)
And the ones that are good enough to interview will sometimes do things like:
  1. Not respond to phone calls or emails
  2. Not take the interview seriously
  3. Ask for special perks to come and visit
  4. Ask what the minimal amount of work they will have to do is (seriously)
  5. Refuse to be hired unless you can guarantee their spouse a job
  6. Insult or yell at the assistant who calls them to schedule interviews.
  7. State that they are not very interested in working hard.
  8. The first 5 questions they ask are all about things like vacation time, what time you leave for the day, etc.

On the other hand, for the right job ad, you can sometimes get 4-5 stellar candidates, all of which look potentially like great fits. Some of them will then eliminate themselves through one of the above methods. But most remain stellar and then turn out to have multiple job offers from good places.

So who are the ones out there complaining? The ones getting the multiple offers?

I KNOW there are at least a handful of unemployed (or significantly underemployed) pathologists out there, because these same individuals apply for every job we advertise for, even if they are primarily trained in nephropathology and AP only and the job includes lab management responsibilities and significant breast/gyn path. I think the job market is very different depending on what you are looking for - if you're looking for a generalist job but don't have many skills, you might find it hard.
 
Patho_logical said:
I’m a current pathology resident. I’ve decided on leaving and going to primary care. Not trying to persuade you either way, but want to give you my perspective just as something to think on.

I also went into path for the reasons you stated: thought it was interesting, challenging, good lifestyle, pay, etc.

Why I want out:

-The work (while interesting) at least in residency at MY PROGRAM is making me miserable. Microscopes and sitting all day have caused me to develop migraines. (I’ve left the surgical lab, thrown up, and gone back to complete my work)
-On the clinical rotations (while super relaxed) I just feel as if I’m wasting my time. (Again, MY PROGRAM) no attending really cares what you do. Not much guidance.
-Autopsy months are depressing
-I found when it comes to actually handling the specimens (which I didn’t much do as a student), I don’t enjoy it. Mostly because it’s potentially infectious and/or smelly.
-Grossing here is every day. The schedule is a 1 day schedule (sign out in the AM, gross in PM). I feel drained after grossing and find it very difficult to make myself study (which, again, you have to do a lot)
-As a med student I was burnt out with reading text books. Path is a lot more of this. (Thought you’d learn more at the scope etc I guess...didn’t anticipate the amount of work and self discipline it requires)
-Finally, I realized I do want to be able to practice near my family. Path has relatively fewer opportunities for jobs.

That said:
If you truly like the microscope (and I mean you need to stare through it for several hours in a day to know) and you don’t mind the sedentary, isolated nature of the work. It is a fascinating field in many ways. For me it just doesn’t outweigh the misery of the day to day practice of pathology. Again this is my opinion based on my experience. YMMV. I find that I do well with long hours as long as I’m busy and don’t hate the task I’m working on. I pondered family medicine vs pathology for a long time. Ultimately now, I realize I made the wrong choice for myself.

Hope whatever you choose works out and you enjoy it.
Click to expand...


I am not trying to belittle your experience and your choices, but I just wanted to touch base on some of those reasons you addressed for leaving as far the original posters questions.

I agree with you on most CP rotations in residency it felt very silly. In actuality, academic CP is led by PHDs. It is unfortunate because in PP you do need to at least understand lab management to a decent extent, QC, inspections, all of that. I feel residents should be part of most administrative meetings during their CP rotations.

Handling the gross specimen is something I would imagine most people don't enjoy too much, but it certainly is helpful (larger stuff mainly). Smelly, yes, gross yes, but so is the patient with bad hygeine, or the one who throws up on you in the ED. Smelly and gross things are pretty much everywhere in medicine. Patients are infectious too. That being said, when you are an attending the amount of grossing tends to be on the lower side depending on your practice, so putting in the time now doesnt mean you will spend your life doing it.

Autopsy, same as above. I did maybe 4 months of autopsy or so in my training. At my job I don't do any Autopsy. I am very happy about this.

As a physician you will always be reading textbooks and will always be tired. Surgical pathology months are hard, but you also have ample time to read during CP rotations for most residencies. Some cushier residencies have reading days and such. Often you have to prompt the pathologist to start talking or teaching, some are better than others. While path has a TON of books, you rarely read every book cover to cover, just use books you like to look up what you need and then continue working.

Pathology is more isolated than other fields but it is certainly not what people make it out to be. In training it was very social, people stop in, share cases, eat lunch together, etc. You present at tumor boards, rads conferences etc. In private practice, much is the same, and I talk to my colleagues every day.

It is certainly more sedentary than most medicine jobs, but some of my colleagues have standing desks and such to help alleviate some of the risks (not the same I know).

As far as microscope sickness, hopefully the OP has learned from their path rotations if they get sick or not. Some folks drive worse than others for sure. I am sorry you suffer from migraines from the scope.
 
maji said:
I am not trying to belittle your experience and your choices, but I just wanted to touch base on some of those reasons you addressed for leaving as far the original posters questions.

I agree with you on most CP rotations in residency it felt very silly. In actuality, academic CP is led by PHDs. It is unfortunate because in PP you do need to at least understand lab management to a decent extent, QC, inspections, all of that. I feel residents should be part of most administrative meetings during their CP rotations.

Handling the gross specimen is something I would imagine most people don't enjoy too much, but it certainly is helpful (larger stuff mainly). Smelly, yes, gross yes, but so is the patient with bad hygeine, or the one who throws up on you in the ED. Smelly and gross things are pretty much everywhere in medicine. Patients are infectious too. That being said, when you are an attending the amount of grossing tends to be on the lower side depending on your practice, so putting in the time now doesnt mean you will spend your life doing it.

Autopsy, same as above. I did maybe 4 months of autopsy or so in my training. At my job I don't do any Autopsy. I am very happy about this.

As a physician you will always be reading textbooks and will always be tired. Surgical pathology months are hard, but you also have ample time to read during CP rotations for most residencies. Some cushier residencies have reading days and such. Often you have to prompt the pathologist to start talking or teaching, some are better than others. While path has a TON of books, you rarely read every book cover to cover, just use books you like to look up what you need and then continue working.

Pathology is more isolated than other fields but it is certainly not what people make it out to be. In training it was very social, people stop in, share cases, eat lunch together, etc. You present at tumor boards, rads conferences etc. In private practice, much is the same, and I talk to my colleagues every day.

It is certainly more sedentary than most medicine jobs, but some of my colleagues have standing desks and such to help alleviate some of the risks (not the same I know).

As far as microscope sickness, hopefully the OP has learned from their path rotations if they get sick or not. Some folks drive worse than others for sure. I am sorry you suffer from migraines from the scope.
Click to expand...

Not belittling. I understand the experience varies, and that’s why I expressed that these were my own experiences.

All valid and true remarks. Depending on where you work and who you work with. I appreciate the reply about migraines they seem to be getting better...I hope. Didn’t get them (never got motion sickness) as a student on rotation. So anyway...

My experience was slightly different. You could get lunch with someone if anyone that you relate to is around when you have time to eat. I remember maybe twice in my year and a half that attendings came and shared cases with us unless it was at a designated one-hour slide review which only happened possibly once a month and was usually canceled at the attending’s request. No cases were shared by other residents. Obviously this is very dependent on where you are and the culture of the program.

The sedentary nature of the work I think is a valid complaint. For me, it’s the worst part (plus migraines). And some may be much more resilient to it or even prefer it. Not me. The very fact that extra money is spent on standing desks speaks for itself.

I agree that pathology is definitely not as isolated as people say. The conferences were actually one of my least favorite aspects, though. We generally had one or two hour-long lectures to give each month on top of any tumor boards we were covering (sometimes multiple tumor boards in the same month) and our general rotation responsibilities. Going through and copying and pasting things into a PowerPoint for conference is not much fun. And I don’t know anyone that’s a huge fan of public speaking. In fact, that’s probably why the attendings have residents (starting at PGY-1) present at every conference we have.

Patients are infectious yes, but generally unless you’re a surgeon you aren’t exposed to much body fluid. It’s not so much the infection risk as it’s obviously mitigated by caution and PPE, but it’s just not enjoyable work. Slicing open a poop filled colon everyday after lunch kind of gets old.

Of course you read a lot in every specialty but it’s not so tedious as pathology. Grading, IHC, molecular...I just have a hard time remaining interested. Which again points to me being in the wrong field. Not that the field isn’t a good one for others. It’s important work. I respect those that enjoy it and do it well.

I just think it’s fair for me to not downplay some of these things as it’s a pain to find out too late that you don’t enjoy the work (realizing you’ll do it for the next 30+ years.). Switching residencies is stressful. And if you are a student “on the fence” about pathology...considering you’ll be at a desk all day or in an uncomfortable lab might make the difference.

To be fair, I feel like you don’t REALLY know until you do it. Hence me joining path in the first place. Cheers.
 
I think the broader picture is to look at things in pathology after training. Copying and pasting in powerpoint is something you don't have to do so often outside of academic pathology. You won't be giving lectures in private practice (usually). A lot of the interaction comes from the business side or lab management side of things. You call your clinicians and surgeons daily to discuss cases, or eat with them at lunch at the doctors lounge. Again, grossing is temporary. I think liking the microscopy is the critical element. And grossing your own case, while not always fun, makes sign out much easier in most cases. As an attending you likely will not slice open poop filled colons on a daily basis.

I would argue knowing diagnostic criteria for a bajillion diseases in IM, medication dosing, or knowing the treatment protocols in heme/onc is just as tedious. Just go to a tumor board and they will talk about trial HBS01900292 which has 4 cycles of X with 3 cycles of Y and radiation at X. Tedium is part of medicine.

But in the end you have to do what interests you!
 
maji said:
I think the broader picture is to look at things in pathology after training. Copying and pasting in powerpoint is something you don't have to do so often outside of academic pathology. You won't be giving lectures in private practice (usually). A lot of the interaction comes from the business side or lab management side of things. You call your clinicians and surgeons daily to discuss cases, or eat with them at lunch at the doctors lounge. Again, grossing is temporary. I think liking the microscopy is the critical element. And grossing your own case, while not always fun, makes sign out much easier in most cases. As an attending you likely will not slice open poop filled colons on a daily basis.

I would argue knowing diagnostic criteria for a bajillion diseases in IM, medication dosing, or knowing the treatment protocols in heme/onc is just as tedious. Just go to a tumor board and they will talk about trial HBS01900292 which has 4 cycles of X with 3 cycles of Y and radiation at X. Tedium is part of medicine.

But in the end you have to do what interests you!
Click to expand...

Thanks for keeping things in perspective! Helps a lot.
 
In Pathology, at least one of these factors will be suboptimal/undesirable:

1. Job
2. Salary
3. Location

It's possible to find your niche in the field, but keep in mind it's going to take more planning in this specialty.
 
Patho_logical said:
I’m a current pathology resident. I’ve decided on leaving and going to primary care. Not trying to persuade you either way, but want to give you my perspective just as something to think on.

I also went into path for the reasons you stated: thought it was interesting, challenging, good lifestyle, pay, etc.

Why I want out:

-The work (while interesting) at least in residency at MY PROGRAM is making me miserable. Microscopes and sitting all day have caused me to develop migraines. (I’ve left the surgical lab, thrown up, and gone back to complete my work)
-On the clinical rotations (while super relaxed) I just feel as if I’m wasting my time. (Again, MY PROGRAM) no attending really cares what you do. Not much guidance.
-Autopsy months are depressing
-I found when it comes to actually handling the specimens (which I didn’t much do as a student), I don’t enjoy it. Mostly because it’s potentially infectious and/or smelly.
-Grossing here is every day. The schedule is a 1 day schedule (sign out in the AM, gross in PM). I feel drained after grossing and find it very difficult to make myself study (which, again, you have to do a lot)
-As a med student I was burnt out with reading text books. Path is a lot more of this. (Thought you’d learn more at the scope etc I guess...didn’t anticipate the amount of work and self discipline it requires)
-Finally, I realized I do want to be able to practice near my family. Path has relatively fewer opportunities for jobs.

That said:
If you truly like the microscope (and I mean you need to stare through it for several hours in a day to know) and you don’t mind the sedentary, isolated nature of the work. It is a fascinating field in many ways. For me it just doesn’t outweigh the misery of the day to day practice of pathology. Again this is my opinion based on my experience. YMMV. I find that I do well with long hours as long as I’m busy and don’t hate the task I’m working on. I pondered family medicine vs pathology for a long time. Ultimately now, I realize I made the wrong choice for myself.

Hope whatever you choose works out and you enjoy it.
Click to expand...


I feel your pain and I'm sorry it didn't work out. Not all programs are created equal.
 
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