MS4 seriously considering switch from rads to path, is it too late?

[niceguy3521]

Hi,

so I am an MS4 who was pretty set on rads and as I have started to go on rads interviews i am realizing that something doesnt feel right and that I dont think this is the best career for me. I believe that if I were completely committed to the field I would be excited to attend the lectures and hear about resident life at each new place, but I actually find it all very boring.

I did an autopsy path month this past summer and really enjoyed it, but since I was mentally set on rads at the time, I don't think I fully gave path a fair shot. Now, I am really regretting that decision.

Regardless, I'd love to hear from path residents and attendings to see if you think a switch at this point in the process (late November) is even possible? Will my residency options take a serious hit for being indecisive and taking so long to come up with this decision? I am a strong rads applicant (AOA, top 5 student at a top 5 med school, step 1 >260, some research, some non first author pubs) who has received rads IV's at top programs. The question is whether I can get path IV's at decent programs this late in the game.

Thanks for your thoughts.

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[KeratinPearls]

Hi,

so I am an MS4 who was pretty set on rads and as I have started to go on rads interviews i am realizing that something doesnt feel right and that I dont think this is the best career for me. I believe that if I were completely committed to the field I would be excited to attend the lectures and hear about resident life at each new place, but I actually find it all very boring.

I did an autopsy path month this past summer and really enjoyed it, but since I was mentally set on rads at the time, I don't think I fully gave path a fair shot. Now, I am really regretting that decision.

Regardless, I'd love to hear from path residents and attendings to see if you think a switch at this point in the process (late November) is even possible? Will my residency options take a serious hit for being indecisive and taking so long to come up with this decision? I am a strong rads applicant (AOA, top 5 student at a top 5 med school, step 1 >260, some research, some non first author pubs) who has received rads IV's at top programs. The question is whether I can get path IV's at decent programs this late in the game.

Thanks for your thoughts.

It doesn't hurt to try. I am sure you can get in. With your scores you should be able to get into a very good residency program. Forget getting into a "decent" program. Aim for the best programs and call up program directors and tell them your situtation. It's worth a shot. Just make sure you truly like pathology since a "autopsy rotation" may not expose you to the true core of pathology, aka surgical pathology, tumor boards, grossing, etc...unless that was also integrated into your rotation.

Start calling programs on Monday and see what happens. If I were you I wouldn't just apply you really need to be proactive at this stage of the game. Get path letters of rec asap.

 

[niceguy3521]

Thanks for the advice/encouragement.

My plan was to meet with the PD at my home institution and email those at others. Do you recommend calling or emailing? And based on what they say, I was then going to just add path programs to my eras list.

as an aside, while on autopsy, I spent a week or so in surg path, so though not a huge amount, I do believe I got enough exposure to it to feel confident that I like AP.

 

[KeratinPearls]

Thanks for the advice/encouragement.

My plan was to meet with the PD at my home institution and email those at others. Do you recommend calling or emailing? And based on what they say, I was then going to just add path programs to my eras list.

as an aside, while on autopsy, I spent a week or so in surg path, so though not a huge amount, I do believe I got enough exposure to it to feel confident that I like AP.

Find the name of the PD and send them an email. If they don't respond try giving them a call. You have nothing to lose. Be ready to explain why you want to do pathology and why the switch. Programs look for applicants who LOVE pathology and are enthusiastic about it. You need letters from ppl who can attest to a sincere enthusiasm for the field...those are key.

 

[pathstudent]

Disn't you read the thread about molecular imaging. Go with rads as radiologists are tomorrows pathologists

 

[Patho2009]

- Email the PDs. They like to be emailed. Make sure you show your distinctive qualifications (by attaching your CV).

- I suggest you re-consider your decision. Feeling excited by observing an autopsy does not mean that the road in pathology is covered with flowers. Like any other field, there are positives and negatives in pathology. I have summerized below the main down-sides of pathology. Others may even add more of these downsides -based on their individual experiences. What I mentioned below is just based on my opinion/experiences. You might see replies contradicting mine.

- Career-wise, rad is far better than pathology-generally speaking- both for payments and finding a decent job.

- Pathology is a broad field and needs a lot of time to be confident in. You can be a very successful radiologist within a shorter time than if you were in pathology.

- Pathology is more "exhaustive" in work than radiology.
For example, while you just sit and dictate your findings on the imaging films, in pathology you do grossing, read the slides and then make your report..which is not an easy task in many complicated/unusual cases. Autopsy, cytology work, and frozen sections (intraoperative consultations) are all added to your daily work in surgical pathology.

While the radiologist simply diagnoses (a mass lesion in the lung), or simply aspirates a nodule in the thyroid or an osteolytic lesion in bone, the stress comes on the pathologist to determine the nature of these lesions. In other words, the stress on pathologists -in most of the times and in my opinion- is much higher than the radiologist. Taken all in consideration, the job of pathologist can be very stressful, overwhelming and "brain draining".

- In contrast to radiology and other areas in medicine, pathology is mainly an academic/ research-oriented field that requires a lot of life-long reading, writing papers, publishing..etc in order to be successful (this is not always the case, especially if you decide to work in a community-based hospital).


I don't want to discourage you but I suggest that you give it a shot, especially if you are still highly interested. A person with such qualifications would not have a problem to get into pathology. If you couldn't do it, stay in rad and don't regret it.

 

[KCShaw]

It's been said time and again, but bears repeating -- most people who bail on pathology really had no idea what they were getting into in the first place. Most people I've worked with are thus very cautious about potentially "wasting" a high match spot on someone who, while perhaps pretty on paper, clearly isn't "set" on pathology.

I think programs are kinda bored of individuals with plus scores who seem to have gotten into medicine because...they have always had plus scores. Not because they have any particular underlying desire to be a doctor, much less a specialist in anything. If this is something you really feel you want to do, you need to be prepared to address those cautions -- whether there's a "switch" involved or not -- or go really take the time and effort to figure out something you like before setting a career path.

You should also be intelligent enough to realize that not everything about the most fitting job/field for you will always be scintillating. You do, of course, need to do the best you can to feel confident the good outweighs the "eh".

 

[Parts Unknown]

- Email the PDs. They like to be emailed. Make sure you show your distinctive qualifications (by attaching your CV).

- I suggest you re-consider your decision. Feeling excited by observing an autopsy does not mean that the road in pathology is covered with flowers. Like any other field, there are positives and negatives in pathology. I have summerized below the main down-sides of pathology. Others may even add more of these downsides -based on their individual experiences. What I mentioned below is just based on my opinion/experiences. You might see replies contradicting mine.

- Career-wise, rad is far better than pathology-generally speaking- both for payments and finding a decent job.

- Pathology is a broad field and needs a lot of time to be confident in. You can be a very successful radiologist within a shorter time than if you were in pathology.

- Pathology is more "exhaustive" in work than radiology.
For example, while you just sit and dictate your findings on the imaging films, in pathology you do grossing, read the slides and then make your report..which is not an easy task in many complicated/unusual cases. Autopsy, cytology work, and frozen sections (intraoperative consultations) are all added to your daily work in surgical pathology.

While the radiologist simply diagnoses (a mass lesion in the lung), or simply aspirates a nodule in the thyroid or an osteolytic lesion in bone, the stress comes on the pathologist to determine the nature of these lesions. In other words, the stress on pathologists -in most of the times and in my opinion- is much higher than the radiologist. Taken all in consideration, the job of pathologist can be very stressful, overwhelming and "brain draining".

- In contrast to radiology and other areas in medicine, pathology is mainly an academic/ research-oriented field that requires a lot of life-long reading, writing papers, publishing..etc in order to be successful (this is not always the case, especially if you decide to work in a community-based hospital).


I don't want to discourage you but I suggest that you give it a shot, especially if you are still highly interested. A person with such qualifications would not have a problem to get into pathology. If you couldn't do it, stay in rad and don't regret it.

I highly suggest you repost this in the rads forum for feedback from their side. Take some gauze.

 

[2121115]

Hi,

so I am an MS4 who was pretty set on rads and as I have started to go on rads interviews i am realizing that something doesnt feel right and that I dont think this is the best career for me. I believe that if I were completely committed to the field I would be excited to attend the lectures and hear about resident life at each new place, but I actually find it all very boring.

I did an autopsy path month this past summer and really enjoyed it, but since I was mentally set on rads at the time, I don't think I fully gave path a fair shot. Now, I am really regretting that decision.

Regardless, I'd love to hear from path residents and attendings to see if you think a switch at this point in the process (late November) is even possible? Will my residency options take a serious hit for being indecisive and taking so long to come up with this decision? I am a strong rads applicant (AOA, top 5 student at a top 5 med school, step 1 >260, some research, some non first author pubs) who has received rads IV's at top programs. The question is whether I can get path IV's at decent programs this late in the game.

Thanks for your thoughts.

LOL'ing at this post for numerous reasons.

 

[niceguy3521]

elaborate, if you please

 

[jenesaispas0005]

I am not a resident but a fellow 4th year student applying for pathology. I can tell you that in my interviews thus far (I have been on 10, 6 more to go---I am a DO student so I am kind of spreading myself a little thinner), that one of the first questions asked is "what experiences have you had in pathology", or of course "why pathology?". No shocker there, of course, but this is not a simple question to answer and they are certainly not looking for a response like "well, I like Dr G" or "I saw an autopsy and it was awesome!!!". I am not trying to belittle your experience because it sems like you did more than just observation of forensics, but bear that in mind.

I really think the PD's and interviewers are looking for people who 1) have experience in pathology from all perspectives, AP and CP and 2) have shown a commitment to pathology. This doesn't mean you have to have done every elective in path, because they know it's not easy or feasible to do that, but I think they would prefer students having gotten experience in pathology in as broad of a way as possible. They don't want people who just got fed up with clinical medicine and want to jump ship before its too late, nor do they want people who just think it's a cakewalk...they want people who understand what pathology is as a residency and career.

I am certainly not trying to beat you down or make it seem like you have no hope or chance. I was fortunate to have been exposed to pathology in the middle of my third year and had the opportunity to change my mind early enough that I could get some extra rotations thrown in (I will have a total of 12 weeks by the time I graduate), but I know some people who have done much fewer than that who have gotten interviews at some good places after applying later.

 

[Bugati]

I agree with other members. Pathology is way more than just forensics (which is the most glamorous part). You need to demonstrate concrete reasoning for this change of heart. Having said that I know somebody who went through a formal withdrawl from NRMP after matching into radiology and then joined pathology. They talked to the program director in person and it was well received. Good luck with your decision.

 

[KCShaw]

Many people, including medical school professors, really have little to no idea what the average AP +/- CP pathologist does on a daily basis. I'm sure some don't even realize we went to medical school and have our own residency/fellowships, given that they may rub elbows with more PhD's calling themselves pathologists over at the medical school than practicing AP/CP pathologists. Others equate "pathology" to "forensic pathology" which most can't even seem to distinguish from "forensic science" or "criminalistics".

About 800 people took the AP board exam, and about the same number the CP exam, in 2008. Only 43 took the forensic path fellowship exam the same year. While autopsy/forensic path can certainly be a part of general AP practice, it often is a minimal to absent part (especially forensic; hospital autopsies are different), depending on where you work. So while medical student autopsy rotations are absolutely beneficial to their education, it really doesn't offer much insight into what pathologists typically do. I'm glad in this case you spent a little time in surg path, as that's often overlooked in the medical student setting; surg path is the most common career path & area most pathologists spend their time working in. You certainly get a lot of exposure to other things in residency, especially if you do AP/CP, but while a lot of people may be CP certified most don't spend a lot of time day-to-day practicing it. Unfortunately CP is probably the one area of pathology medical students get a -little- training in -- blood bank, chemistry, etc., though primarily in interpretation.

Incidentally, while forensic pathology gets a lot of exaggerated entertainment time, it generally pays on the lower end even among pathologists, and you get to deal with lawyers, families, and law enforcement a lot more -- which has its moments. You're also generally under much more scrutiny and may inadvertently be sandwiched in political battles you don't think are your own, making jobs in certain jurisdictions relatively uncertain/volatile. Jobs are out there, but even more so than other pathologists you can expect to have to move..quite possibly across state lines..with every change in job. On the other hand, those who land a job in a good location protected from the worst of the politics can have very good job security, see and do interesting things, and have a comfortable lifestyle.

 

[pathstudent]

I highly suggest you repost this in the rads forum for feedback from their side. Take some gauze.

No doubt. Pathologists love to downplay the importance or radiology. You hear quotes like "radiologists just point stuff out, they don't have any pressure to make a diagnosis" Like that Raider guy who considers himself a "super-diagnostician" who "steps in when all other doctors have failed".

Radiologists have been a perpetual revolution in medicine, expecially the last 30 years.

 

[Daddydoc]

It's never too late to switch, just do yourself a favor and investigate it thoroughly before switching. You don't want to rush in and regret the decision later. In my program we have two residents who switched late from rads to path.

 

[BU Pathology]

Back when I would write 40 to 50 Dean's letters per year, there would typically be one or 2 students in late November - early December who had not crystalized their career plans. It is a little unusual, but it is not too late.

The more important question is whether pathology is the correct career choice for you. As others have stated, you need to be sure that you have clear and compelling reasons for selecting pathology as a career. These need to be articulated in your ERAS statement, and also when you interview.

It will also be extremely helpful to talk with the program director of pathology at your current institution, to explore the career more fully. Hopefully you can convince the PD of your interest, and she/he will be willing to write a letter of refernce for you. That letter should specifically address your interest in pathology.

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